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Content-class: urn:content-classes:message
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Thread-Topic: Health Cae Service Data Reporting Guide Definitional Issues
Thread-Index: AcSy3axUDsL94rrATLmukSZNyaFD4A==
Message-ID:  <[log in to unmask]>
Date:         Fri, 15 Oct 2004 11:42:53 -0600
Reply-To:     Workgroup for Health Care Service Data Reporting Guide for the
              PH-Consortium-L <[log in to unmask]>
Sender:       Workgroup for Health Care Service Data Reporting Guide for the
              PH-Consortium-L <[log in to unmask]>
From:         Robert Davis <[log in to unmask]>
Subject:      Health Cae Service Data Reporting Guide Definitional Issues

Hello Everybody,
 
I am back from an invigorating 2 weeks of standards meetings.  One week attending the HL7 meeting in Atlanta and the other week attending the X12 meeting in Miami.   Anyone with issues to bring forward to either of those organizations please do not hesitate to contact me.   
 
While I was off getting my standards fix, issues continue to surface.   My new experiences continue to reinforce my old experiences in that developing unambiguous definitions for the terms we use are our biggest challenges.  
 
The issue for discussion today is the definition of how to interpret the meaning of the Principal Diagnosis for patients in the emergency department setting.    Below are some thoughts on that issue that I solicited prior to this posting.
 
In the case of emergency department visits, the Principal/Primary Diagnosis Code is that diagnosis established to be chiefly responsible for occasioning the visit to the Emergency Department.  This definition is from the New York State data specifications document.   The term Principal Diagnosis was expanded to include the word Primary to accommodate just this situation.  
 
In vetting this definition to the state hospital association representatives on the National Uniform Billing Committee There was also concern raised that a definition of principal/primary diagnosis include a clarification about from "who's perspective" this definition applies.   This issue was raised to avoid confusion between definitions of principal/primary, admitting diagnosis, and the patient's reason for visit.  With this in mind, I would propose that the principal/primary diagnosis is from the perspective of the physician responsible for care.  
 
An FYI from a standards perspective, the next version (5010) of the 837 Institutional Claim and  837 Health Care Service: Data Reporting Guide implementation guides are creating separate data points for principal diagnosis, admitting diagnosis, and the patient's reason for visit.  This is also true of the proposed UB-04, which would allow the reporting of up to 3 patient's reasons for visit codes.   
 
In summary the questions for the group today are:  
 
What would the best definition for principal/primary diagnosis in the emergency department setting from your perspective?   
 
Is the proposed UB-04 creation of separate data points for patient's reason for visit supportable by your systems?
 
In other business, we are planning a conference call in early November to discuss the ANSI ASC X12N process for approving implementation guides as a standard.  This will be significant since the next version of all 837 implementation guides, including the Health Care Service Data Reporting Guide, will be going through that process soon.   For now, we are interested in finding out how many people would be interested in participating in such a call so we can arrange for the appropriate number of conference call lines. 
 
Thanks in advance. 
 
Bob Davis
 
 

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