Utilization Flag software is one in a family of databases and software tools developed as part of the Healthcare Cost and Utilization Project (HCUP), a Federal-State-Industry partnership sponsored by the Agency for Healthcare Research and Quality. HCUP databases, tools, and software inform decision making at the national, State, and community levels.

Contents:

• Overview of Utilization Flags for ICD-10-PCS
• Purpose
• Description
• Data Elements Required for Assigning the Utilization Flags for ICD-10-PCS
• Downloading Information
• Questions?

The Utilization Flag for ICD-10-PCS software creates 30 data elements that reveal additional information about use of health care services. By combining information from ICD-10-PCS procedure codes and Uniform Billing (UB-04) revenue codes, it is possible to obtain a more complete picture of utilization of services rendered in health care settings such as hospitals, emergency departments, and ambulatory surgery centers.

Detailed documentation for the ICD-10-PCS Utilization Flag assignments is provided below. The document contains a tale for each flag, including the variable, description, UB-04 revenue codes, and ICD-10-PCS procedure codes.

• Table of Revenue Codes and Procedure Codes for Utilization Flags for ICD-10-PCS (PDF file, 172 KB)

The Utilization Flags for ICD-10-PCS can be employed to study issues such as use of intensive care units and to more reliably examine utilization of diagnostic and therapeutic services, beyond the information that can be gleaned from ICD-10-PCS procedure codes.

A broad range of services, from simple diagnostic tests to resource-intense procedures, occur in the inpatient and outpatient hospital setting. In administrative health care data based on claims, use of services may be reported using ICD-10-PCS procedure codes, charges to the revenue centers of the hospital in which services were performed, or both.

ICD-10-PCS procedure codes provide information on health care services, but there is concern about under-reporting certain procedures, such as non-invasive, diagnostic services. In addition, ICD-10-PCS codes do not provide information on some services, such as stays in intensive care units (ICU) and psychiatric units.

UB-04 revenue codes identify services and accommodations using revenue codes that are accompanied by charge information specific to the revenue center. Detailed charges based on revenue codes provide additional evidence that the patient received a specific service.

Using a combination of the UB-04 revenue codes, ICD-10-PCS procedure codes, and Clinical Classifications Software (CCS) for ICD-10-CM/PCS procedure categories, 30 utilization flags were developed for a range of services. The following table lists the flags by type:

Both SAS and SPSS programs are available for assigning the utilization flags to administrative databases. The following table lists the required data elements.

Data Elements Required for Assigning the Utilization Flags

The SAS utilization flag assignment program allows the revenue codes either to be included in the same file as the procedure codes and CCS, or to be in a separate file. In the HCUP State databases available for purchase through the HCUP Central Distributor, the revenue codes are stored in a separate file. The SPSS version of the program requires that the revenue codes be included in the same file as the procedure codes. The SAS and SPSS programs assign the 30 utilization flags, output the resulting data set, and calculate summary and detailed statistics for each flag.

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Detailed Description of the Utilization Flags

Methods Series Report #2006-04 Development of Utilization Flags for Use with UB-92 Administrative Data (PDF file, 258 KB)
Appendices: A-F (PDF file, 452 KB). This Methods Series details the initial development of the utilization flags. Revenue code categories included in the SAS and SPSS programs are reviewed annually and updated as appropriate.

Software Program Files

SAS software programs (in ZIP format).
SPSS software programs (in ZIP format).

Questions regarding the Utilization Flag software for ICD-10-PCS may be directed to HCUP User Support through the following channels:

• e-mail: hcup@ahrq.gov
• Phone (toll free): 1-866-290-HCUP.