The 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 (beta version)
• Overview of the Development of the Utilization Flags
• Description of the Utilization Flags for ICD-10-PCS (beta version)
• Data Elements Required for Assigning the Utilization Flags for ICD-10-PCS (beta version)
• Downloading Information for the Utilization Flags for ICD-10-PCS (beta version)
• Archives for Earlier Beta Versions of the Utilization Flags for ICD-10-PCS
• Questions?

The Utilization Flag software for International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) creates 30 data elements (i.e., utilization flags) that reveal additional information about use of healthcare services. By combining information from Uniform Billing (UB-04) revenue center codes and ICD-10-PCS procedure codes, it is possible to obtain a more complete picture of utilization of services rendered in healthcare settings such as hospitals, emergency departments, and ambulatory surgery centers.

WARNING: The beta version of the Utilization Flags for ICD-10-PCS has not been thoroughly evaluated. Preliminary findings show that some utilization flags, such as the one for blood transfusions, may not be consistently reported by ICD-10-PCS codes and the grouping of ICD-10-PCS codes by the beta version of the Clinical Classifications Software (CCS) may be insufficient. The tool needs to be transitioned to use the refined version of the CCS for ICD-10-PCS. In addition, the utilization flag definitions have not been modified to account for the use of Healthcare Common Procedure Coding System (HCPCS) procedure codes in outpatient data. The Utilization Flags tool will be evaluated and revised in 2021.

The Utilization Flag software was developed originally using 2003 HCUP inpatient and outpatient data with UB-04 revenue center codes. Some of the utilization flags were specific to the inpatient setting (e.g., intensive care and newborn accommodations), and others identified services often performed in an outpatient setting (e.g., lithotripsy and cardiac stress test). Nineteen of the 30 utilization flags used ICD-9-CM procedure codes to augment the revenue center codes. HCPCS procedures codes on outpatient data were not considered. The remaining utilization flags depend only on UB-04 revenue center codes. A detailed description of the development of the original Utilization Flags is included in the HCUP Methods Series Report #2006-04 Development of Utilization Flags for Use with UB-92 Administrative Data (PDF file, 258 KB) and Appendices: A-F (PDF file, 452 KB).

The beta version of the Utilization Flag for ICD-10-PCS was created prior to the availability of ICD-10-PCS coded data by linking ICD-10-PCS codes to ICD-9-CM codes via the General Equivalence Mappings (GEMs) available from the Centers for Medicare & Medicaid Services (CMS) website. When the United States transitioned to the use of ICD-10-PCS on October 1, 2015, only procedures performed in the inpatient setting were reported using ICD-10-PCS codes. Outpatient procedures were reported using HCPCS codes. No adjustment was made to the Utilization Flag software for the HCPCS procedure coding on outpatient data.

Using a combination of the UB revenue center codes, ICD-10-PCS procedure codes, and beta version of the CCS for ICD-10-PCS procedure categories, 30 utilization flags identify a range of services. The following table lists the flags by type:

The document Table of Revenue Codes and Procedure Codes for Utilization Flags for ICD-10-PCS (PDF file, 172 KB) contains the definition of each utilization flag, including the data element name, description, UB revenue center codes, and ICD-10-PCS procedure codes, if used.

A SAS program is available for assigning the utilization flags to administrative databases. The following table lists the data elements expected by the SAS program. Names of data elements are consistent with those used in the HCUP databases.

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 SAS program assigns the 30 utilization flags, outputs the resulting data set, and calculates summary and detailed statistics for each flag.

The ZIP folder includes the Tool, a load program, and instructions for applying the Tool to your data using the load program.

Utilization Flags v2020.1 (beta version): Fiscal Year 2020, Updated October 2019 (valid for ICD-10-PCS codes through September 2020)

• Utilization Flags for ICD-10-PCS, v2020.1 (beta version) (ZIP file, 170 KB)

WARNING: Preliminary findings show that some utilization flags, such as the one for blood transfusions, may not be consistently reported by ICD-10-PCS codes, and the grouping of ICD-10-PCS codes by the beta version of the CCS may be insufficient. The refined version of the CCS for ICD-10-PCS is in progress and will be available in December of 2020. In addition, the utilization flag definitions have not been modified to account for the use of HCPCS procedure codes in outpatient data. The Utilization Flags tool will be evaluated and revised in 2021.

Copies of previous versions of the Utilization Flags for ICD-10-PCS are available for users who need to replace or access the old programs.

• Version 2019.1 (beta version): Fiscal Year 2019, Updated October 2018 (valid for ICD-10-PCS codes through September 2019)
  • Utilization Flags for ICD-10-PCS, v2019.1 (beta version) (ZIP file, 13 KB).
• Version 2018.1 (beta version): Fiscal Year 2018, Updated October 2017 (valid for ICD-10-PCS codes through September 2018)
  • Utilization Flags for ICD-10-PCS, v2018.1 (beta version) (ZIP file, 61 KB).
• Version 2017.1 (beta version): Fiscal Year 2017, Updated December 2016 (valid for ICD-10-PCS codes through September 2017)
  • Utilization Flags for ICD-10-PCS, v2017.1 (beta version) (ZIP file, 13 KB).

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.