Utilization Flags

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HCUP databases, tools, and software inform decision making at the national, State, and community levels. <br><br> Contents:<a name="return"></a> <ul> <li><a href="#overview">Utilization Flags for Revenue Center Codes and ICD-9-CM Procedures</a> <ul> <li><a href="#overview">Overview</a></li> <li><a href="#purpose">Purpose</a></li> <li><a href="#description">Description</a></li> <li><a href="#data">Required Data Elements</a></li> <li><a href="#download">Downloading Information</a></li> </ul> </li> <li><a href="#archive">Archive for the Beta Version of the Utilization Flags for ICD-10-PCS Procedures</a></li> <li><a href="#questions">Questions?</a></li> </ul> </div> </td></tr> <tr><td> </td></tr> <tr><td> <div class="texttitle"><a name="overview">Utilization Flags for Revenue Center Codes and ICD-9-CM Procedures: Overview</a></div><div class="pagetext"> <br> The Utilization Flag software creates 30 data elements that reveal additional information about use of healthcare services. By combining information from ICD-9-CM procedure codes and Uniform Billing (UB-04) revenue center 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. <br><br> This documentation provides an overview of the following: <ul> <li>The different types of utilization flags </li> <li>Data elements required for assigning the utilization flags </li> <li>Downloadable, electronic files that contain the SAS and SPSS programs to create the utilization flags.</li> </ul> Detailed documentation is available under the HCUP Methods Series Report 2006-04 <a href="/reports/methods/2006_4.pdf" target="_blank">Development of Utilization Flags for Use with UB-92 Administrative Data </a>(PDF file, 258 KB) and accompanying <a href="/reports/methods/2006_4_appendice.pdf " target="_blank">Appendices: A-F</a> (PDF file, 452 KB). This Methods Series details the initial development of the utilization flags. Revenue code categories are reviewed annually and updated as appropriate. </div></td></tr> <tr><td> </td></tr> <tr><td align="left" class="pagetext"><a href="#return">Return to Contents</a></td></tr> <tr><td> </td></tr> <tr><td> <div class="texttitle"><a name="purpose">Utilization Flags for Revenue Center Codes and ICD-9-CM Procedures: Purpose</a></div><div class="pagetext"> <br> The Utilization Flags 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-9-CM 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 healthcare data based on claims, use of services may be reported using ICD-9-CM procedure codes, charges to the revenue centers of the hospital in which services were performed, or both. ICD-9-CM procedure codes provide information on healthcare services, but there is concern about under-reporting certain procedures, such as non-invasive, diagnostic services. In addition, ICD-9-CM 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. </div></td></tr> <tr><td> </td></tr> <tr><td align="left" class="pagetext"><a href="#return">Return to Contents</a></td></tr> <tr><td> </td></tr> <tr><td> <div class="texttitle"><a name="description">Utilization Flags for Revenue Center Codes and ICD-9-CM Procedures: Description</a></div><div class="pagetext"> <br> Using a combination of the UB-04 revenue codes, ICD-9-CM procedure codes, and Clinical Classifications Software (CCS) procedure categories, 30 utilization flags were developed for a range of services. The following table lists the flags by type:</div> <br><br> <table width="75%" class="pagetext" align="center" border="1" cellspacing="0" cellpadding="8"> <tr> <td colspan="2" align="center"><strong>Utilization Flags</strong></td> </tr> <tr> <td colspan="2"><strong>Accommodation</strong></td> </tr> <tr> <td>     Intensive Care Unit (ICU)</td> <td>Coronary Care Unit (CCU)</td> </tr> <tr> <td>     Newborn Level II</td> <td>Newborn Level III</td> </tr> <tr> <td>     Newborn Level IV</td> <td> </td> </tr> <tr> <td colspan="2"><strong>Cardiac Services</strong></td> </tr> <tr> <td>     Cardiac Catheterization Lab</td> <td>Cardiac Stress Test</td> </tr> <tr> <td>     Echocardiogram</td> <td>Electrocardiogram (EKG)</td> </tr> <tr> <td colspan="2"><strong>Imaging and Diagnostic Tests</strong></td> </tr> <tr> <td>     Computed Tomography (CT) Scan</td> <td>Chest X-Ray</td> </tr> <tr> <td>     Electroencephalogram (EEG)</td> <td>Ultrasound</td> </tr> <tr> <td>     Magnetic Resonance Technology (MRT)</td> <td>Nuclear Medicine</td> </tr> <tr> <td colspan="2"><strong>Devices</strong></td> </tr> <tr> <td>     Pacemaker</td> <td>Other Implants</td> </tr> <tr> <td colspan="2"><strong>Therapeutic Services</strong></td> </tr> <tr> <td>     Lithotripsy</td> <td>Occupational Therapy</td> </tr> <tr> <td>     Physical Therapy </td> <td>Respiratory Therapy</td> </tr> <tr> <td>     Therapeutic Radiology and Chemotherapy </td> <td>Renal Dialysis</td> </tr> <tr> <td>     Speech-Language Pathology </td> <td>Erythropoietin (EPO)</td> </tr> <tr> <td>     Mental Health and Substance Abuse </td> <td>Blood</td> </tr> <tr> <td colspan="2"><strong>Other</strong></td> </tr> <tr> <td>     Emergency Department</td> <td>Observation Room</td> </tr> <tr> <td>     Organ Acquisition </td> <td> </td> </tr> </table> </div></td></tr> <tr><td> </td></tr> <tr><td align="left" class="pagetext"><a href="#return">Return to Contents</a></td></tr> <tr><td> </td></tr> <tr><td> <div class="texttitle"><a name="data">Utilization Flags for Revenue Center Codes and ICD-9-CM Procedures: Required Data Elements</a></div> <div class="pagetext"> <br> Both SAS and SPSS programs are available for assigning the utilization flags to administrative databases. The following table lists the required data elements. <br><br> <strong>Data Elements Required for Assigning the Utilization Flags using ICD-9-CM Procedures</strong></div> <br> <table width="90%" class="pagetext" border="1" cellspacing="0" cellpadding="8"> <tr> <td scope="col"><strong>Data Elements</strong></td> <td scope="col"><strong>Description</strong></td> </tr> <tr> <td scope="row">KEY</td> <td>Unique record identifier</td> </tr> <tr> <td scope="row">REVCD1-REVCDn</td> <td>Array of dimension n of four-character UB-04 revenue codes, including the leading zero. The assignment program allows the user to specify the length of the array. UB-04 revenue codes are updated by National Uniform Billing Committee. The Utilization Flag software is valid for revenue codes beginning October 1993.</td> </tr> <tr> <td scope="row">PR1-PRn</td> <td>Array of dimension n of ICD-9-CM procedure codes, decimals removed. The assignment program allows the user to specify the length of the array. The ICD-9-CM codes are revised every October. New codes are added, existing codes are deleted, and definitions of current codes are changed. The Utilization Flag software is valid for ICD-9-CM procedure codes beginning October 1993. </td> </tr> <tr> <td scope="row">PRCCS1-PRCCSn</td> <td>Array of dimension n of AHRQ CCS procedure categories. The length of the array must be the same as the length of the ICD-9-CM procedure array. The program to assign the procedure CCS is available at <a href="/tools_software.jsp">www.hcup-us.ahrq.gov/tools_software.jsp.</a></td> </tr> <tr> <td scope="row">NPR</td> <td>NPR indicates the total number of ICD-9-CM procedure codes reported on the discharge record. For example, if a discharge record has five procedures reported, then NPR equals five. The value on NPR is never larger than the dimension of the array of ICD-9-CM procedures.</td> </tr> </table> <div class="pagetext"> <br><br> 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 <a href="/tech_assist/centdist.jsp">HCUP Central Distributor,</a> 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. </div></td></tr> <tr><td> </td></tr> <tr><td align="left" class="pagetext"><a href="#return">Return to Contents</a></td></tr> <tr><td> </td></tr> <tr><td> <div class="texttitle"><a name="download">Utilization Flags for Revenue Center Codes and ICD-9-CM Procedures: Downloading Information</a></div><div class="pagetext"> <br> The following ZIP folders include the CSV mapping file and a mapping program in SAS and SPSS. <br><br> <ul> <li><strong>Utilization Flags for revenue center codes and ICD-9-CM procedures valid between October 1992 and September 2015:</strong><br> <ul> <li><a href="SASUtilizationFlagsPGMSept2015.zip">SAS software programs</a> (ZIP format, 6 KB)</li> <li><a href="SPSSUtilizationFlagsPGMSept2015.zip">SPSS software programs</a> (ZIP format, 3 KB)</li> </ul> </li> </ul> </div></td></tr> <tr><td align="left" class="pagetext"><a href="#return">Return to Contents</a></td></tr> <tr><td> </td></tr> <tr><td> <div class="texttitle"><a name="archive">Archive for the Beta Version of the Utilization Flags for ICD-10-PCS Procedures</a></div><div class="pagetext"> <br> The beta version of the Utilization Flags for ICD-10-PCS was developed prior to ICD-10-PCS data being available and has not been thoroughly evaluated or updated. 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. 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. <br><br> It is important to note that the available software (v2018.1) has not been updated for ICD-10-PCS codes effective after September 2018. The ZIP folder includes the CSV mapping file, a SAS mapping program, and instructions for adding the utilization flags to your data. <br> <ul> <li><strong>Beta version of Utilization Flags for revenue center codes and ICD-10-PCS procedures, v2018.1:</strong> Fiscal Year 2018, Released October 2017 (valid for ICD-10-PCS codes through September 2018) <ul> <li><a href="ICD10PCS_UtilizationFlags_FY2018_1.zip">Utilization Flags for ICD-10-PCS, v2018.1 (beta version</a> (ZIP format, 61 KB))</li> </ul> </li> </ul> </div></td></tr> <tr><td> </td></tr> <tr><td align="left" class="pagetext"><a href="#return">Return to Contents</a></td></tr> <tr><td> </td></tr> <tr><td> </td></tr> <tr><td> <div class="texttitle"><a name="questions">Questions?</a></div><div class="pagetext"> <br> Questions regarding the Utilization Flag software may be directed to HCUP User Support through the following channels: <ul> <li>e-mail: <a href="mailto:hcup@ahrq.gov">hcup@ahrq.gov</a></li> <li>Phone (toll free): 1-866-290-HCUP. </li> </ul> </div></td></tr> <tr><td> </td></tr> <tr><td align="left" class="pagetext"><a href="#return">Return to Contents</a></td></tr> <tr><td> </td></tr> </table> </div>  <hr width="75%" align="center" class="hrruleblue"> <table width="100%" data-swiftype-index="false"> <tr> <td align="center" class="citationtext"> Internet Citation: Utilization Flags. Healthcare Cost and Utilization Project (HCUP). September 2021. 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Utilization Flags