Types of Ambulatory Surgery and Other Outpatient Services Collected by the Partner

The Colorado Hospital Association (CHA) has collected information on ambulatory surgeries since 1991. Beginning in 2017, CHA defines an ambulatory surgery record based on revenue codes. In 2015, CHA's definition included CPT procedure codes under 69999. This change in definition occurred because of hospitals only submitting CPT procedures in anticipation of the transition to the ICD-10-CM/PCS coding system on October 1, 2015. Through 2014, they defined ambulatory surgeries by an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) primary procedure code of 86.99 or below for which the patient required less than an overnight stay or a place of service indicating ambulatory surgery center (ASC). Every hospital in the used both ICD-9-CM and Current Procedural Terminology (CPT®) to code procedures, but hospitals only sent ICD-9-CM codes to the hospital association.

Outpatient Data File Provided to HCUP by the Partner

Beginning in 2017, the Colorado Hospital Association provided HCUP with a combined inpatient and outpatient data file. Further, CHA provides HCUP with place of service types: Emergency Room (value 1) and Outpatient Surgery (value 2). Previously, CHA had provides HCUP with their complete ambulatory surgery file (but did not receive a complete ED file), which also included place of service types: Observation (value 3) and Other Outpatient (value 4). Beginning in data year 1991, they provided the ambulatory surgery data in a dedicated, single source file. Prior to data year 1991, Colorado supplied records for ambulatory surgeries in the same file as their inpatient discharge records; they distinguished ambulatory surgeries by a record type indicator, as explained in the table.

Starting in data year 2017, the Partner selected records meeting their definition of outpatient surgery based on the following criteria:

A record is considered an Outpatient Surgery if it is not classified as an Emergency Room visit and has one or more of the following Revenue Codes:

In data year 2016, the Partner selected records based on CPT codes meeting their definition of ambulatory surgery and excluded CPT codes for procedures such as blood draw, administration of anesthesia, wound closure, biopsy, and insertion of a catheter.

Selection of Records for Inclusion in the SASD

All records identified by Colorado as ambulatory surgery (AS) are included in the SASD (HCUP data element STATE_AS=1 based on State-specific criteria).

Types of Facilities Included in the Files Provided to HCUP by the Partner

The Colorado Hospital Association collects data on ambulatory surgeries performed in hospital-owned facilities. Data collection began in 1988 for hospitals with more than 50 beds. Hospitals with fewer than 50 beds were added in 1989. The Colorado Hospital Association does not collect data from ambulatory surgery facilities that are not owned by a hospital.

Identification of Hospital-Owned Ambulatory Surgery and Other Types of Outpatient Facilities in the SASD

The designation of a facility as hospital-owned is specific to its financial relationship with a hospital that provides inpatient care and not related to its physical location. Hospital-owned ambulatory surgery and other outpatient care facilities may be contained within the hospital, physically attached to the hospital, or located in a different geographic area. The designation as hospital-owned means that HCUP can identify that the hospital is billing for this service.

Starting in data year 2018, the HCUP data element HOSPITAL_OWNED can be used to identify hospital-owned facilities with ambulatory surgery and possibly other outpatient care data in the SASD. A facility is considered hospital-owned (HOSPITAL_OWNED = 1) if any one of the following is true:

• The facility is listed in the American Hospital Association (AHA) Annual Survey Database^TM.
• The facility is not listed in the AHA database, but the facility provides inpatient discharge data to HCUP.
• Documentation provided by the data source clearly indicates that the facility is hospital-owned.

If the facility in the SASD does not meet any of the above criteria, it is marked as not being owned by a hospital (HOSPITAL_OWNED = 0). Not all hospitals report to the AHA, so there is a possibility that some facilities marked with HOSPITAL_OWNED=0 are hospital-owned.

From data year 1998-2018, the HCUP data element was called FREESTANDING. A facility is considered hospital-owned (FREESTANDING = 0) if any one of the following is true:

• The facility is listed in the American Hospital Association (AHA) Annual Survey Database^TM.
• The facility is not listed in the AHA database, but the facility provides inpatient discharge data to HCUP.
• Documentation provided by the data source clearly indicates that the facility is hospital-owned.

If the facility in the SASD does not meet any of the above criteria, it is marked as not being owned by a hospital (FREESTANDING = 1). Not all hospitals report to the AHA, so there is a possibility that some facilities marked with FREESTANDING=1 are hospital-owned.

Exclusion of Records During HCUP Processing

Beginning with 2016 data, records with a discharge disposition of "still a patient" are retained in the HCUP SASD. Prior to 2016 data, these records were excluded.

Beginning in 2010, records with a designation of "admitted as an inpatient" are retained in the SASD, even though this rarely occurs. Prior to 2010, records with a designation of "admitted as an inpatient" were excluded from the files.