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

The Nebraska Hospital Association (NHA) collects data on ambulatory surgery and other outpatient services such as observation services and emergency department visits. NHA defines an ambulatory surgery record as having the following:

• Uniform Billing Form (UB-04) bill code of 13X, 83X, or 85X indicating an outpatient claim
• Any of the following revenue center codes
  • 0360-0369 for operating room
  • 0480-0481 for cardiac catheterization
  • 0490-0499 for ambulatory surgical care
  • 0720-0729 for delivery room gynecological procedure
  • 0750-0759 for gastrointestinal services
  • 0761 for treatment room
  • 0790-0799 for extracorporeal shock wave therapy
• A surgical procedure code defined as
  • Current Procedural Terminology (CPT®) procedure code in the range of 10000-69999 and 93501-93533, excluding codes 36415, 36416, and 59400-59410
  • Healthcare Common Procedure Coding System (HCPCS) codes G0104, G0105, and G0297.

NHA creates three separate indicator flags that identify ambulatory surgery, observation services, and emergency department visits. One outpatient record can indicate multiple types of outpatient services.

Outpatient Data File Provided to HCUP by the Partner

Starting in data year 2010, NHA has provided data on ambulatory surgery, observation services, and emergency department visits to HCUP. Prior to data year 2010, NHA provided only ambulatory surgery and emergency department records to HCUP from their broader outpatient data set.

NHA prohibits the release of discharge records for patients with HIV diagnoses. These discharges are not included in the source file provided to HCUP and are therefore not included in the HCUP files.

Selection of Records for Inclusion in the SASD

All records identified by NHA as ambulatory surgery are included in the SASD (STATE_AS=1 based on ambulatory surgery indicator flag). Any other nonemergent outpatient records (STATE_ED not equal to 1) also are included in the SASD.

Additionally, any record in the SASD that also have evidence of ED services based on the HCUP criteria (HCUP data element HCUP_ED > 0), are also included in the HCUP State Emergency Department Databases (SEDD). These records will have the same value for the HCUP data element KEY.

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

NHA collects data on ambulatory surgery and other outpatient services performed in hospital-owned facilities. Although it is voluntary, hospital-owned facilities report all claims data regardless of payer for ambulatory surgery and other outpatient services. NHA 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.