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MIRCal - FAQs Data Specific
Frequently asked questions pertinent to specific data types are listed below. Many of these questions are answered in greater length in our data reporting manuals found on the Manuals and Guides page. If you would like to submit a question of your own, please fill out our Submit a Question form.
Inpatient (IP) Specific FAQs:
- 1. What are the file specifications (format) for inpatient data submissions?
- 2. What are an inpatient report periods and due dates?
- 3. What codes are used for inpatient care?
- 4. Will IP data elements be changed to National Standards in the future?
- 5. What are "Exception Edits"? Will they flag as an error?
- 6. What admit date do we report if an ED or AS patient came in on August 1st and was admitted to the same hospital on August 2nd?
- 7. What do we report if an ED or AS patient was sent to observation and then was admitted to our hospital?
Emergency Department (ED) and Ambulatory Surgery (AS) Specific FAQs:
- 8. What are the ED and AS report periods and due dates?
- 9. Why are providers required to report their data to OSHPD?
- 10. What are the data elements for ED and AS?
- 11. What range of CPT codes should be reported to OSHPD?
- 12. Do we have to report modifiers? Do we report F codes and T codes?
- 13. What will the data be used for?
Emergency Department (ED) Specific FAQs:
Ambulatory Surgery (AS) Specific FAQs:
- 15. What is an Ambulatory Surgery Clinic (ASC)?
- 16. Which hospitals must report outpatient surgery procedures?
- 17. What is a hospital-operated ASC?
- 18. What service date do we report if an AS patient came in on May 23rd, stayed overnight, and was dismissed on May 24th?
- 19. What admit date do we report if an AS patient came in on August 1st and was admitted to the same hospital on August 2nd?
- 20. What do we report if an AS patient was sent to observation and then was admitted to our hospital?
- 21. Do we need to submit procedure data for every patient that comes to our facility?
Inpatient (IP) Specific FAQs:
Q1. What are the file specifications (format) for inpatient data submissions?
- A. The information for inpatient data submissions is available in the Format and File Specifications section of the California Inpatient Data Reporting Manual, Appendix C.
Q2. What are the inpatient report periods and due dates?
- A. Currently there are two report periods and due dates each year. January - June data are due September 30 of that year. July - December data are due March 31 of the following year. OSHPD may change the report periods in the future. This would be done through the regulatory process.
Q3. What codes are used for inpatient care?
- A. ICD-9-CM codes are used for inpatient diagnoses, procedures, and external causes of injury. The OSHPD ICD-9-CM Coding Edit Manual may be used as a reference guide for background and the logic behind any coding edits that occur in your data.
Q4. Will IP data elements be changed to National Standards in the future?
- A. The current inpatient data elements are defined in law. OSHPD plans on moving them to a national standard format and definition in the future.
Q5. What are "Exception Edits?" Will they flag as an error?
- A. The "Exception Edits" will flag your data for a possible error if it's over an allowable percentage; you should verify your data for accuracy. For example: your "Unknown" Social Security Numbers (SSNs) are over the Error Tolerance Level (ETL). Although exception edits will not impact your submission approval, if you find that your data are not accurate, you may want to make corrections as needed.
Q6. What admit date do we report if an ED or AS patient came in on August 1st and was admitted to the same hospital on August 2nd?
- A. The admit date is August 2nd. This is clarified in the California Inpatient Data Reporting Manual under "Admission Date". It states,"Patients are often seen in the emergency room on one day and remain until the next day and are then admitted to inpatient care. The admission date reported is the date the patient is actually admitted to inpatient care." This is consistent with CMS requirements on admission date. This scenario may also apply to an AS patient. Do not confuse admission date with service date.
Q7. What do we report if an ED or AS patient was sent to observation and then was admitted to our hospital?
- A. In the ED/AS Manual, Appendix E — MIRCal Regulation Section 97213 for Required Reporting, states that a hospital shall not report an ED or AS record if the encounter resulted in a same-hospital admission. Keep in mind that the inpatient record has different coding structures for all data elements, such as race, ethnicity, payer categories, disposition, procedure codes, sex, and zip code. You would follow the requirements for reporting the inpatient record. The procedure dates showing three days (or 72 hours) prior to admission will be accepted. This has been in practice since 1993 when hospitals were concerned with CMS requirements requiring them to bundle related records together.
Emergency Department (ED) and Ambulatory Surgery (AS) Specific FAQs:
Q8. What are the ED and AS report periods and due dates?
- A. As per Title 22 Regulations, there are four ED and AS data report periods each year. The report due date is 45 days after the end of each quarterly report period.
- Report Period: January 1 through March 31
- Due Date: May 15 of the same year
- Report Period: April 1 through June 30
- Due Date: August 14 of the same year
- Report Period: July 1 through September 30
- Due Date: November 14 of the same year
- Report Period: October 1 through December 31
- Due Date: February 14 of the following year
Q9. Why are providers required to report their data to OSHPD?
- A. Inpatient discharge data have been collected and used since 1980. Today, data users want more timely information on the healthcare Californians are receiving. To meet the healthcare industry and public's demand, legislation was passed in 1998 to collect Emergency Department and Ambulatory Surgery data. Section 128736 of the California Health and Safety Code dictates that ED & AS shall be reported to OSHPD.
Q10. What are the data elements for ED and AS?
- A. The data elements are:
- Date of Birth
- Disposition of Patient
- Ethnicity
- Expected Source of Payment
- Other Diagnoses
- Other External Cause of Injury
- Other Procedures (CPT-4)
- Patient Social Security Number
- Principal Diagnosis
- Principal External Cause of Injury
- Principal Language Spoken
- Principal Procedure (CPT-4)
- Race
- Service Date
- Sex
- Zip Code
For detailed information regarding reporting requirements for each data element, refer to the California Emergency Department and Ambulatory Surgery Data Reporting Manual.
Q11. What range of CPT codes should be reported to OSHPD?
- A. The CPT code range accepted by OSHPD includes any of the 00001-99999 (Category I codes) and the "T" codes (Category III codes) that qualify as surgical risk, procedural risk and/or anesthetic risk. Modifiers or the optional "F" codes (Category II codes) or any of the HCPCS codes will not be accepted as valid CPT codes. Principal Procedure: The patient's principal procedure is one that is surgical in nature, or carries a procedural risk, or carries an anesthetic risk. The procedure related to the principal diagnosis as the chief reason for the encounter shall be selected as the principal procedure. The procedure shall be coded according to the Current Procedural Terminology, Fourth Edition (CPT-4)
- Other Procedures: All significant procedures are to be reported. A significant procedure is one that is surgical in nature, or carries a procedural risk, or carries an anesthetic risk. Procedures shall be coded according to the Current Procedural Terminology, Fourth Edition (CPT-4).
Q12. Do we have to report modifiers? Do we report F codes and T codes?
- A. Modifiers are not accepted when reporting to OSHPD. The full range of CPT codes, except those in Category II, should be used to report ambulatory surgery procedures performed.
- Category I CPT codes, established by the CPT Editorial Panel, are required for reporting services and procedures performed to OSHPD.
- Category II CPT codes (F codes), as a set of supplemental tracking codes for performance measurements, are not accepted when reporting to OSHPD.
- Category III CPT codes (T codes), as a set of temporary codes for emerging technology, services, and procedures, are required to be used instead of Category I's unlisted codes when reporting to OSHPD.
Q13. What will the data be used for?
- A. Data users request patient data for a variety of purposes. Some current uses of inpatient data include injury surveillance and child injury prevention. Facilities also request data for internal quality assurance measuring, product development, and market-share analysis. Future uses of ED data may be emergency medical service planning and identifying trends in the utilization of Emergency Department settings. Future uses of AS data may be planning ambulatory surgery services and identifying trends in the utilization of AS settings. Patient data provide vital information for improving healthcare for Californians.
Emergency Department (ED) Specific FAQs:
Q14. What service date do we report if an ED patient came in on May 23rd, stayed overnight, and was dismissed on May 24th?
- A. The service date is the start of care. Care began on May 23rd and ended on May 24th. In billing, there are terms like "From Date" and "To Date". The start of care would be considered the "From Date" for billing. This will be more important to remember when you submit a quarterly report. For example, if you submit a Jan-Mar report, it should contain service dates of January 1 through March 31. For Jan-Mar report period, do not submit an ED record showing a service date of April 1. Instead this record will go into the next report period for April-June.
Ambulatory Surgery (AS) Specific FAQs:
Q15. What is an Ambulatory Surgery Clinic (ASC)?
- A. Any distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization. A surgical clinic may be hospital-operated or "freestanding" and provides ambulatory surgical care for patients who remain less than 24 hours. A "Freestanding" ambulatory surgery clinic is licensed by the state (Section 1204, paragraph 1 of subdivision B) and is not a part of a hospital.
Q16. Which hospitals must report outpatient surgery procedures?
- A. Senate Bill (SB) 1973 states that hospitals and freestanding ambulatory surgery clinics are required to report to OSHPD if they perform procedures on an outpatient basis in:
- General Operating Rooms
- Ambulatory Surgery Rooms
- Endoscopy Units
- Cardiac Catheterization Laboratories
Q17. What is a hospital-operated ASC?
- A. The hospital-operated ASC must be physically distinct from other operations of the hospital.
Q18. What service date do we report if an AS patient came in on May 23rd, stayed overnight, and was dismissed on May 24th?
- A. The service date is the start of care. Care began on May 23rd and ended on May 24th. In billing, there are terms like "From Date" and "To Date". The start of care would be considered the "From Date" for billing. This will be more important to remember when you submit a quarterly report. For example, if you submit a Jan-Mar report, it should contain service dates of January 1 through March 31. For Jan-Mar report period, do not submit an AS record showing a service date of April 1. Instead this record will go into the next report period for April-June.
Q19. What admit date do we report if an AS patient came in on August 1st and was admitted to the same hospital on August 2nd?
- A. The admit date is August 2nd. This is clarified in the California Inpatient Data Reporting Manual under "Admission Date". It states, "Patients are often seen in the emergency room on one day and remain until the next day and are then admitted to inpatient care." The admission date reported is the date the patient is actually admitted to inpatient care. This is consistent with CMS requirements on admission date. Do not confuse admission date with service date.
Q20. What do we report if an AS patient was sent to observation and then was admitted to our hospital?
- A. In the ED/AS Manual, Appendix E — MIRCal Regulation Section 97213 for Required Reporting, "A hospital shall not report an AS record if the encounter resulted in a same-hospital admission." The AS record would be combined with the IP record. A separate AS record would not be reported. Follow the requirements for inpatient record reporting. Procedure dates showing three days (or 72 hours) prior to admission will be accepted on the IP record. This has been in practice since 1993 when hospitals were concerned with CMS requirements requiring them to bundle related records together.
Q21. Do we need to submit procedure data for every patient that comes to our facility?
- A. California State Law (Title 22, Section 128700) states, "Ambulatory surgery procedures" mean those procedures performed on an outpatient basis in the general operating rooms, ambulatory surgery rooms, endoscopy units, or cardiac catheterization laboratories of a hospital or a freestanding AS clinic.Two criteria must be fulfilled: 1) procedure is performed on an outpatient basis, and 2) procedure is performed in one of these specified areas: general operating rooms, AS rooms, endoscopy units, or cardiac catheterization laboratories of a hospital or a freestanding AS clinic. Once both of the above criteria are met, then your facility will follow the regulations for principal and other procedures. The regulations are posted on our website.
- Principal Procedure: The patient's principal procedure is one that is surgical in nature or carries a procedural risk, or carries an anesthetic risk. The procedure related to the principal diagnosis as the chief reason for the encounter shall be selected as the principal procedure.
- Other Procedures: All significant procedures are to be reported. A significant procedure is one that is surgical in nature, or carries a procedural risk, or carries an anesthetic risk. Procedures shall be coded according to the Current Procedural Terminology, Fourth Edition (CPT-4).
Page last revised: July 6, 2011 10:01 AM