USCDI Export for the Public

Medical: The amount the insured individual pays, as a set percentage of the cost of covered medical services, as an out-of-pocket payment to the provider. Example: Insured pays 20% and the insurer pays 80%.
Pharmacy: Amount to be collected from a patient that is included in the Patient Pay Amount that is due to a per prescription copay or coinsurance.

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

The amount the insured individual pays, as a set percentage of the cost of covered medical services, as an out-of-pocket payment to the provider. Example: Insured pays 20% and the insurer pays 80%.

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

Amount submitted by the provider for reimbursement of health care services. This amount includes non-covered services.

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

High-level categorization of the claim.

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

Specifies the type of claim. (e.g., inpatient institutional, outpatient institutional, physician, etc.).

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

Claim processing status code

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

Identifies the place where the patient was identified as needing admission to a facility. This is a two position code mapped from the standard values for the UB-04 Source of Admission code (FL-15).

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

In the past year whether patient has been able to unable to find affordable or pay for childcare. (LOINC) LA30127-7 Synonyms: (ICD-10-CM) Z59.68 (Unable to pay for child care)

LOINC 93031-3 In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?

In the past year whether patient has been unable to afford or access medicine or or any health care (medical, dental, mental health, vision) services. (LOINC) LA30128-5 LA15832-1 (Very hard), 2; LA14745-6 (Hard), 3; LA22683-9 (Somewhat)" Synonyms: (SNOMEDCT) 423593006 Inadequate healthcare resources (ICD-10-CM) Z59.63 (Unable to pay for medical care) Z59.61 (Unable to pay for prescriptions)

LOINC 93031-3 In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?

In the past year whether patient has been unable to afford or access a phone. (LOINC) LA30129-3 LA13918-0 (With little difficulty), 3; LA13920-6 (with some difficulty), 2; LA13919-8 (With much difficulty) Synonyms: (SNOMEDCT) 5501000175107 Lack of telephone in home environment (ICD-10-CM) Z59.65 (Unable to pay for phone)

LOINC 93031-3 In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?

Inability to pay for, threat of shutoff and lack of access to utilities. (LOINC) LA30124-4 : Synonyms: (ICD-10-CM) Z59.1 Inadequate housing (lack of heat, restriction of space, technical home defects, unsatisfactory surroundings) Z59.62 (Unable to pay for utilities)

LOINC 93031-3 In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?

Inability to obtain or purchase adequate clothing or to wash and maintain clothing in adequate condition. (LOINC) LA30126-9 Synonym: (SNOMEDCT) 46017004 Clothing disheveled 248164005 Clothing dirty 225521004 Clothes need changing " (ICD-10-CM) Z59.66 (Lack of adequate clothing)

LOINC 93031-3 In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?

Version of the DRG codes assigned for inpatient facility claims. Claim diagnosis related group (DRG) code value. Name of the DRG grouper assigned; i.e., MS-DRG, AP-DRG or APR-DRG

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

Cancer patients with similar prognoses are grouped by using prognostic stage group tables. Clinical and pathological stage groups are defined for each case as appropriate. These disease-specific groups are composed of the following categories: • cT, cN, and cM or pM • pT, pN, and cM or pM • factors for both groups, if applicable Rules for assigning prognostic stage groups: Prognostic stage groups are based on combinations of T, N, M, and relevant prognostic factors and usually define groups of patients with similar outcomes to help define prognosis and appropriate treatment, as well as to enable comparisons of similar groups of patients between institutions and over time.

SNOMED CT has content related to the AJCC T category under the hierarchy of 385356007 'Tumor stage finding' but it is outdated and inaccurate. SNOMED CT codes do not always make a distinction between clinical and pathological classifications (e.g. cT1 and pT1) and are represented by the same SNOMED CT code 23351008 'T1 category'). SNOMED CT does not have complete T,N,M staging terminology and is an incomplete data set. Most importantly, the SNOMED structure is not a good fit for the AJCC data elements that can change as new editions/versions of the AJCC Cancer Staging System are published. However, the AJCC is planning on submitting the data elements to the National Library of Medicine’s Value Set Authority Center (VSAC), in parallel to the submission to USCDI. The AJCC feels that VSAC would be an appropriate centralized repository for AJCC data elements. This would facilitate EHR systems' use of the data elements that the AJCC develops and maintains.

For both Clinical (cM) and Pathological (pM) the M Category is defined as the absence or presence of distant metastases in sites and/or organs outside the local tumor area and regional nodes as defined for each cancer site. For some cancer sites, the location and volume or burden of distant metastases are included. Distant Metastasis (M) Categories: The distant metastasis category specifies whether distant metastasis is present. M0 No evidence of distant metastasis M1 Distant metastasis

SNOMED CT has content related to the AJCC T category under the hierarchy of 385356007 'Tumor stage finding' but it is outdated and inaccurate. SNOMED CT codes do not always make a distinction between clinical and pathological classifications (e.g. cT1 and pT1) and are represented by the same SNOMED CT code 23351008 'T1 category'). SNOMED CT does not have complete T,N,M staging terminology and is an incomplete data set. Most importantly, the SNOMED structure is not a good fit for the AJCC data elements that can change as new editions/versions of the AJCC Cancer Staging System are published. However, the AJCC is planning on submitting the data elements to the National Library of Medicine’s Value Set Authority Center (VSAC), in parallel to the submission to USCDI. The AJCC feels that VSAC would be an appropriate centralized repository for AJCC data elements. This would facilitate EHR systems' use of the data elements that the AJCC develops and maintains.

For both Clinical (cN), Pathological (pN) and Neoadjuvant (ycN or ypN), the N Category is defined as Cancer in the regional lymph nodes as defined for each cancer site, including • absence or presence of cancer in regional node(s), and/or • number of positive regional nodes, and/or • involvement of specific regional nodal groups, and/or • size of nodal metastasis or extension through the regional node capsule, and/or • In-transit and satellite metastases, somewhat unique manifestations of nonnodal intralymphatic regional disease, usually found between the primary tumor site and draining nodal basins. Regional Lymph Node (N) Categories Categorizing regional lymph node involvement depends on its existence and extent. NX No information about the N category for the regional lymph nodes, or it is unknown or cannot be assessed N0 No regional lymph node involvement with cancer and for some disease sites, nonnodal regional disease as noted earlier N1, N2, or N3 Evidence of regional node(s) containing cancer, with • an increasing number, and/or • regional nodal group involvement, and/or • size of the nodal metastatic cancer deposit, or • non-nodal regional disease as noted earlier for melanoma and Merkel cell carcinoma, and for colorectal carcinoma

SNOMED CT has content related to the AJCC T category under the hierarchy of 385356007 'Tumor stage finding' but it is outdated and inaccurate. SNOMED CT codes do not always make a distinction between clinical and pathological classifications (e.g. cT1 and pT1) and are represented by the same SNOMED CT code 23351008 'T1 category'). SNOMED CT does not have complete T,N,M staging terminology and is an incomplete data set. Most importantly, the SNOMED structure is not a good fit for the AJCC data elements that can change as new editions/versions of the AJCC Cancer Staging System are published. However, the AJCC is planning on submitting the data elements to the National Library of Medicine’s Value Set Authority Center (VSAC), in parallel to the submission to USCDI. The AJCC feels that VSAC would be an appropriate centralized repository for AJCC data elements. This would facilitate EHR systems' use of the data elements that the AJCC develops and maintains.

A coded term that indicates the responsibilities of a person’s job for directing work and managing personnel, as reported by the person. Pay grade is used for a military position, since it distinguishes between officers and enlisted service members and conveys similar meaning across all branches of service.

Occupational Data for Health (Value Set -Job Supervisory Level or Pay Grade (ODH))

UB04 (Form Locator 4) type of bill code provides specific information for payer purposes. The first digit of the three-digit number denotes the type of facility.

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

On Institutional claims, the first day on the billing statement covering services rendered to the beneficiary (i.e. 'Statement Covers From Date’). On Professional and Non-Clinician claims, Earliest of any of the line-item level dates. It is almost always the same as Claim Service End Date except for DME claims - where some services are billed in advance.

NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.

A coded term that characterizes the arrangement between the employer and the person in a job, such as 'paid work, self-employed' or 'voluntary work in disaster/emergency response', as reported by the person.

PHVS_WorkClassification_ODH