All data elements and data element codes listed below shall be reported. All facilities submitting data in compliance with Rules 59B-9.030 through 59B-9.039, F.A.C., shall report the following required data elements as stipulated by the Agency.
    (1) AHCA Facility Number. An identification number assigned by the Agency for reporting purposes. The number must match the facility number recorded on the header record. A valid identification number must be between one (1) digit and eight (8) digits. A required entry.
    (2) Patient Control Number. An alpha-numeric code containing standard letters or numbers assigned by the facility as a unique identifier for each record submitted in the reporting period to facilitate retrieval of individual’s account of services (accounts receivable) containing the financial billing records and any postings of payment. The ‘Patient Control Number’ is defined as ‘Record id’ in the schema. Up to twenty four (24) characters. Duplicate patient control numbers are not permitted. The facility must maintain a key list to locate actual records upon request by the Agency. A required field.
    (3) Medical or Health Record Number. An alpha-numeric code assigned to the patient’s medical or health record by the facility. The medical/health record number references a file that contains the history of treatment. It should not be substituted for the Patient Control Number which is the financial record associated with a visit. Up to twenty four (24) characters. A required field.
    (4) Patient Social Security Number. The social security number (SSN) of the patient. A nine digit field to facilitate retrieval of individual case records, to be used to track multiple patient visits, and for medical research. Reporting 777777777 is acceptable for those patients where efforts to obtain the SSN have been unsuccessful or the patient is under two (2) years of age and does not have a SSN or for patients who are non-U.S. citizens who have not been issued SSNs. If only the last four digits of a patients SSN are known, report 77777XXXX where XXXX represent the last known four digits of the patient SSN. The last four digit SSN format must be used only when the full SSN is unknown and not as a substitute for all nine digit SSN’s. A required entry.
    (5) Patient Ethnicity. Self-designated by the patient, patient’s parent or guardian. Use “”Unknown”” where efforts to obtain the information from the patient or from the patient’s parent or guardian have been unsuccessful. The patient’s ethnic background shall be reported as one choice from the following list of alternatives. A required entry. Must be a two (2) digit code as follows:
    (a) E1 = Hispanic or Latino. A person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.
    (b) E2 = Non-Hispanic or Latino. A person not of any Spanish culture or origin.
    (c) E7 = Unknown.
    (6) Patient Race. Self-designated by the patient, patient’s parent or guardian. Use “”Unknown”” where efforts to obtain the information from the patient or from the patient’s parent or guardian have been unsuccessful. The patient’s racial background shall be reported as one choice from the following list of alternatives. A required entry. Must be a one (1) digit code as follows:
    (a) 1 – American Indian or Alaskan Native. A person having origins in any of the original peoples of North and South America (including Central America) America, and who maintains cultural identification through tribal affiliation or community recognition.
    (b) 2 – Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian subcontinent. This area includes, for example, Cambodia, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.
    (c) 3 – Black or African American. A person having origins in any of the black racial groups of Africa.
    (d) 4 – Native Hawaiian or other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands.
    (e) 5 – White. A person having origins in any of the original peoples of Europe, North Africa, or the Middle East.
    (f) 6 – Other. Any other possible options not covered in the above categories, including a patient who has more than one race.
    (g) 7 – Unknown. Use if the patient refuses or fails to disclose.
    (7) Patient Birth Date. The date of birth of the patient. A ten character field in the format YYYY-MM-DD where MM represents the numbered months of the year from 1 to 12, DD represents numbered days of the month from 1 to 31, and YYYY represents the year in four digits. Unknown birthdates should use the default of 1880-01-01 where efforts to obtain the patient’s birth date have been unsuccessful. A birth date after the patient visit ending date is not permitted. A required entry.
    (8) Patient Sex – The patient sex at the time of admission. A required entry. Alpha characters must be in upper case. Must be a one (1) digit code as follows:
    (a) M – Male.
    (b) F – Female.
    (c) U – Unknown. Use where efforts to obtain the information have been unsuccessful or where the patient’s sex cannot be determined due to a medical condition.
    (9) Patient Zip Code. The five digit United States Postal Service ZIP Code of the patient’s address. Use 00009 for foreign residences. Use 00007 for homeless patients. Use 00000 where efforts to obtain the information have been unsuccessful. A required entry.
    (10) Patient Country Code. The country code of residence. A two (2) digit upper case alpha code from the Code for Representation of Names of Countries, ISO 3166 or latest release. Use 99 where the country of residence is unknown, or where efforts to obtain the information have been unsuccessful. A required entry for type of service “”2″”.
    (11) Type of Service Code. A code designating the type of service, either ambulatory surgery or emergency department visit. A required entry. Must be a one (1) digit code as follows:
    (a) 1 – Ambulatory surgery, as described in subsection 59B-9.034(1) , F.A.C.
    (b) 2 – Emergency department visit, as described in subsection 59B-9.034(2), F.A.C.
    (12) Source or Point of Origin of Admission. Must be a one (1) character alpha code or two (2) digit numeric code indicating the direct source or point of patient origin for this visit. A required entry if type of service is “”2″”. Zero fill if type of service is “”1″”. Alpha characters must use upper case.
    (a) 01 – Non-health care facility point of origin – The patient presented to this facility for outpatient services. Includes patients coming from home or workplace.
    (b) 02 – Clinic or Physician’s Office. The patient presented to this facility for outpatient services from a clinic or physician’s office.
    (c) 04 – Transfer from a hospital. The patient was transferred to this facility as an outpatient from an acute care facility. Transfer must be from a different hospital.
    (d) 05 – Transfer from a Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF). The patient was referred to this facility as a transfer from a SNF or ICF where the patient was a resident.
    (e) 06 – Transfer from another health care facility. The patient was referred to this facility for services by another health care facility not defined elsewhere in this code list where he or she was an inpatient or outpatient.
    (f) 08 – Court/Law Enforcement. The patient was referenced to this facility upon the direction of a court of law, or upon the request of a law enforcement agency representative for outpatient or referenced diagnostic services. Includes transfers from incarceration facilities.
    (g) 09 – Information Not Available. The means by which the patient was referred to this hospital’s outpatient department is not known.
    (h) D – Transfer from one distinct unit of the hospital to another distinct unit of the same hospital resulting in a separate claim. The patient received outpatient services in this facility as a transfer from within this hospital resulting in a separate claim to the payer.
    (i) E – Transfer from Ambulatory Surgery Center. The patient was referred to this facility for outpatient or referenced diagnostic services from an ambulatory surgery center.
    (j) F – Transfer from hospice and under a hospice plan of care or enrolled in a hospice program. The patient was referred to this facility for outpatient or referenced diagnostic services from a hospice.
    (13) Principal Payer Code. Describes the primary source of expected reimbursement for services rendered based on the patient’s status at the time of reporting. A required entry. Must be a one (1) character alpha field using upper case as follows:
    (a) A – Medicare. Patients covered by Medicare where Centers for Medicare & Medicaid Services is the direct payer.
    (b) B – Medicare Managed Care. Patients covered by Medicare Advantage plans, Medicare HMO, Medicare PPO, Medicare Private Fee for Service or any other type of Medicare plan where Centers for Medicare & Medicaid Services is not the direct payer.
    (c) C – Medicaid. Patients covered by state administered, non-managed Florida Medicaid. This would include those Medicaid recipients enrolled in MediPass.
    (d) D – Medicaid Managed Care. Patients covered by Medicaid HMOs, Medicaid provider sponsored networks (PSNs) or other Medicaid funded plans that are licensed in the state of Florida. This would include any type of program where the patient qualifies for Medicaid but payment is not directly from the State of Florida Medicaid program regardless of whether the hospital has a contract with that plan.
    (e) E – Commercial Health Insurance. Patients covered by any type of private coverage, including HMO, PPO or self-insured plans.
    (f) H – Workers Compensation. Patients covered by any type of workers compensation plan, including self insured plans, managed care plans or the State of Florida sponsored workers compensation plan.
    (g) I – TriCare or Other Federal Government. Patients covered by any federal government program for active and retired military and their families; Black Lung, Section 1011; the Federal Prison System; or any other federal program.
    (h) J – VA. Patients covered by the Veteran’s Administration (VA).
    (i) K – Other State/Local Government. Patients covered by a state program or local government that does not fall into any of the payer categories listed. This would include those covered by the Florida Department of Corrections or any county or local corrections department, patients covered by county or local government indigent care programs if the reimbursement is at the patient level; any out-of-state Medicaid programs and county health departments or clinics.
    (j) L – Self Pay. Patients with no insurance coverage.
    (k) M – Other. This would include patients covered by any other type of payer not meeting the descriptions in paragraphs (a)-(j), above, or paragraphs (l)-(o), below.
    (l) N – Non-Payment. Includes charity, professional courtesy, no charge, research/clinical trial, refusal to pay/bad debt, Hill Burton free care, research/donor that is known at the time of reporting.
    (m) O – KidCare. Includes Healthy Kids, MediKids and Children’s Medical Services.
    (n) P – Unknown. Unknown shall be reported if principal payer information is not available and type of service is “”2″” and patient status is “”07″”.
    (o) Q – Commercial Liability Coverage. Patients whose health care is covered under a liability policy, such as automobile, homeowners or general business.
    (14) Principal Diagnosis Code. The code representing the diagnosis chiefly responsible for the services performed during the visit. Must contain a valid ICD-10-CM diagnosis code if type of service is “”1″” indicating ambulatory surgery. Must contain a valid ICD-10-CM diagnosis code if type of service is “”2″” indicating an emergency department visit unless patient status is “”07″” indicating that the patient left against medical advice or discontinued care. A blank field is permitted if type of service is “”2″” and patient status is “”07.”” If not space filled, must contain a valid ICD-10-CM diagnosis code for the reporting period. A diagnosis code cannot be used more than once as a principal or other diagnosis for each visit reported. The code must be entered with a decimal point that is included in the valid code. Alpha characters must be in upper case.
    (15) Other Diagnosis Code (1), Other Diagnosis (2), Other Diagnosis (3), Other Diagnosis (4), Other Diagnosis (5), Other Diagnosis (6), Other Diagnosis (7), Other Diagnosis (8), Other Diagnosis (9). A code representing a diagnosis related to the services provided during the visit. If no principal diagnosis code is reported, another diagnosis code must not be reported unless the patient discharge status is “”07″” indicating that the patient left against medical advice or discontinued care. No more than nine other diagnosis codes may be reported. Less than nine entries is permitted. If not space filled, must contain a valid ICD-10-CM code for the reporting period. A diagnosis code cannot be used more than once as a principal or other diagnosis for each visit reported. The code must be entered with use of a decimal point that is included in the valid code. Alpha characters must be in upper case.
    (16) Evaluation and Management Code (1), Evaluation and Management Code (2), Evaluation and Management Code (3), Evaluation and Management Code (4), Evaluation and Management Code (5). A code representative of the patient acuity level for the services provided. If type of service is “”2,”” must contain a valid Evaluation and Management (EM) Code range 99281-99285; 99288; 99291-99292; and G0380-G0384, even if the only service provided to a registered patient is triage or screening. If patient discharge status is “”07″” meaning the patient left against medical advice or discontinued care, or where a visit occurs resulting in zero charges, enter default code 99999 to indicate that the patient was not evaluated by a physician. No more than five EM codes may be reported. Less than five entries is permitted. Ambulatory surgical centers, type of service “”1,”” should not report Evaulation and Management codes. A required field.
    (17) Other CPT or HCPCS Procedure Code (1), Other CPT or HCPCS Procedure Code (2), Other CPT or HCPCS Procedure Code (3), Other CPT or HCPCS Procedure Code (4), Other CPT or HCPCS Procedure Code (5), Other CPT or HCPCS Procedure Code (6), Other CPT or HCPCS Procedure Code (7), Other CPT or HCPCS Procedure Code (8), Other CPT or HCPCS Procedure Code (9), Other CPT or HCPCS Procedure Code (10), Other CPT or HCPCS Procedure Code (11), Other CPT or HCPCS Procedure Code (12), Other CPT or HCPCS Procedure Code (13), Other CPT or HCPCS Procedure Code (14), Other CPT or HCPCS Procedure Code (15), Other CPT or HCPCS Procedure Code (16), Other CPT or HCPCS Procedure Code (17), Other CPT or HCPCS Procedure Code (18), Other CPT or HCPCS Procedure Code (19), Other CPT or HCPCS Procedure Code (20), Other CPT or HCPCS Procedure Code (21), Other CPT or HCPCS Procedure Code (22), Other CPT or HCPCS Procedure Code (23), Other CPT or HCPCS Procedure Code (24), Other CPT or HCPCS Procedure Code (25), Other CPT or HCPCS Procedure Code (26), Other CPT or HCPCS Procedure Code (27), Other CPT or HCPCS Procedure Code (28), Other CPT or HCPCS Procedure Code (29), Other CPT or HCPCS Procedure Code (30). A code representing a procedure or service provided during the patient visit. If not space filled, must be a valid CPT or HCPCS code for the reporting period. Alpha characters must be in upper case. No more than thirty (30) other CPT or HCPCS procedure codes may be reported. Less than thirty (30) entries or no entry is permitted.
    (18) Attending Practitioner Identification Number. The Florida license number of the medical doctor, osteopathic physician, dentist, podiatrist, chiropractor or advanced practice registered nurse who had primary responsibility for the patient’s care during the visit. An alpha-numeric field of up to fifteen (15) characters, alpha characters must be in upper case. For military physicians not licensed in Florida, use US999999999. Use NA if the patient was not treated by a medical doctor, osteopathic physician, dentist, podiatrist, chiropractor, or advanced practice registered nurse. A required entry.
    (19) Attending Practitioner National Provider Identification (NPI). A unique ten (10) character identification number assigned to a provider. A required entry for providers in the US or its territories and providers not in the U.S. or its territories upon mandated HIPAA NPI implementation date. For military physicians, medical residents, or individuals not required to obtain a NPI number, use 9999999999.
    (20) Operating or Performing Practitioner Identification Number. The Florida license number of the medical doctor, osteopathic physician, dentist, podiatrist, chiropractor or advanced practice registered nurse who had primary responsibility for the principal procedure performed. The operating or performing practitioner may be the attending practitioner. An alpha-numeric field of up to fifteen (15) characters, alpha characters must be in upper case. For military physicians not licensed in Florida, use US999999999. A required entry. A blank or no entry is permitted if a principal procedure is not reported.
    (21) Operating or Performing Practitioner National Provider Identification (NPI). A unique ten (10) character identification number assigned to a provider. A required entry for providers in the U.S. or its territories and providers not in US or its territories upon mandated HIPAA NPI implementation date. For military physicians, medical residents, or individuals not required to obtain a NPI number, use 9999999999.
    (22) Other Operating or Performing Practitioner Identification Number. The Florida license number of a different operating or performing practitioner. Report a medical doctor, osteopathic physician, dentist, podiatrist, chiropractor or advanced practice registered nurse who rendered care to the patient other than the person reported in paragraph (18) or (20), above. An alpha-numeric field of up to fifteen (15) characters, alpha characters must be in upper case. For military physicians not licensed in Florida, use US999999999. A blank or no entry is permitted.
    (23) Other Operating or Performing Practitioner National Provider Identification (NPI). A unique ten (10) character identification number assigned to a provider. A required entry for providers in the US or its territories and providers not in US or its territories upon mandated HIPAA NPI implementation date. For military physicians, medical residents, or individuals not required to obtain a NPI number, use 9999999999.
    (24) Pharmacy Charges. Charges for medication. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no pharmacy charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
    (25) Medical and Surgical Supply Charges. Charges for supply items required for patient care. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no medical and surgical supply charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
    (26) Laboratory Charges. Charges for the performance of diagnostic and routine clinical laboratory tests. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no laboratory charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
    (27) Radiology and Other Imaging Charges. Charges for the performance of diagnostic and therapeutic radiology services including computed tomography, mammography, magnetic resonance imaging, nuclear medicine, and chemotherapy administration of radioactive substances. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no radiology or computed tomography charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
    (28) Cardiology Charges (Cardiac Cath). Charges for cardiac procedures rendered such as heart catheterization. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no cardiology charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
    (29) Operating Room Charges. Charges for the use of the operating room. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no operating room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
    (30) Anesthesia Charges. Charges for anesthesia services by the facility. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no anesthesia charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
    (31) Recovery Room Charges. Charges for the use of the recovery room. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no recovery room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
    (32) Emergency Room Charges. Charges for medical examinations and emergency treatment. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no emergency room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
    (33) Trauma Response Charges. Charges for a trauma team activation at a State of Florida licensed Trauma Center. Report charges for revenue code 68X used in the UB-04. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report zero (0) if there are no trauma response charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
    (34) Treatment or Observation Room Charges. Charges for use of a treatment room or for the room charge associated with observation services. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no treatment or observation room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
    (35) Gastro-Intestinal (GI) services. Charges for gastro-intestinal procedures rendered such as colonoscopy and endoscopy services. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no GI charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
    (36) Extra-Corporeal Shock Wave Therapy (Lithotripsy). Charges for Extra-Corporeal Shock Wave Therapy (Lithotripsy) procedures. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no Lithotripsy charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
    (37) Other Charges. Other facility charges not included in paragraphs (24) to (36), above. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no other charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
    (38) Total Gross Charges. The total of undiscounted charges for services rendered by the reporting entity. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Include charges for services rendered by the ambulatory center excluding professional fees. Negative amounts are not permitted unless verified separately by the reporting entity. The sum of pharmacy charges, medical and surgical supply charges, laboratory charges, radiology and other imaging charges, cardiology charges, operating room charges, anesthesia charges, recovery room charges, emergency room charges, treatment or observation room charges, Gastro-Intestinal (GI) services, Extra-Corporeal Shock Wave Therapy (Lithotripsy), and other charges must equal total charges, plus or minus 13. A required entry.
    (39) Patient Visit Beginning Date. The date at the beginning of the patient’s visit for ambulatory surgery or the date at the time of registration in the emergency department. A ten (10) character field in the format YYYY-MM-DD where MM represents the numbered months of the year from 1 to 12, DD represents numbered days of the month from 1 to 31, and YYYY represents the year in four digits. Patient visit beginning date must equal or precede the patient visit ending date. A required entry.
    (40) Patient Visit Ending Date. The date at the end of the patient’s visit. A ten (10) character field in the format YYYY-MM-DD where MM represents the numbered months of the year from 1 to 12, DD represents numbered days of the month from 1 to 31, and YYYY represents the year in four digits. Patient visit ending date must equal or follow the patient visit beginning date. Patient visit ending date must occur within the calendar quarter included in the data report.
    (41) Hour of Arrival. The hour on a 24-hour clock during which the patient’s visit for ambulatory surgery began or during which registration in the emergency department occurred. A required entry. Use 99 where efforts to obtain the information have been unsuccessful. Must be two digits as follows:
A.M. HOURS
    (a) 00 – 12:00 midnight to 12:59:59
    (b) 01 – 01:00 to 01:59:59
    (c) 02 – 02:00 to 02:59:59
    (d) 03 – 03:00 to 03:59:59
    (e) 04 – 04:00 to 04:59:59
    (f) 05 – 05:00 to 05:59:59
    (g) 06 – 06:00 to 06:59:59
    (h) 07 – 07:00 to 07:59:59
    (i) 08 – 08:00 to 08:59:59
    (j) 09 – 09:00 to 09:59:59
    (k) 10 – 10:00 to 10:59:59
    (l) 11 – 11:00 to 11:59:59
P.M. HOURS
    (m) 12 – 12:00 noon to 12:59:59
    (n) 13 – 01:00 to 01:59:59
    (o) 14 – 02:00 to 02:59:59
    (p) 15 – 03:00 to 03:59:59
    (q) 16 – 04:00 to 04:59:59
    (r) 17 – 05:00 to 05:59:59
    (s) 18 – 06:00 to 06:59:59
    (t) 19 – 07:00 to 07:59:59
    (u) 20 – 08:00 to 08:59:59
    (v) 21 – 09:00 to 09:59:59
    (w) 22 – 10:00 to 10:59:59
    (x) 23 – 11:00 to 11:59:59
    (y) 99 – Unknown.
    (42) Emergency Department (ED) Hour of Discharge. The hour on a 24-hour clock during which the patient left the emergency department. A required entry. Use 99 where efforts to obtain the information have been unsuccessful or type of service is “”1.”” Must be two digits as follows:
A.M. HOURS
    (a) 00 – 12:00 midnight to 12:59:59
    (b) 01 – 01:00 to 01:59:59
    (c) 02 – 02:00 to 02:59:59
    (d) 03 – 03:00 to 03:59:59
    (e) 04 – 04:00 to 04:59:59
    (f) 05 – 05:00 to 05:59:59
    (g) 06 – 06:00 to 06:59:59
    (h) 07 – 07:00 to 07:59:59
    (i) 08 – 08:00 to 08:59:59
    (j) 09 – 09:00 to 09:59:59
    (k) 10 – 10:00 to 10:59:59
    (l) 11 – 11:00 to 11:59:59
P.M. HOURS
    (m) 12 – 12:00 noon to 12:59:59
    (n) 13 – 01:00 to 01:59:59
    (o) 14 – 02:00 to 02:59:59
    (p) 15 – 03:00 to 03:59:59
    (q) 16 – 04:00 to 04:59:59
    (r) 17 – 05:00 to 05:59:59
    (s) 18 – 06:00 to 06:59:59
    (t) 19 – 07:00 to 07:59:59
    (u) 20 – 08:00 to 08:59:59
    (v) 21 – 09:00 to 09:59:59
    (w) 22 – 10:00 to 10:59:59
    (x) 23 – 11:00 to 11:59:59
    (y) 99 – Unknown.
    (43) Patient’s Reason for Visit ICD-10-CM Code (Admitting Diagnosis). The code representing the patient’s chief complaint or stated reason for seeking care in the Emergency Department. Must contain a valid ICD-10-CM code for the reporting period if type of service is “”2″” indicating an emergency department visit. If not space filled, must contain a valid ICD-10-CM diagnosis code. The code must be entered with use of a decimal point that is included in the valid code. Space fill if type of service is “”1″” indicating ambulatory surgery. Alpha characters must be in upper case.
    (44) External Cause of Morbidity Code (1), External Cause of Morbidity Code (2) and External Cause of Morbidity Code (3). A code representing circumstances or conditions as the cause of the injury, poisoning or other adverse effects recorded as a diagnosis. No more than three (3) external cause of morbidity codes may be reported. Less than three (3) or no entry is permitted. If not space filled, must be a valid ICD-10-CM cause of morbidity code for the reporting period. An external cause of morbidity code cannot be used more than once for each encounter reported. The code must be entered with use of a decimal point that is included in the valid code. Alpha characters must be in upper case.
    (45) Service Location. A code designating services performed at an offsite emergency department location at facilities whose license includes a “”offsite”” emergency department. For type of service “”2,”” enter an upper case “”A through Z”” for services performed at each offsite emergency department location. Facilities with a single off-site location will use service location code “”A.”” The Agency will assign an alpha service code to identify each location if a facility has more than one location. The Agency’s Data Layout will reference the assigned offsite identifiers for each facility having more than one location. Remove element tag if type of service is “”1″” or for hospitals without an offsite emergency department location.
    (46) Patient Status. Patient disposition at end of visit. A required entry. Must be a two (2) digit code as follows:
    (a) 01 – Discharged to home or self care (routine discharge).
    (b) 02 – Transferred to a short-term general hospital for inpatient care.
    (c) 03 – Transferred to a skilled nursing facility with Medicare certification in anticipation of skilled care.
    (d) 04 – Transferred to an intermediate care facility.
    (e) 05 – Transferred to a designated cancer center or Children’s Hospital.
    (f) 06 – Discharged to home under care of home health care organization service in anticipation of covered skilled care.
    (g) 07 – Left against medical advice or discontinued care.
    (h) 20 – Expired.
    (i) 21 – Discharged or transferred to court/law enforcement.
    (j) 50 – Discharged to hospice – home.
    (k) 51 -. Transferred to hospice. Hospice medical facility (certified) providing hospice level of care.
    (l) 62 – Transferred to an Inpatient Rehabilitation Facility (IRF) including rehabilitation distinct part units of a hospital.
    (m) 63 – Discharged or transferred to a Medicare certified long term care hospital.
    (n) 64 – Discharged or transferred to a Nursing Facility certified under Medicaid but not certified under Medicare.
    (o) 65 – Discharged or transferred to a psychiatric hospital including psychiatric distinct part units of a hospital.
    (p) 66 – Discharged or transferred to a Critical Access hospital.
    (q) 70 – Discharged or transferred to another type of health care institution not defined elsewhere in this code list.
    (47) Trailer Record: The last record in the data file shall be a trailer record and must accompany each data set. Report only the total number of patient data records contained in the file, excluding header and trailer records. The number entered must equal the number of records processed. Do not include leading zeros.
Rulemaking Authority Florida Statutes § 408.15(8). Law Implemented 408.061, 408.062, 408.063 FS. History-New 1-1-10, Amended 12-5-10, Formerly 59B-9.018, Amended 10-1-15, 1-1-18, 2-16-23.