Search Data Variables

The code used to identify the 6th external cause of injury, poisoning, or other adverse effect.

The present on admission (POA) indicator code associated with the diagnosis E codes (principal and secondary).

In response to the Deficit Reduction Act of 2005, CMS began to distinguish between hospitalization diagnoses that occurred prior to versus during the admission. The objective was to eventually not pay hospitals more if the patient acquired a condition (e.g., infection) during the admission. This present on admission (POA) field is used to indicate whether the diagnosis was present on admission.

Medicare claims did not indicate whether a diagnosis was POA until 2011.

The code used to identify the 7th external cause of injury, poisoning, or other adverse effect.

The present on admission (POA) indicator code associated with the diagnosis E codes (principal and secondary).

In response to the Deficit Reduction Act of 2005, CMS began to distinguish between hospitalization diagnoses that occurred prior to versus during the admission. The objective was to eventually not pay hospitals more if the patient acquired a condition (e.g., infection) during the admission. This present on admission (POA) field is used to indicate whether the diagnosis was present on admission.

Medicare claims did not indicate whether a diagnosis was POA until 2011. 

The code used to identify the 8th external cause of injury, poisoning, or other adverse effect.

The present on admission (POA) indicator code associated with the diagnosis E codes (principal and secondary).

In response to the Deficit Reduction Act of 2005, CMS began to distinguish between hospitalization diagnoses that occurred prior to versus during the admission. The objective was to eventually not pay hospitals more if the patient acquired a condition (e.g., infection) during the admission. This present on admission (POA) field is used to indicate whether the diagnosis was present on admission.

Medicare claims did not indicate whether a diagnosis was POA until 2011.

The code used to identify the 10th external cause of injury, poisoning, or other adverse effect.

The present on admission (POA) indicator code associated with the diagnosis E codes (principal and secondary).

In response to the Deficit Reduction Act of 2005, CMS began to distinguish between hospitalization diagnoses that occurred prior to versus during the admission. The objective was to eventually not pay hospitals more if the patient acquired a condition (e.g., infection) during the admission. This present on admission (POA) field is used to indicate whether the diagnosis was present on admission.

Medicare claims did not indicate whether a diagnosis was POA until 2011.

The code used to identify the 11th external cause of injury, poisoning, or other adverse effect.

The present on admission (POA) indicator code associated with the diagnosis E codes (principal and secondary).

In response to the Deficit Reduction Act of 2005, CMS began to distinguish between hospitalization diagnoses that occurred prior to versus during the admission. The objective was to eventually not pay hospitals more if the patient acquired a condition (e.g., infection) during the admission. This present on admission (POA) field is used to indicate whether the diagnosis was present on admission.

Medicare claims did not indicate whether a diagnosis was POA until 2011.

The code used to identify the 12th external cause of injury, poisoning, or other adverse effect.

The present on admission (POA) indicator code associated with the diagnosis E codes (principal and secondary).

In response to the Deficit Reduction Act of 2005, CMS began to distinguish between hospitalization diagnoses that occurred prior to versus during the admission. The objective was to eventually not pay hospitals more if the patient acquired a condition (e.g., infection) during the admission. This present on admission (POA) field is used to indicate whether the diagnosis was present on admission.

Medicare claims did not indicate whether a diagnosis was POA until 2011.

The diagnostic related group to which a hospital claim belongs. A unique identifier of a hospital case type that is based on similar clinical problems.

The diagnostic related group to which a hospital claim belongs for prospective payment purposes.

On an institutional claim, the code that indicates the beneficiary stay under the prospective payment system (PPS) which, although classified into a specific diagnosis related group, has an unusually long length (day outlier) or exceptionally high cost (cost outlier).

Code indicating the disposition or outcome of the processing of the claim record.

In the source CMS National Claims History (NCH), claims are transactional records and several iterations of the claim may exist (e.g., original claim, an edited/updated version - which also cancels the original claim, etc.).

The final reconciled version of the claim is contained in CCW-produced data files, unless otherwise requested. For final claims (at least those that are final at the time of the data file), this value will always be '01'.

The claims adjustment payment amount for Hospitals that are not meaningful users of certified Electronic Health Record (EHR) technology.

This field is a switch that identifies which hospitals are Electronic Health Records(EHR) meaningful users, and distinguishes hospitals that will have a payment penalty for not being meaningful users.

The date the service covered by this claim ended. For capitation premium payments, the date on which the period of coverage related to this payment ends/ended.

The type of facility. 

The type of facility. 

This field is stored in the CMS Integrated Data Repository (IDR) as the final action indicator; however, CMS has verified that for 2015 encounter records, this field should not be used to identify the final version of the record. Note that the term “final action” is used differently in encounter data, compared to fee-for-service (FFS) claims.

This amount further adjusts the standard Medicare Payment amount (field called PPS_STD_VAL_PYMT_AMT) by applying additional standardization requirements (e.g. sequestration).

The third digit of the type of bill (TOB3) submitted on an institutional claim record to indicate the sequence of a claim in the beneficiary's current episode of care. 

The third digit of the type of bill (TOB3) submitted on an institutional claim record to indicate the sequence of a claim in the beneficiary's current episode of care.

The first day on the billing statement covering services rendered to the beneficiary (a.k.a. 'Statement Covers From Date'). 

The first day on the billing statement covering services rendered to the beneficiary (a.k.a. 'Statement Covers From Date'). 

Under the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS), the payment amount based on the MS-LTC-DRG. This amount does not include any applicable outlier payment amount.

The terminal digit of the Healthcare Common Procedure Coding System (HCPCS) version used to code the claim. 

The code used to identify those Home Health PPS claims that have 4 visits or less in a 60-day episode.

If an HHA provides 4 visits or less, they will be reimbursed based on a national standardized per visit rate instead of Home Health resource groups (HHRGs).

Effective with Version 'I', the code used to identify the means by which the beneficiary was referred for Home Health services. 

The count of the number of HHA visits as derived by CMS. 

On an institutional claim, the date the beneficiary was admitted to the hospice care. 

This field is a switch that identifies hospitals subject to a Hospital Acquired Conditions (HAC) reduction of what they would otherwise be paid under the inpatient prospective payment system (IPPS). 

This field represents the Hospital Readmission Reduction (HRR) Program Payment Amount. The amount is the reduction to the claim for a readmission. 

This field is the code used to identify whether the hospital is participating in the Hospital Readmissions Reduction (HRR) program.

 Under the Hospital Readmissions Reduction (HRR) Program, the amount used to identify the readmission adjustment factor that will be applied.

This is the unique identification number for the claim.

Each Part A or institutional Part B claim has at least one revenue center record.

Each non-institutional Part B claim has at least one claim line.

All revenue center records or claim lines on a given claim have the same CLM_ID. It is used to link the revenue lines together and/or to the base claim.

The code indicating the type and priority of an inpatient admission associated with the service on an intermediary submitted claim.

The code indicating the type and priority of an inpatient admission associated with the service on an intermediary submitted claim. 

Claim Inpatient Initial MS Diagnosis Related Group (DRG) Code

This is the amount field used to identify a payment adjustment given to hospitals to account for the higher costs per discharge for low income hospitals under the Inpatient Prospective Payment System (IPPS).

Code indicating type of adjustment record claim/encounter represents at claim detail level.

Claim adjustment reason codes communicate why a service line was paid differently than it was billed.

For services received during a single encounter with a provider, the date the service was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, this would be the date on which the service began. For capitation premium payments, the date on which the period of coverage related to this payment began.

The total number of lines on the claim within the TAF

The total number of lines on the claim as recorded by the state when TMSIS data submitted

For services received during a single encounter with a provider, the date the service was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, the date on which the service ended. For capitation premium payments, the date on which the period of coverage related to this payment ends/ended.

This variable identifies an individual line number on a claim.

Each revenue center record or claim line has a sequential line number to distinguish distinct services that are submitted on the same claim.

All revenue center records or claim lines on a given claim have the same CLM_ID.

This variable identifies an individual line number on an encounter record claim. 

Each revenue center record or claim line has a sequential line number to distinguish distinct services that are submitted on the same encounter record. 

All revenue center records or claim lines on a given claim have the same encounter join key (variable called ENC_JOIN_KEY).