CHIA USER WORKGROUP
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CENTER FOR HEALTH INFORMATION AND ANALYSIS
Don Kirkwood (Manager of Data Release and Procurement)
Sylvia Hobbs (
Associate Director of Data Strategy and User Support)
Scott Curley (Manager Privacy & Compliance)
January 24, 2023
Announcements
:
APCD Release CY 2021 Updates
FY21 Case Mix Release Projections
Website Updates
User Support Questions
Case Mix and MA APCD Comparison of Bariatric Surgery
Case Mix and MA APCD Comparison of Arrival via Ambulance
Case Mix and MA APCD Comparison of COVID-19 Diagnosis
CDC WONDER addition of Massachusetts 2021 Death Data
Q&A
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User Workgroup | CHIA User Support
Available for request
Applicants with
approved projects
that require updated APCD
data (CY 2021 Data) should submit to CHIA a completed Exhibit
B (
Certificate of Continued Need and Compliance
) of the Data
Use Agreement. After submitting a completed Exhibit B you will
receive an invoice (if applicable) for the requested data. Upon
payment of the invoice the order for the data will be placed.
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User Workgroup | CHIA User Support
*CURRENT* RELEASE TIMEFRAMES FOR EACH FILE:
Inpatient (HIDD)
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Emergency Department (ED)
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Outpatient Observation (OOD)
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Applicants with
approved projects
that require newly available year(s) of Case Mix
Data (e.g., FY 19) should submit to CHIA a completed Exhibit B (
Certificate of
Continued Need and Compliance
) of the Data Use Agreement. After submitting a
completed Exhibit B you will receive an invoice (if applicable) for the requested
data. Upon payment of the invoice the order for the data will be placed.
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User Workgroup| CHIA User Support
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Request IDs will be communicated to Data Requestors via email.
Please visit
http://www.chiamass.gov/status-of-data-requests/
to see
the current status of releases.
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User Workgroup| CHIA User Support
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Answer
: A wide variety of bariatric procedures coded as CPT codes are performed in outpatient observation stay but on
a small volume of patients (see Table 1 below, asterisk for cell suppression of less than 11). During the pandemic, there
was an increase in sleeve gastrectomy and unlisted laparoscopy stomach procedures which are newer bariatric
interventions that do not yet have a code.
Table 1. FY2016 through FY2021 Outpatient Observation Stay Bariatric Procedures
Answer (continued)
: Even though the volume of bariatric procedures performed in
observation stay is low, the volume of observation stays who have a history of bariatric
surgery (ICD-10-CM Z98.84) increased by 28% from FY2019 to FY2020 (see Figure 1 below).
The top ICD-10-PCS procedures performed on observation stay patients with a history of
bariatric surgery are related to endoscopic inspections and repairs (See Table 1 below).
Figure 1. FY2016 through FY2021 Volume of Observation Stays with a History of Bariatric Surgery
Table 1. Top 15 ICD-10 Procedures Performed on Observation Stays with a History of Bariatric Surgery
Answer (continued)
: In the case mix hospital inpatient discharge data from FY2018 through
FY2021, the monthly volume of patients with a history of bariatric surgery has not widely
varied except in April 2020 during the height of the pandemic (
See Figure 1 below
).
Figure 1. FY2018 through FY2021 Monthly Volume of Inpatient Discharges with a History of Bariatric Surgery
Table 1. Top 10 ICD-10 Procedures Performed on Inpatient Discharges with a History of Bariatric Surgery
Answer (continued)
: In the MA APCD Release 10, even with the impact
in the reduction of claims due to Gobeille vs. Liberty Mutual, a higher
volume of bariatric procedures can be found in the medical claims data
(
See Table 1 below
). However, more pronounced than in case mix, the
onset on the pandemic resulted in a significant decrease in distinct
Massachusetts residents seeking bariatric procedures.
See Figure 1.
Table 1. Bariatric Procedures in MA APCD Release 10 Medical Claims by Year
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Answer
: Some hospitals, like Boston Children’s Hospital, have their own ambulance services
and you would see the billing for the ambulance service rolled into the inpatient patient
revenue codes in the hospital inpatient discharge services file or as an HCPCS code in the
outpatient emergency department services file.
Ambulance services are separate outpatient care settings, have separate NPIs, and bill separately from the hospitals.
The most detailed information on HCPCS/CPT procedures performed in ambulance, the transport distance, and billing
can be found in the MA APCD. Those services can be found using the following taxonomy codes:
Ambulance Billing
3416A0800X
Air Transport
3416L0300X
Land Transport
3416S0300X
Water Transport
Ambulance Service Taxonomy Codes
Ambulance Service Revenue Codes
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http://www.chiamass.gov/ma-apcd-and-case-mix-user-workgroup-
information/
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User Workgroup | CHIA User Support
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•
The next User Group will meet Tuesday
February, 28.
•
http://www.chiamass.gov/ma-apcd-and-case-mix-user-workgroup-
information/
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https://www.chiamass.gov/resultant-research-using-chia-data
Questions related to MA APCD:
apcd.data@chiamass.gov
Questions related to Case Mix:
casemix.data@chiamass.gov
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User Workgroup | CHIA User Support
This content provides information about the CHIA User Workgroup, including updates on data releases, support announcements, and available datasets for request. It outlines the process for requesting CY 2021 data, Case Mix FY21 release timelines, and website updates for APCD and Case Mix databases. Users can find details on how to access the data, submit requests, and stay informed on the status of data releases.
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CHIA USER WORKGROUP Don Kirkwood (Manager of Data Release and Procurement) Sylvia Hobbs (Associate Director of Data Strategy and User Support) Scott Curley (Manager Privacy & Compliance) January 24, 2023 CENTER FOR HEALTH INFORMATION AND ANALYSIS
Agenda Announcements: APCD Release CY 2021 Updates FY21 Case Mix Release Projections Website Updates User Support Questions Case Mix and MA APCD Comparison of Bariatric Surgery Case Mix and MA APCD Comparison of Arrival via Ambulance Case Mix and MA APCD Comparison of COVID-19 Diagnosis CDC WONDER addition of Massachusetts 2021 Death Data Q&A 2 User Workgroup | CHIA User Support
MA APCD CY 2021 Available for request Applicants with approved projects that require updated APCD data (CY 2021 Data) should submit to CHIA a completed Exhibit B (Certificate of Continued Need and Compliance) of the Data Use Agreement. After submitting a completed Exhibit B you will receive an invoice (if applicable) for the requested data. Upon payment of the invoice the order for the data will be placed. CY 2021 Data includes data on services from January 2017 December 2021 with six months of claim runout. 3 User Workgroup | CHIA User Support
Case Mix FY21 Release *CURRENT* RELEASE TIMEFRAMES FOR EACH FILE: Inpatient (HIDD) Available for request Emergency Department (ED) Available for request Outpatient Observation (OOD) Applicants with approved projects that require newly available year(s) of Case Mix Data (e.g., FY 19) should submit to CHIA a completed Exhibit B (Certificate of Continued Need and Compliance) of the Data Use Agreement. After submitting a completed Exhibit B you will receive an invoice (if applicable) for the requested data. Upon payment of the invoice the order for the data will be placed. Available for request 4 User Workgroup| CHIA User Support
Website Release Updates Updates on the production of APCD and Case Mix databases and status of data requests are now posted to CHIA s website! Aim #1 is to provide weekly or bi-weekly status update on CHIA data products as they are in development. Aim #2 is to provide applicants with information about expected fulfillment status for individual data requests. Request IDs will be communicated to Data Requestors via email. Please visit http://www.chiamass.gov/status-of-data-requests/ to see the current status of releases. User Workgroup| CHIA User Support 5
Question Question: CHIA previously gave a webinar on bariatric procedures in the MA : CHIA previously gave a webinar on bariatric procedures in the MA APCD. We are studying the volume of such procedures nationwide and would like APCD. We are studying the volume of such procedures nationwide and would like to determine the extent of procedures in the case mix data versus the MA APCD. to determine the extent of procedures in the case mix data versus the MA APCD. Types of Bariatric Procedures Answer: A wide variety of bariatric procedures coded as CPT codes are performed in outpatient observation stay but on a small volume of patients (see Table 1 below, asterisk for cell suppression of less than 11). During the pandemic, there was an increase in sleeve gastrectomy and unlisted laparoscopy stomach procedures which are newer bariatric interventions that do not yet have a code. Table 1. FY2016 through FY2021 Outpatient Observation Stay Bariatric Procedures Description Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device and subcutaneous port components Unlisted laparoscopy procedure, stomach 2016 2017 2018 2019 2020 2021 26 11 17 * 15 * * * * 11 17 13 Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy) Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (eg, gastric band and subcutaneous port components) Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less) Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device component only Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric restrictive device component only Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric restrictive device component only Gastric restrictive procedure, open; revision of subcutaneous port component only Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy Gastric restrictive procedure, open; removal of subcutaneous port component only * * * * * 16 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Gastric restrictive procedure, open; removal and replacement of subcutaneous port component only * * * * * * continued
Answer (continued): Even though the volume of bariatric procedures performed in observation stay is low, the volume of observation stays who have a history of bariatric surgery (ICD-10-CM Z98.84) increased by 28% from FY2019 to FY2020 (see Figure 1 below). The top ICD-10-PCS procedures performed on observation stay patients with a history of bariatric surgery are related to endoscopic inspections and repairs (See Table 1 below). Figure 1. FY2016 through FY2021 Volume of Observation Stays with a History of Bariatric Surgery Types of Bariatric Procedures 2021 2006 2020 2093 2019 1634 2018 1747 2017 1756 2016 1057 900 1075 1250 1425 1600 1775 1950 2125 2300 Table 1. Top 15 ICD-10 Procedures Performed on Observation Stays with a History of Bariatric Surgery Procedure Code 0DJ08ZZ 0FT44ZZ 0DTJ4ZZ 0DB68ZX 0JB80ZZ 0DB38ZX 0DB58ZX 0DJD8ZZ 0WQF4ZZ 0WUF0JZ 0J080ZZ 0WUF4JZ 0DB68ZZ 0DBA8ZX 0WJG4ZZ Description Inspection of Upper Intestinal Tract, Via Natural or Artificial Opening Endoscopic Resection of Gallbladder, Percutaneous Endoscopic Approach Resection of Appendix, Percutaneous Endoscopic Approach Excision of Stomach, Via Natural or Artificial Opening Endoscopic, Diagnostic Excision of Abdomen Subcutaneous Tissue and Fascia, Open Approach Excision of Lower Esophagus, Via Natural or Artificial Opening Endoscopic, Diagnostic Excision of Esophagus, Via Natural or Artificial Opening Endoscopic, Diagnostic Inspection of Lower Intestinal Tract, Via Natural or Artificial Opening Endoscopic Repair Abdominal Wall, Percutaneous Endoscopic Approach Supplement Abdominal Wall with Synthetic Substitute, Open Approach Alteration of Abdomen Subcutaneous Tissue and Fascia, Open Approach Supplement Abdominal Wall with Synthetic Substitute, Percutaneous Endoscopic Approach Excision of Stomach, Via Natural or Artificial Opening Endoscopic Excision of Jejunum, Via Natural or Artificial Opening Endoscopic, Diagnostic Inspection of Peritoneal Cavity, Percutaneous Endoscopic Approach continued
Answer (continued): In the case mix hospital inpatient discharge data from FY2018 through FY2021, the monthly volume of patients with a history of bariatric surgery has not widely varied except in April 2020 during the height of the pandemic (See Figure 1 below). Types of Bariatric Procedures Figure 1. FY2018 through FY2021 Monthly Volume of Inpatient Discharges with a History of Bariatric Surgery 1200 1000 800 600 400 200 0 201710 201711 201712 201801 201802 201803 201804 201805 201806 201807 201808 201809 201810 201811 201812 201901 201902 201903 201904 201905 201906 201907 201908 201909 201910 201911 201912 202001 202002 202003 202004 202005 202006 202007 202008 202009 202010 202011 202012 202101 202102 202103 202104 202105 202106 202107 202108 202109 Table 1. Top 10 ICD-10 Procedures Performed on Inpatient Discharges with a History of Bariatric Surgery Procedure Code 0DJ08ZZ 0D164ZA 0DB68ZX 0W3P8ZZ 0DB64Z3 0WUF0JZ 0BQT4ZZ 0D9670Z 0DJD8ZZ 0DBA8ZX Description Inspection of Upper Intestinal Tract, Via Natural or Artificial Opening Endoscopic Bypass Stomach to Jejunum, Percutaneous Endoscopic Approach Excision of Stomach, Via Natural or Artificial Opening Endoscopic, Diagnostic Control Bleeding in Gastrointestinal Tract, Via Natural or Artificial Opening Endoscopic Excision of Stomach, Percutaneous Endoscopic Approach, Vertical Supplement Abdominal Wall with Synthetic Substitute, Open Approach Repair Diaphragm, Percutaneous Endoscopic Approach Drainage of Stomach with Drainage Device, Via Natural or Artificial Opening Inspection of Lower Intestinal Tract, Via Natural or Artificial Opening Endoscopic Excision of Jejunum, Via Natural or Artificial Opening Endoscopic, Diagnostic continued
Answer (continued): In the MA APCD Release 10, even with the impact in the reduction of claims due to Gobeille vs. Liberty Mutual, a higher volume of bariatric procedures can be found in the medical claims data (See Table 1 below). However, more pronounced than in case mix, the onset on the pandemic resulted in a significant decrease in distinct Massachusetts residents seeking bariatric procedures. See Figure 1. Fig 1. MA APCD Distinct Bariatric Procedure Patients 6100 4600 3100 1600 100 2016 2017 2018 2019 2020 2021 Table 1. Bariatric Procedures in MA APCD Release 10 Medical Claims by Year Procedure Code Description 2016 2017 2018 2019 2020 2021 43775 Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy) Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less) Unlisted laparoscopy procedure, stomach 2926 2988 2925 1353 292 161 43644 43659 1029 290 870 335 787 369 371 158 89 60 47 29 Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device and subcutaneous port components Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device component only 43774 337 336 271 106 13 * 43645 25 43 34 10 11 * 43772 38 26 22 * * * Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (eg, gastric band and subcutaneous port components) 43770 41 18 13 * * * 43888 Gastric restrictive procedure, open; removal and replacement of subcutaneous port component only Revision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric restrictive device (separate procedure) 11 * * * * * 43848 * * * * * * Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric restrictive device component only 43846 * * 14 * * * 43771 12 * * * * * Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric restrictive device component only Gastric restrictive procedure, open; removal of subcutaneous port component only Gastric restrictive procedure, open; revision of subcutaneous port component only Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch) 43773 43887 43886 * * * * * * * * * * * * * * * * * * 43847 * * * * * * 43845 * * * * * *
Question Question: It is unclear to me what level of information on ambulance services I : It is unclear to me what level of information on ambulance services I can obtain from the case mix data versus the MA APCD. I see revenue codes for can obtain from the case mix data versus the MA APCD. I see revenue codes for ambulance services, but no additional information. ambulance services, but no additional information. Ambulance Billing Answer: Some hospitals, like Boston Children s Hospital, have their own ambulance services and you would see the billing for the ambulance service rolled into the inpatient patient revenue codes in the hospital inpatient discharge services file or as an HCPCS code in the outpatient emergency department services file. Ambulance services are separate outpatient care settings, have separate NPIs, and bill separately from the hospitals. The most detailed information on HCPCS/CPT procedures performed in ambulance, the transport distance, and billing can be found in the MA APCD. Those services can be found using the following taxonomy codes: Ambulance Service Taxonomy Codes 3416A0800X Air Transport 3416L0300X Land Transport 3416S0300X Water Transport Ambulance Service Revenue Codes Revenue Code 0549 0548 0547 0546 0545 0544 0543 0542 0541 0540 Description AMBULANCE - OTHER AMBULANCE AMBULANCE - EKG TRANSMISSION AMBULANCE - PHARMACY AMBULANCE - NEONATAL AMBULANCE SERVICES AMBULANCE - AIR AMBULANCE AMBULANCE - OXYGEN AMBULANCE - HEART MOBILE AMBULANCE - MEDICAL TRANSPORT AMBULANCE - SUPPLIES AMBULANCE - GENERAL CLASSIFICATION
CDC Wonder Updated to Include 2021 Death Data CDC Wonder Updated to Include 2021 Death Data
Where can I find past User Workgroup Presentations? http://www.chiamass.gov/ma-apcd-and-case-mix-user-workgroup- information/ 13 User Workgroup | CHIA User Support
When is the next User Group meeting? The next User Group will meet Tuesday February, 28. http://www.chiamass.gov/ma-apcd-and-case-mix-user-workgroup- information/
Resultant Research Using CHIA Data https://www.chiamass.gov/resultant-research-using-chia-data
Questions? Questions related to MA APCD: apcd.data@chiamass.gov Questions related to Case Mix: casemix.data@chiamass.gov REMINDER: Please include your IRBNet ID#, if you currently have a project using CHIA data. 16 User Workgroup | CHIA User Support
