PENNSYLVANIA AMBULATORY SURGERY DATA:

PENNSYLVANIA AMBULATORY SURGERY DATA: Data Notes 2016 2nd Quarter Pennsylvania Health Care Cost Containment Council December 2016 ay Status Report for

Pennsylvania Health Care Cost Containment Council Special Requests 225 Market Street, Suite 400 Harrisburg, PA 17101 Phone: (717) 232-6787 Fax: (717) 232-3821 Website: www.phc4.org E-mail: specialrequests@phc4.org

Table of Contents Introduction... 1 General Concepts... 2 Section I: Issues Affecting the Data Statewide... 3 Facility Specific... 5 Section II: Facility Profile Changes Profile Changes... 9 Section III: Field Descriptions Ambulatory Surgery Data... 10 Supplemental Procedure File Data... 15 Facility Profile Data... 15 Physician Profile Data... 16 Appendix 1: Procedures Collected... 17 Appendix 2: Pennsylvania Regions... 18 Appendix 3: Pennsylvania County Codes... 20 Appendix 4: State Code... 21 Appendix 5: Type of Bill... 22 Ambulatory Surgery Data: 2016 Second Quarter Data Notes Table of Contents December 2016

Introduction This document is intended to provide general information regarding the contents of the 2016 Second Quarter non-confidential outpatient and freestanding ambulatory surgery center data (referred to in this document as Ambulatory Surgery Data ). It includes information regarding field definitions, relevant facility information, and specific issues that affect the data. The first section, Issues Affecting the Data, describes circumstances that you should be aware of before analyzing the data provided. The second section, Facility Profile Changes, lists Pennsylvania facilities that merged, closed, opened, or had name changes in this quarter. The third section, Field Descriptions, contains a brief description of each field, and, where applicable, a list of the valid entries for the field. All fields in the non-confidential ambulatory surgery data are included in this section whether provided by the facilities or assigned by Pennsylvania Health Care Cost Containment Council (PHC4). Some fields collected from the facilities and used in analysis are not included in this file to protect patient confidentiality. Admit, discharge, and procedure dates, as well as other fields are used to calculate or assign information such as length of stay or procedure day of week, but are not included in this file. The PHC4 collects statewide inpatient discharge data as well as ambulatory surgery data. Every reasonable effort has been made to ensure the accuracy of the information obtained from the Uniform Claims and Billing Form (UB-04) data elements. For a few data elements, the interpretation of the definition may vary among facilities. PHC4 s Data Collection Edits and Validation Edits provide an opportunity for data sources to correct financial, patient, and physician specific errors that may have occurred prior to, during or after submission of data. The ultimate responsibility for data accuracy lies with individual providers. The PHC4, agents and staff make no representation, guarantee, or warranty, expressed or implied that the data including financial, hospital-supplied payor, patient, and physician specific information is error-free, or that the use of this data will prevent differences of opinion or disputes with those who use published reports or purchase data. The PHC4 will bear no responsibility or liability for the results or consequences of its use. Ambulatory Surgery Data: 2016 Second Quarter Data Notes 1 Introduction December 2016

General Concepts Pennsylvania facilities that perform outpatient or ambulatory care services submit a data record for each claim that includes a procedure listed in Appendix 1 to the PHC4 on a quarterly basis. To minimize the data collection burden on the facilities, the majority of the data provided is based on the Uniform Billing (UB) standards. Facilities generally extract the encounter data from their billing systems. Facilities submit UB data for all outpatient claims in a quarter to PHC4 via its secure Webbased data upload process. Facilities with overall error rates at or below 15% are provided with reports listing any data that were identified as invalid, and asked to make corrections. Facilities that have over 15% of their records in error are asked to correct and resubmit their data. After a corrections phase to allow the facilities to make these changes, the database is closed to any further changes and it is made available for purchase. Ambulatory Surgery Data: 2016 Second Quarter Data Notes 2 General Concepts December 2016

SECTION I ISSUES AFFECTING THE DATA Statewide Procedures Collected. PHC4 collects outpatient and ambulatory surgery claims with procedures coded as HCPCS Level I CPT-4 and HCPCS Level II codes in the HCPCSRAT code position (included in the supplemental procedure file). Not all claims are collected: only claims with HCPCS Level I CPT-4 codes listed in Appendix 1 or any HCPCS Level II codes are submitted to PHC4. If a facility submits a claim that was not needed, then the facility is notified and asked to remove the claim from their submission. PHC4 does not purge these claims. A few claims, therefore, may be present even though they do not have a HCPCS procedure code that is in the list of relevant codes. Series Billing. The PHC4 data collection file format is modeled after the uniform billing format, which is used by Centers for Medicare and Medicaid Services (CMS) and other health care payers for claims submission. When a patient receives several treatments requiring several visits to an outpatient care unit or ambulatory surgery facility, series billing is sometimes used by facilities to simplify the claim submission process. In these instances, rather than submit one record for each visit of a patient, the facility rolls up several visits into one submission record. Thus, if data users wish to know the number of outpatient or ambulatory visits associated with a type of procedure, it would not be sufficient to simply count the number of records. Records coded with the series billing standard represent more than one visit. The Procedure Days After Services Began field (in the supplemental procedure file) will allow data users to identify most records with series billing, and adjust accordingly. Data to Identify Payers. Facilities generally provide information on the expected payer at the time the care is delivered, and this data is not validated for accuracy by any payers. Furthermore, all Uninsured data consists of Self-Pay as well as Charity/Indigent Care. Therefore, those individuals who are unable to pay cannot be distinguished from those who choose not to pay for insurance coverage. Procedure Modifiers. The HCPCS Level I CPT-4 coding system provides for procedure modifiers in addition to the procedure codes, to indicate discounted procedures, terminated procedures, locations of the procedures, and other things. The HCPCSRAT field in the supplemental procedure file consists of 5 characters for the base code plus 8 characters for up to four HCPCS modifiers, plus 1 extra/unused position. Ambulatory / Inpatient Crossover. Billing for ambulatory surgery care that is followed up with an inpatient stay may or may not be included in this file depending on the payer class. Medicare, for instance, requires that if a patient has a diagnostic or other medical procedure in an outpatient or ambulatory surgery setting and is then admitted as an inpatient within 72 hours, then the bill for both ambulatory surgery and inpatient services must be bundled together and submitted as one inpatient record. Thus this combined record should appear in PHC4 s inpatient data. Other payers may or may not have similar requirements. Ambulatory Surgery Data: 2016 Second Quarter Data Notes 3 Issues Affecting the Data December 2016

Pseudo Patient Identifier. As explained in the field definitions section of this document, this pseudo patient identifier is based upon patient identification fields submitted by the facility, and is intended to be used as a unique patient identifier to match readmissions or transfers. Under rare circumstances the Pseudo Patient Identifier may be identical for two patients who are not the same. Historically in a given quarter of ambulatory surgery data, about one percent of all pairs of matching Pseudo Patient Identifiers represent records that do not have the same values of patient identification fields as submitted by the facilities. We advise you to use caution, then, when basing conclusions on analysis using this field. We hope to be able to revise our methods of assigning the Pseudo Patient Identifier in the future so that it is truly unique for a given set of patient identification fields as submitted by the facilities. Grace Period for New Facilities. New facilities are provided with a grace period after their creation. This grace period lasts two full quarters following the quarter in which they were created, during which time they are able to establish and implement systems in order to submit data to PHC4. During this time these facilities do not appear in the facility profiles. Once the grace period expires, the facilities begin submitting data to PHC4 and will appear in the facility profiles Ambulatory Surgery Data: 2016 Second Quarter Data Notes 4 Issues Affecting the Data December 2016

Facility Specific: Facilities that did not send UB data. The following facilities did not submit any data in the timeframes for this quarter. Their records, therefore, do not appear in the non-confidential files. PAF Facility Name Discharges 9335 Delaware Valley Orthopedic and Spine SurgiCenter Unknown 9153 Einstein Medical Center Montgomery Short Procedure Unit Unknown 9054 Endoscopy Center at St. Mary, The Unknown 9865 Foot and Ankle Surgical Center, LLC Unknown 9009 Rhawn Street Endoscopy Center Unknown 9074 Ridley Crossing Surgical Center Unknown 9052 Valley Ambulatory Surgical Center Unknown 9086 Williamsport Surgery Center Unknown Facilities with Error Rates >15%. The following facilities have error rates greater than 15% in the following fields: Uniform Patient ID/SSN Invalid PAF Facility Name % in Error 9157 Alfred I. dupont Hospital for Children Surgery Center, Bryn Mawr, The 52.61% 9173 Allegheny Health Network Surgery Center-Bethel Park, LLC 31.17% 9024 Allegheny Regional Endoscopy Center 94.20% 9795 Ambulatory Endoscopic Surgical Center of Bucks County 66.73% 9850 Ambulatory Surgery Center at Bucks County 42.82% 9117 American Access Care of Pennsylvania 25.38% 9151 American Access Care of South Philadelphia, LLC 19.38% 9085 Angelina Theresa Bucci Eye Surgery Center, Inc. 16.38% 9038 Berks Ambulatory Surgery Center, LLC 100.00% 9235 Berkshire Eye Surgery Center 53.33% 9047 Brookpark Surgery Center, LLC 19.05% 9495 Bryn Mawr Medical Specialists 28.98% 9665 Carbon-Schuylkill Endoscopy Center, Inc. 25.34% 9895 Center for the Surgical Arts, LLC 100.00% 1880 Children's Hospital of Philadelphia 45.24% 9920 Children's Hospital of Philadelphia Brandywine Valley Specialty Care 40.60% and Surgery Center, The 9172 Children's Hospital of Philadelphia King of Prussia Specialty Care and 40.95% Ambulatory Surgery Center 9142 Children's Surgery Center of Malvern, LLC 82.51% 9127 Children's Surgery Center, LLC/Lancaster 90.90% 9580 CHP North Surgery Center 17.58% 9375 College Heights Endoscopy Center, LLC 22.74% 3115 Coordinated Health Orthopedic Hospital, LLC 24.04% 9970 Cumberland Surgery Center 17.50% 9250 Delaware Valley Laser Surgery Institute 32.36% 9136 East Stroudsburg Ambulatory Surgery Center 28.29% 9048 Endoscopy Center of Bucks County, LP 48.52% 9845 Endoscopy Center of Central Pennsylvania LLC 37.56% 9725 Endoscopy Center, LLC, The 38.77% 9110 Eye Surgery Center, The 77.32% 9835 Eynon Surgery Center, LLC 58.07% 9610 Gastrointestinal Specialists 59.11% Ambulatory Surgery Data: 2016 Second Quarter Data Notes 5 Issues Affecting the Data December 2016

Uniform Patient ID/SSN Invalid (continued) PAF Facility Name % in Error 9057 Gateway Surgery Center, LLC 78.64% 9039 Grand View Hospital Endoscopy Center @ Harleysville 15.19% 9130 Grandview Surgery & Laser Center 79.61% 9128 Grant SurgiCenter LLC 18.22% 9535 Hershey Endoscopy Center, LLC 99.61% 9124 Hillside Endoscopy Center, LLC 62.83% 9710 Holy Redeemer Health System ASC 28.74% 9119 Jefferson Surgical Center at the Navy Yard 31.01% 9585 Keystone Kidney Center 90.48% 9023 Kole Plastic Surgery Center 100.00% 9078 Langhorne Surgical Center 45.22% 9705 Leo R. McCafferty, MD, Plastic Surgery 80.00% 9255 Lewisburg Plastic Surgery and Laser Center 24.35% 9156 Main Line Fertility Center 15.46% 9370 Memorial Hospital Outpatient Surgery Center 29.26% 9042 Mountain Laurel Surgery Center 42.04% 9355 North Shore Endoscopy Center, LLC 20.97% 9655 Northeast Regional Surgery Center, LLC 81.72% 9017 OSS Ambulatory Surgery Center 21.25% 9171 Pain Center of Wyoming Valley, LLC 100.00% 9230 Paoli Surgery Center 42.40% 9139 Peters Township Surgery Center, LLC 58.20% 9755 Philadelphia Institute of Cosmetic Surgery 19.77% 9154 Philadelphia Surgery Center 100.00% 9144 Premier Surgery Center of Pittsburgh 60.26% 9004 Radiance - A Private Outpatient Surgery Center 38.25% 9063 Red Lion Surgicenter 42.71% 9123 Riddle Surgical Center, LLC 21.93% 9775 Schuylkill Endoscopy Center 41.33% 9840 Scranton Endoscopy Center 39.57% 9143 Shriners Hospital for Children-Erie Ambulatory Surgery Center 28.38% 3380 Shriners Hospitals for Children/Philadelphia 25.51% 9141 Skin Center, The 100.00% 9470 South Hills Endoscopy Center 30.16% 9138 South Hills Surgery Center, LLC 56.56% 9330 Southwestern Ambulatory Surgery Center, LLC 37.92% 4910 St. Christopher's Hospital for Children 35.90% 9089 State Hill SurgiCenter LLC 16.76% 9965 Surgery Center of Lancaster 41.47% 9975 Surgery Center of Lebanon, LP 20.51% 9068 Surgery Center of the Main Line, The 26.56% 4075 Surgical Specialty Center at Coordinated Health 24.45% 9018 Valley Eye Surgical Center 82.60% 9555 Valley Forge Surgical Center, LP 17.46% 9037 Valley Surgical Center, Inc. 58.38% 9158 Vincera Surgery Center, LLC 68.96% 9008 West Chester Endoscopy Center 17.35% 9035 Western PA Surgery Center 48.07% 9168 Wexford Surgery Center 17.94% 3450 Wills Eye Hospital 44.37% 9500 Wills Eye Surgery Center of Plymouth Meeting 57.94% 9410 Wills Surgery Center of Bucks County 36.64% 9780 Wills Surgery Center of Philadelphia Stadium Campus 34.36% 9060 Wills Surgery Center of the Northeast 50.99% Ambulatory Surgery Data: 2016 Second Quarter Data Notes 6 Issues Affecting the Data December 2016

Primary Payer Type and Primary Health Plan ID Number Mismatch PAF Facility Name % in Error 9138 South Hills Surgery Center, LLC 58.60% Blank Health Plan ID PAF Facility Name % in Error 9024 Allegheny Regional Endoscopy Center 16.83% 9970 Cumberland Surgery Center 35.00% 9365 Endoscopy Center of Pennsylvania Hospital 20.09% 1010 Robert Packer Hospital 17.09% 9980 Robert Packer Hospital Endoscopy Center 18.33% 9007 Tri-County Eye Surgery & Laser Center 16.56% 9700 Valley View Surgical Center 17.34% 9168 Wexford Surgery Center 18.74% Primary Payer Type Invalid PAF Facility Name % in Error 9138 South Hills Surgery Center, LLC 44.57% ECI Code Invalid PAF Facility Name % in Error 9660 Philadelphia Surgical Center 16.11% Duplicate Diagnosis Codes PAF Facility Name % in Error 9078 Langhorne Surgical Center 18.15% Principal Diagnosis Invalid PAF Facility Name % in Error 9085 Angelina Theresa Bucci Eye Surgery Center, Inc. 17.66% 9023 Kole Plastic Surgery Center 48.39% Change in Volume of Claims: PAF9515, Brandywine Surgery Center, submitted a partial submission of one record because of a miscommunication of personnel. PAF9057, Gateway Surgery Center, LLC, experienced an increase in records because a new physician was added to the staff. PAF9147, Geisinger Medical Center-Center for Aesthetics and Cosmetic Surgery- Woodbine, experienced a decrease in records because the primary physician left the practice. PAF4500, Jersey Shore Hospital, experienced a decrease in records because a surgeon left the facility. PAF9118, Laser Spine Surgery Center of Pennsylvania, LLC, experienced a decrease in records because they distributed patients throughout their centers to ensure maximum capacity. PAF9139, Peters Township Surgery Center, LLC, experienced an increase in records because a physician was added to the staff. PAF9685, Progressive Laser Surgical Institute, experienced an increase in records because of normal increase in census. Ambulatory Surgery Data: 2016 Second Quarter Data Notes 7 Issues Affecting the Data December 2016

PAF3410, St. Luke's Hospital - Anderson Campus, experienced a decrease in records because of a decrease in census. PAF4920, St. Luke's Hospital Bethlehem, experienced an increase in records because previous data submissions had patient visits grouped into one series encounter claim record per month, whereas now, patient visits are billed for each individual encounter on the actual date of service. PAF2360, St. Luke's Miners Memorial Medical Center, experienced an increase in records because previous data submissions had patient visits grouped into one series encounter claim record per month, whereas now, patient visits are billed for each individual encounter on the actual date of service. PAF4890, St. Luke's Quakertown Hospital, experienced an increase in records because previous data submissions had patient visits grouped into one series encounter claim record per month, whereas now, patient visits are billed for each individual encounter on the actual date of service. PAF9135, Surgical Specialty Center of Northeastern PA, LLC, experienced an increase in records because on March 2016, the facility acquired PAF9100, Kingston Ophthalmology ASC, LLC, The. PAF2460, Uniontown Hospital, experienced an increase in records because of under reporting in previous quarters. PAF9158, Vincera Surgery Center, LLC, experienced an increase in records because the facility recently achieved in network status with several insurance companies. PAF2510, Warren General Hospital, experienced a decrease in records because of normal decrease in claims. Ambulatory Surgery Data: 2016 Second Quarter Data Notes 8 Issues Affecting the Data December 2016

Section II FACILITY PROFILE CHANGES Name Changes: PAF9077, North Pointe Surgery Center/Lancaster, was North Pointe Surgery Center, effective April 2016. PAF9145, Reading Surgery Center of the Surgical Institute of Reading, LLC, was Reading Ambulatory Surgery Center, LP, effective April 2016. PAF0640, UPMC Jameson, was Jameson Memorial Hospital, effective May 2016. New Facilities: PAF9173, Allegheny Health Network Surgery Center-Bethel Park, LLC, opened on July 2015. PAF9172, Children's Hospital of Philadelphia King of Prussia Specialty Care and Ambulatory Surgery Center, opened on June 2015. PAF9171, Pain Center of Wyoming Valley, LLC, opened May 2015. Closed Facility: PAF2040, Saint Joseph s Hospital/Philadelphia, closed effective March 2016. Merged Facility: PAF9100, Kingston Ophthalmology ASC, LLC, The, merged into PAF9135, Surgical Specialty Center of Northeastern PA, LLC, effective March 2016. Ambulatory Surgery Data: 2016 Second Quarter Data Notes 9 Facility Profile Changes December 2016

Section III FIELD DESCRIPTIONS This section explains the definitions of the fields for the ambulatory surgery data, supplemental procedure data, facility profiles, and physician profiles. Ambulatory Surgery Data The contents of these fields are either submitted by the facilities or assigned by PHC4 based upon other fields submitted by the facilities. Many of the fields have a limited number of valid values; when this is true, a table of valid values appears after the field description. Please note: values that do not appear in this table should not be considered valid for the field. Council staff provides assistance and feedback to the facilities to provide them with the opportunity to edit and correct the contents of the fields submitted. The ultimate responsibility of the accuracy of the field contents rests with the facilities. We can only assure that the information contained in the fields provided accurately reflects the facilities final submissions. Record Identification System-assigned unique record sequence number. This is a unique identifier for each record in a given quarter. It is assigned by PHC4 during file processing. Processing Year. This is a four-digit year indicator for the record. It tells the year of the ambulatory visit for the patient. When multiple years are combined, this may be used to distinguish records. This field is based upon the data submission, not calculated from the through (discharge) date. Processing Quarter. This is a single digit quarter indicator for the record. It tells the quarter of the ambulatory visit for the patient. When multiple quarters of a single year are combined, this may be used to distinguish records. This field is based upon the data submission, not calculated from the through (discharge) date. Data Type. This field is set to O for all of the ambulatory surgery data. When this data is combined with inpatient data, then this field may be used to distinguish records. Facility Identification Pennsylvania Facility Number (PAF). This is the PHC4 assigned facility identification number for the facility submitting the record. This field may be used to link to facility profile information. Facility Region Code. PHC4 divides the state into nine separate regions for the purposes of reporting. This code indicates the region to which PHC4 has assigned the facility for these purposes. Appendix 2 contains a list and map of the facility regions by county. Patient Data Patient Sex. This is the character code for patient sex as submitted by the facility. Value M F U Description Male Female Unknown Ambulatory Surgery Data: 2016 Second Quarter Data Notes 10 Field Descriptions December 2016

Patient Hispanic/Latino Origin or Descent. This is the code for a patient s ethnic descent as submitted by the facility. An admission clerk often collects this field and its reliability varies among the facilities. Value Description 1 Patient is of Hispanic/Latino origin or descent 2 Patient is not of Hispanic/Latino origin or descent Patient Race Code. This is the character code for patient race as submitted by the facility. Like the previous field, an admission clerk often collects race and its reliability varies among the facilities. Value W B A I P M N U Description White Alone Black Alone Asian Alone American Indian and Alaskan Native Alone Native Hawaiian or Pacific Islander Two or More Race Groups Other Unknown Pseudo Patient Identifier. This is the unique patient identifier created by PHC4. To create this field, PHC4 applies an encryption technique to specific patient identification fields as submitted by the facilities. (If any one of these fields is blank or invalid, then the Pseudo Patient Identifier will be blank.) The Pseudo Patient Identifier is only as reliable as the combination of these identification fields. The Pseudo Patient Identifier is intended to be used to match patients across hospitalizations or to analyze patient readmission or transfer patterns. Patient Age in Years. This is the age of the patient in years. This field is calculated from the date of birth and the from date (date services began) as submitted by the facility. If the patient is less than one year old, the age in years is 0. If the patient s age is unknown due to missing information in either the date of birth or the from date (date services began) fields, the age is blank. Patient Age in Days. This is a code to indicate the age of the patient in days. This field is only calculated for patients less than one year old. Again, the date of birth and the from date (date services began) as submitted by the facility are used for the calculation. Value Description (blank) Age unknown or > 1 year 1 0-28 days 2 29-59 days 3 60-90 days 4 91-121 days 5 122-152 days 6 153-183 days 7 184-214 days 8 215-245 days 9 246-276 days 10 277-307 days 11 308-338 days 12 339-366 days Patient Zip Code. This is the first five digits of the home zip code of the patient as submitted by the facilities. Furthermore, the following special cases have specific entries to describe them: Value OUTCU HOMEL UNKNO Description Patient s home is outside of the country. Patient is homeless and has no zip code. Patient s zip code is unknown. Ambulatory Surgery Data: 2016 Second Quarter Data Notes 11 Field Descriptions December 2016

Patient Home County Code. This is the Pennsylvania county code for the county in which the patient resides. This field is assigned by PHC4 based upon the patient zip code as submitted by the facility in combination with an updated zip code table provided by the United States Postal Service. A number of the Pennsylvania zip codes cross county lines; in these instances, PHC4 assigns the zip code to a single county. If the patient resides in Pennsylvania, the Pennsylvania county code is used. If the patient resides outside of the state, then the federal county code is used. Appendix 3 lists the Pennsylvania county codes. Please note that federal county codes are not unique among states; different counties in different states can have the same federal county code. Furthermore, the federal county codes are not uniquely different than the Pennsylvania county code. Patient State Code. This is the two character United States Postal Service standard state code for the patient s state of residence. This field is assigned by PHC4 based upon the patient zip code as submitted by the facility. Appendix 4 contains a list of the state codes. Accident State. This is the two-digit state abbreviation where the auto accident occurred and is required when the services reported on the claim are related to the accident. Appendix 4 contains a list of the state codes. Admission Data Point of Origin for Admission or Visit. This is the code indicating the source of the admission (visit) as submitted by the facility. Please note that some values have different meanings depending upon the type of admission. Value Description 1 Non-Health Care Facility Point of Origin 2 Clinic or Physician s Office 4 Transfer from a Hospital 5 Transfer from a Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF) or Assisted Living Facility (ALF) 6 Transfer from another Health Care Facility 8 Court/Law Enforcement D Transfer from One Distinct Unit of the Hospital to another Distinct Unit of the Same Hospital Resulting in a Separate Claim to the Payer E Transfer from Ambulatory Surgery Center F Transfer from Hospice Facility Discharge Data Discharge Day of the Week. This is the code for the day of the week on which the end of services took place. This field is assigned by PHC4 based upon the end of services/through (discharge) date. Value Description 1 Sunday 2 Monday 3 Tuesday 4 Wednesday 5 Thursday 6 Friday 7 Saturday Ambulatory Surgery Data: 2016 Second Quarter Data Notes 12 Field Descriptions December 2016

Diagnosis Codes PHC4 accepts three external cause of injury codes (E-code), principal diagnosis code, and up to seventeen (17) secondary diagnosis codes. External Cause of Injury Code (E-Code) 1-3. This is the ICD.10.CM code that indicates an external cause of injury, poisoning or adverse effect as supplied by the facility. Principal Diagnosis Code. This is the ICD.10.CM diagnosis code assigned at discharge as the reason for the treatment as submitted by the facility. Other Diagnosis Codes 1-17. These are additional ICD.10.CM diagnosis codes assigned to describe additional conditions that coexist at admission or are discovered during the services as submitted by the facility. Physician Data The National Provider Identifier (NPI) and Pennsylvania state license numbers for each of the referring and operating physicians are to be supplied by the facility. PHC4 validated the operating submitted NPI numbers with the Centers for Medicare and Medicaid Services (CMS). PHC4 did not validate the Pennsylvania state license numbers. Please note: a number may be a valid NPI number without being the correct NPI. The NPI numbers are intended to be used with the accompanying physician profiles. Operating Physician. The identification number (NPI and state license numbers) of the individual with the primary responsibility for performing the surgical procedure(s). Other Provider Provider Type Qualifier (1-2). This is the code to identify whether the associated other physician (Other Provider Secondary Identifier) is a referring physician, another operating physician, or rendering physician. Value Description DN Referring Physician. The provider who sends the patient to another provider for services. ZZ Other Operating Physician. An individual performing a secondary surgical procedure or assisting the Operating Physician. 82 Rendering Provider. The health care professional who delivers or completes a particular medical service or non-surgical procedure. Other Provider Secondary Identifier (1-2). This is the identification number (NPI and state license numbers) of the other provider/physician as submitted by the facility. Payer Identification Primary Payer. This is a two digit code that identifies the primary payer type as submitted by the facility. The first digit describes the general payer class. The second digit generally describes the different types of insurance coverage (products). The table of valid values appears below. Description Type of Payer Type of Product Value First Digit Second Digit 00 Uninsured Self-Pay or Charity/Indigent Care 12 Medicare PPO 13 Medicare POS 14 Medicare Part A or B Fee for Service 15 Medicare HMO 22 Medicaid PPO Ambulatory Surgery Data: 2016 Second Quarter Data Notes 13 Field Descriptions December 2016

Description Type of Payer Type of Product Value First Digit Second Digit 24 Medicaid Fee for Service 25 Medicaid HMO 32 Blue Cross PPO 33 Blue Cross POS 34 Blue Cross Fee for Service 35 Blue Cross HMO 39 Blue Cross Unknown / Not Listed 42 Commercial PPO 43 Commercial POS 44 Commercial Fee for Service 45 Commercial HMO 47 Commercial Workers Compensation 48 Commercial Automobile 49 Commercial Unknown / Not Listed 82 Government PPO 84 Government Fee for Service 85 Government HMO 89 Government Unknown / Not Listed 99 Unknown / Not Listed Unknown / Not Listed Secondary Payer. This is a two digit code that identifies the secondary payer type as submitted by the facility. The valid values for this field are the same as for the primary payer. Tertiary Payer. This is a two digit code that identifies the tertiary (third stage) payer type as submitted by the facility. The valid values for this field are the same as for the primary payer. Payer ID/Health Plan ID. This is the National Association of Insurance Commissioners assigned identification number for the primary payer as submitted by the facility. PHC4 assigns the following values to these miscellaneous payers that are not assigned an NAIC code. Value Description 1111111 Self-Pay or Charity/Indigent Care 1000000 Out-of-State Blue Cross 2222222 Behavioral Health Coverage 3333333 Automobile Insurance 4444444 Workers Compensation 5555555 State Owned Psychiatric 6666666 Federal /State/County funded programs except Medicaid and Medicare 7777777 Third Party Administrators 8888888 Medicaid Fee for Service 9999999 Medicare Fee for Service Additional Data Elements Type of Bill. This is a code to indicate the type of bill as submitted by the facility. Appendix 5 contains an explanation of the meaning for each digit in the type of bill. Summary Charges Summary charges are the sum of charges submitted by the facility (as defined by the revenue codes) for each category. Room & Board Charges. This is the sum of the charges as defined by revenue codes submitted by the facility that relate to room and board. Ambulatory Surgery Data: 2016 Second Quarter Data Notes 14 Field Descriptions December 2016

Ancillary Charges. This is the sum of the charges as defined by revenue codes submitted by the facility that relate to ancillary services. Drug Charges. This is the sum of the charges as defined by revenue codes submitted by the facility that relate to the pharmacy (drugs). Equipment Charges. This is the sum of the charges as defined by revenue codes submitted by the facility that relate to medical equipment and supplies. Specialty Charges. This is the sum of the charges as defined by revenue codes submitted by the facility that relate to special care units. Miscellaneous Charges. This is the sum of the charges as defined by revenue codes submitted by the facility that are not contained in any of the above groups. Total of Charges. This is the sum of Room & Board, Ancillary, Drug, Equipment, Specialty, and Miscellaneous charges. Non-covered Charges. This is the sum of all charges that are not covered by the payer as submitted by the facility. Professional Fees. This is the sum of the charges as defined by revenue codes submitted by the facility that relate to professional services. Supplemental Procedure File Data (SPF) To accommodate the UB04 format, we are supplying the procedure data as a supplemental file. Procedure Data Healthcare Common Procedure Coding System (HCPCSRAT) Codes. (Level I CPT-4 and Level II) These are the procedure codes to indicate the procedure(s) performed on the patient during the ambulatory surgery services/visit as submitted by the facility. Procedure Day of the Week. This is the day of the week on which the services were provided. This field is assigned based upon the service date as submitted by the facility. Valid values are the same as for discharge day of the week. Procedure Days After Services Began. This represents the difference in the number of days between the from date (date services began) and the corresponding procedure (service) date. This will allow for the identification of series bills, as well as identifying which procedures took place on subsequent visits. As is true for the procedure day of week, there are rare instances in which the true procedure day of the week is ambiguous due to uncertainty in the year associated with the procedure month and day. This can occur if the record represents a series billing that is greater than one year in duration. Facility Profile Data The facility profiles contain facilities that provide inpatient and/or outpatient services. Each record in the facility profile represents a data provider that submits inpatient and/or outpatient records. State Psychiatric hospitals are not included in this file. Pennsylvania Facility Number (PAF). This is the PHC4 assigned facility identification number for the facility. This field may be used to link to the ambulatory surgery data. Ambulatory Surgery Data: 2016 Second Quarter Data Notes 15 Field Descriptions December 2016

Facility Name. This is the facility name in the submission quarter as it appeared on their license with the Department of Health (with few exceptions). The name of the facility may have changed since the quarter of submission. Facility Type. This code describes the type of facility. Value Description 001 Specialty General Acute Care Hospital 002 Long-Term Acute Care Hospital 005 Psychiatric Hospital 006 Rehabilitation Hospital 007 Ambulatory Surgery Center 008 Specialty Hospital 011 General Acute Care Hospital Facility Bed Count. This is the number of licensed beds at the facility as reported by the facility on the Department of Health license. This number does not include bassinets and skilled nursing beds. Facility Region Code. PHC4 assigns geographical regions to the state for the purposes of reporting. This code identifies the region in which the facility is located. Appendix 2 contains a list and map of the facility regions by county. Facility Zip Code. This is the zip code for the facility. Facility County Code. This is the Pennsylvania county code for the county of the facility as submitted by the facility. Appendix 3 lists the Pennsylvania County Codes. National Provider Identifier. This is the unique identification number assigned to the provider submitting the bill. The National Provider Identifier (NPI) number is assigned to the facility by the Centers for Medicare and Medicaid Services. Inpatient Discharges. When applicable, this is the total number of inpatient discharges for the quarter for the facility, which applies only to hospitals. Outpatient Cases. When applicable, this is the total number of outpatient cases for the quarter for the facility. Physician Profile Data Each record in the physician profile represents a unique physician National Provider Identifier (NPI) number used in the ambulatory/outpatient data. Physician License Number. This is the NPI number as submitted by the facilities. Physician Name. This is the name of the physician when recorded by Centers for Medicare and Medicaid Services (CMS). Otherwise, it is the name submitted by the facilities and is identified that there was no match to the CMS file. Match Indicator. This is a field provided to indicate if the physician NPI number from the ambulatory/outpatient database is recorded by the CMS. Ambulatory Surgery Data: 2016 Second Quarter Data Notes 16 Field Descriptions December 2016

Appendix 1 The Specified Procedures and Coding Guidelines: Claim records that meet all three criterions are included in the quarterly Ambulatory/Outpatient procedure submission files: The Statement Cover Period Through Date is in the submission quarter. At least one HCPCS Level I CPT-4 code is within the specified code ranges (see list below) or any HCPCS Level II code is used. The Ambulatory/Outpatient procedure was performed in any of the following locations within a hospital facility or freestanding ambulatory surgery center: general operating room, ambulatory surgery room, short-term procedure unit, endoscopy or GI lab/unit, cardiac catheterization laboratory, radiology department, outpatient oncology unit, or similar locations. The names of the locations/units listed are intended to be used as general terms. Location names may differ from facility to facility. Emergency room claim records should not be submitted. HCPCS Level I CPT-4 Code Ranges: Surgery / Endoscopy: All codes within the range of 10021-69990 Chemotherapy: All codes within the range of 96401-96549 Cardiovascular: Cardiac catheterization codes within the range of 93451-93583 Cardiovascular therapeutic codes within the range of 92920 92998 HCPCS Level II Code Ranges: All codes Ambulatory Surgery Data: 2016 Second Quarter Data Notes 17 Appendix 1 Procedures Collected December 2016

Appendix 2 Pennsylvania Regions Region 1 Counties Allegheny Armstrong Beaver Butler Fayette Greene Washington Westmoreland Region 2 Counties Cameron Clarion Clearfield Crawford Elk Erie Forest Jefferson Lawrence McKean Mercer Potter Venango Warren Region 3 Counties Bedford Blair Cambria Indiana Somerset Region 4 Counties Centre Clinton Columbia Lycoming Mifflin Montour Northumberland Snyder Tioga Union Region 5 Counties Adams Cumberland Dauphin Franklin Fulton Huntingdon Juniata Lancaster Lebanon Perry York Region 6 Counties Bradford Lackawanna Luzerne Monroe Pike Sullivan Susquehanna Wayne Wyoming Region 7 Counties Berks Carbon Lehigh Northampton Schuylkill Region 8 Counties Bucks Chester Delaware Montgomery Region 9 County Philadelphia Ambulatory Surgery Data: 2016 Second Quarter Data Notes 18 Appendix 2 Pennsylvania Regions December 2016

Mercer Lawrence Beaver Crawford Allegheny Washington Greene Erie Butler Venango REGION 1 Fayette REGION 2 Clarion Armstrong Warren Forest Westmoreland Jefferson Indiana Somerset Cambria McKean Elk Clearfield REGION 3 Bedford Cameron Blair Fulton Potter Centre Huntingdon Clinton Mifflin Franklin Tioga REGION 4 Juniata Perry Lycoming Snyder Cumberland REGION 5 Adams Union Montour Dauphin Bradford Sullivan Columbia Northumberland York Lebanon REGION 6 Luzerne Schuylkill Lackawanna REGION 7 Lancaster Susquehanna Wyoming Berks Carbon Lehigh Monroe Northampton REGION 8 Pike Bucks Montgomery Chester Delaware Wayne Philadelphia REGION 9 Ambulatory Surgery Data: 2016 Second Quarter Data Notes 19 Appendix 2 Pennsylvania Regions December 2016

Appendix 3 Pennsylvania County Codes Code County Region 001 Adams 5 002 Allegheny 1 003 Armstrong 1 004 Beaver 1 005 Bedford 3 006 Berks 7 007 Blair 3 008 Bradford 6 009 Bucks 8 010 Butler 1 011 Cambria 3 012 Cameron 2 013 Carbon 7 014 Centre 4 015 Chester 8 016 Clarion 2 017 Clearfield 2 018 Clinton 4 019 Columbia 4 020 Crawford 2 021 Cumberland 5 022 Dauphin 5 023 Delaware 8 024 Elk 2 025 Erie 2 026 Fayette 1 027 Forest 2 028 Franklin 5 029 Fulton 5 030 Greene 1 031 Huntingdon 5 032 Indiana 3 033 Jefferson 2 034 Juniata 5 035 Lackawanna 6 Code County Region 036 Lancaster 5 037 Lawrence 2 038 Lebanon 5 039 Lehigh 7 040 Luzerne 6 041 Lycoming 4 042 McKean 2 043 Mercer 2 044 Mifflin 4 045 Monroe 6 046 Montgomery 8 047 Montour 4 048 Northampton 7 049 Northumberland 4 050 Perry 5 051 Philadelphia 9 052 Pike 6 053 Potter 2 054 Schuylkill 7 055 Snyder 4 056 Somerset 3 057 Sullivan 6 058 Susquehanna 6 059 Tioga 4 060 Union 4 061 Venango 2 062 Warren 2 063 Washington 1 064 Wayne 6 065 Westmoreland 1 066 Wyoming 6 067 York 5 Ambulatory Surgery Data 2016 Second Quarter Data Notes 20 Appendix 3 Pennsylvania County Codes December 2016

Appendix 4 State Code AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY AS FM GU MH MP PW PR VI New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Fed State Micronesia Guam Marshall Islands Northern Mariana Isl Palau Puerto Rico Virgin Islands Ambulatory Surgery Data: 2016 Second Quarter Data Notes 21 Appendix 4 State Codes December 2016

Appendix 5 Type of Bill First Digit Leading Zero Second Digit - Type of Facility 1 Hospital 2 Skilled Nursing 3 Home Health 4 Religious Non-Medical 6 Intermediate Care 7 Clinic 8 Special Facility or ASC Surgery Third Digit - Bill Classification Second Digit = 1 (Hospital) 1 Inpatient (Including Medicare Part A) 2 Inpatient (Medicare Part B Only) 3 Outpatient 4 Laboratory Services Provided to Non-patients 8 Swing Beds Second Digit = 2 (Skilled Nursing) 1 Inpatient (Including Medicare Part A) 2 Inpatient (Medicare Part B Only) 3 Outpatient 8 Swing Beds Second Digit = 3 (Home Health) 2 Under a Plan of Treatment 4 Not Under a Plan of Treatment Second Digit = 4 (Religious Non-Medical) 1 Inpatient 3 Outpatient Services Second Digit = 6 (Intermediate Care) 5 Level I 6 Level II Second Digit = 7 (Clinic) 1 Rural Health 2 Hospital Based of Independent Renal Dialysis Center 3 Free-Standing 4 ORF 5 CORF 6 CMHC 7 Federally Qualified Health Centers 8 Licensed Freestanding Emergency Medical Facility 9 Other Second Digit = 8 (Special Facility) 1 Hospice (Non-Hospital Based) 2 Hospice (Hospital-Based) 3 Ambulatory Surgery Center 4 Freestanding Birthing Center 5 Critical Access Hospital 6 Residential Facility 9 Other Ambulatory Surgery Data: 2016 Second Quarter Data Notes 22 Appendix 5 Type of Bill December 2016

Appendix 5 Type of Bill Fourth Digit Frequency of Bill All Facilities 0 Non-Payment/Zero Claim 1 Admit through Discharge Claim 2 Interim - First Claim 3 Interim - Continuing Claim 4 Interim - Last Claim 5 Late Charges Only Claim 7 Replacement of Prior Claim 8 Void/Cancel of Prior Claim 9 Final Claim for Home Health PPS Episode F Beneficiary Initiated Adjustment Claim G CWF Initiated Adjustment Claim H CMS Initiated Adjustment Claim I Intermediary Adjustment Claim J Initiated Adjustment Claim Other K OIG Initiated Adjustment Claim M MSP Initiated Adjustment Claim O Non-Payment/Zero Claims P QIO Adjustment Claim Q Reconsideration/Reopening Outside of Timely Limits X Void/Cancel Prior Abbreviated Encounter Y Replacement Prior Abbreviated Encounter Z New Abbreviated Encounter Submission Hospice Only A Hospice Election Notice B Hospice Termination Revocation Notice C Hospice Change of Provider Notice D Hospice Election Void/Cancel E Hospice Change of Ownership Ambulatory Surgery Data: 2016 Second Quarter Data Notes 23 Appendix 5 Type of Bill December 2016