PENNSYLVANIA AMBULATORY SURGERY DATA:

PENNSYLVANIA AMBULATORY SURGERY DATA: Data Notes 2013 2nd Quarter Pennsylvania Health Care Cost Containment Council January 2014 ay Status Report for

Pennsylvania Health Care Cost Containment Council Special Requests Unit 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... 8 Section III: Field Descriptions Ambulatory Surgery Data... 9 Supplemental Procedure File Data... 14 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: 2013 Second Quarter Data Notes Table of Contents January 2014

Introduction This document is intended to provide general information regarding the contents of the 2013 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: 2013 Second Quarter Data Notes 1 Introduction January 2014

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: 2013 Second Quarter Data Notes 2 General Concepts January 2014

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: 2013 Second Quarter Data Notes 3 Issues Affecting the Data January 2014

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: 2013 Second Quarter Data Notes 4 Issues Affecting the Data January 2014

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 9795 Ambulatory Endoscopic Surgical Center of Bucks County Unknown 9085 Angelina Theresa Bucci Eye Surgery Center, Inc Unknown 9111 Conyngham Valley Surgicenter Unknown 9054 Endoscopy Center at St. Mary Unknown 9074 Ridley Crossing Surgical Center Unknown 9950 Surgery & Laser Center Unknown 9052 Valley Ambulatory Surgical Center Unknown 9086 Williamsport Surgery Center Unknown PAF9885, Altoona Specialty Center, LLC, stated in documentation that no ambulatory surgery has been performed during this quarter. 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 9850 Ambulatory Surgery Center at Bucks County 38.07% 9000 Abington Surgical Center 31.34% 9038 Berks Ambulatory Surgery Center, L.L.C. 100.00% 9235 Berkshire Eye Surgery Center 61.80% 9098 Blue Bell Surgery Center, LLC 17.60% 9895 Center for the Surgical Arts, LLC 100.00% 9920 Children's Hosp of Philadelphia ASC at Exton 32.11% 1880 Children's Hospital of Philadelphia 36.93% 9127 Children's Surgery Center, LLC 94.50% 9142 Childrens Surgery Center of Malvern, LLC 70.55% 9725 Endoscopy Center, LLC 37.56% 9048 Endoscopy Center of Bucks County 38.21% 9110 Eye Surgery Center 74.26% 9835 Eynon Surgery Center, LLC 42.65% 9610 Gastrointestinal Specialists 44.98% 9057 Gateway Surgery Center, LLC 78.99% 9130 Grandview Surgery & Laser Center 34.69% 9128 Grant SurgiCenter LLC 15.23% 9119 Jefferson Surgical Center at the Navy Yard 34.65% 9585 Keystone Kidney Center 77.61% 9023 Kole Plastic Surgery Center 91.67% 9255 Lewisburg Plastic Surgery and Laser Center 19.32% 9088 McCandless Endoscopy Center, LLC 75.95% Ambulatory Surgery Data: 2013 Second Quarter Data Notes 5 Issues Affecting the Data January 2014

Uniform Patient ID/SSN Invalid PAF Facility Name % in Error 4640 Mid-Valley Hospital 20.39% 9042 Mountain Laurel Surgery Center 27.75% 9134 New Britain Surgery Center 18.81% 9078 Pain and Surgical Center of Langhorne 32.34% 9230 Paoli Surgery Center 28.67% 9139 Peters Township Surgery Center 23.92% 9144 Premier Surgery Center of Pittsburgh 43.04% 9004 Radiance - A Private Outpatient Surgery Center 31.59% 9915 Reading Endoscopy Center 28.13% 9063 Red Lion Surgicenter 35.65% 9275 Regional Ambulatory Surgery Center 24.70% 9775 Schuylkill Endoscopy Center 33.60% 9840 Scranton Endoscopy Center 22.26% 9143 Shriners Hospital for Children-Erie Ambulatory Surgery Center 30.26% 3380 Shriners Hospitals for Children/Philadelphia 24.76% 9141 Skin Center, The 100.00% 9138 South Hills Surgery Center, LLC 21.62% 4910 St Christopher's Hospital for Children 25.23% 9965 Surgery Center of Lancaster 34.16% 9975 Surgery Center of Lebanon, LP 15.79% 4075 Surgical Specialty Center at Coordinated Health 16.39% 9018 Valley Eye Surgical Center 44.81% 9555 Valley Forge Surgical Center, LP 17.46% 9037 Valley Surgical Center Inc. 16.31% 9008 West Chester Endoscopy Center 26.91% 9035 Western PA Surgery Center 19.37% 9285 Wills Community Surgical Services of Center City, Inc. 37.19% 9780 Wills Surgery Center of Philadelphia Stadium Campus 16.94% 9500 Wills Eye Surgery Center of Plymouth Meeting 24.76% 9410 Wills Surgery Center of Bucks County 17.56% 9060 Wills Surgery Center of the Northeast 50.65% Primary Payer Type Invalid PAF Facility Name % in Error 9138 South Hills Surgery Center, LLC 99.62% No HCPCS Code in the specified range PAF Facility Name % in Error 9037 Valley Surgical Center Inc. 45.23% Revenue Code Invalid PAF Facility Name % in Error 9915 Reading Endoscopy Center 18.89% 9285 Wills Community Surgical Services of Center City, Inc 33.96% Ambulatory Surgery Data: 2013 Second Quarter Data Notes 6 Issues Affecting the Data January 2014

Primary Health Plan ID Number of Primary Payer Invalid PAF Facility Name % in Error 9138 South Hills Surgery Center, LLC 100.00% 9007 Tri-County Eye Surgery & Laser Center 99.89% Operating Physician ID Invalid PAF Facility Name % in Error 9143 Shriners Hospital for Children-Erie Ambulatory Surgery Center 100.00% 9138 South Hills Surgery Center, LLC 27.82% Ambulatory Surgery Data: 2013 Second Quarter Data Notes 7 Issues Affecting the Data January 2014

Section II FACILITY PROFILE CHANGES Change in Volume of Claims PAF9099, Associates in Kidney Disease and Hypertension, PC, experienced a decrease in records because patients are going to their other associated facility, PAF9101, Renal Endocrine Associates. PAF9043, Betz Ophthalmology Associates, ASC, experienced a decrease in records because the physician went on an extended vacation where he missed doing surgery for several weeks. PAF9920, Children s Hospital of Philadelphia ASC at Exton, experienced fluctuating records within the quarter because of scheduling conflicts with staff. PAF9870, Laurel Laser & Surgery Center - Brookville, experienced an increase in records because most of the patients are elderly, which typically have procedures done in the spring and summer months. PAF9101, Renal Endocrine Associates, PC, experienced an increase in records because the patients are coming from their associated facility, PAF9099, Associates in Kidney Disease and Hypertension, PC. PAF9560, Tri-County Outpatient Surgical Facility, experienced a decrease in records because the physician took time off. PAF5000, Troy Community Hospital, experienced a decrease in records because of the only surgeon leaving the facility. Also the high average charges are because the facility started doing Neoro-stimilators. Facility Name Change: PAF9600, changed its name from Surgery Center of Pennsylvania, LLC to Crozer Keystone Surgery Center at Haverford, effective April 8, 2013. Closed Facilities: PAF9016, Elmwood Endoscopy Center, effective February 11, 2013. PAF9655, Northeast Regional Surgery Center, LLC, still not open after being closed by flooding on September 10, 2011. New Facilities: PAF3440, Einstein Medical Center Montgomery, opened on September 29, 2012. PAF9147, Geisinger Medical Center-Center for Aesthetics and Cosmetic Surgery-Woodbine, opened on August 31, 2012. PAF9149, Sam Surgery Center, LLC, opened on September 21, 2012. Ambulatory Surgery Data: 2013 Second Quarter Data Notes 8 Facility Profile Changes January 2014

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. Ambulatory Surgery Data: 2013 Second Quarter Data Notes 9 Field Descriptions January 2014

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 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 Ambulatory Surgery Data: 2013 Second Quarter Data Notes 10 Field Descriptions January 2014

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. 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 Ambulatory Surgery Data: 2013 Second Quarter Data Notes 11 Field Descriptions January 2014

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 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.9.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.9.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.9.CM diagnosis codes assigned to describe additional conditions that coexist at admission or are discovered during the services as submitted by the facility. Pennsylvania State Physician License Number Pennsylvania state license numbers for each of the referring and operating physicians are to be supplied by the facility. PHC4 validates the submitted license numbers with the Department of State, Bureau of Professional Licensure. Please note: a number may be a valid license number without being the correct license number. These license numbers are intended to be used with the accompanying physician profiles. Operating Physician. The identification number for 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 Pennsylvania state physician license number of the other provider/physician as submitted by the facility. Ambulatory Surgery Data: 2013 Second Quarter Data Notes 12 Field Descriptions January 2014

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 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. Health Plan Identification Number. 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 Additional Data Elements 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 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. Ambulatory Surgery Data: 2013 Second Quarter Data Notes 13 Field Descriptions January 2014

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. 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. Ambulatory Surgery Data: 2013 Second Quarter Data Notes 14 Field Descriptions January 2014

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. 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. Ambulatory Surgery Data: 2013 Second Quarter Data Notes 15 Field Descriptions January 2014

Physician Profile Data Each record in the physician profile represents a unique physician license number used in the ambulatory/outpatient data. Physician License Number. This is the Pennsylvania state license number as submitted by the facilities. Physician Name. This is the name of the physician when recorded by Department of State, Bureau of Professional Licensure. Otherwise, it is the name submitted by the facilities and is identified that there was no match to the Department of State file. Match Indicator. This is a field provided to indicate if the physician license number from the ambulatory/outpatient database is recorded by the Department of State, Bureau of Professional Licensure. Ambulatory Surgery Data: 2013 Second Quarter Data Notes 16 Field Descriptions January 2014

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 hospital-based Ambulatory/Outpatient unit 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, etc. The names of these locations/units listed are intended to be used as general terms. Locations names may differ from facility to facility. 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 93451-93581 Cardiovascular therapeutic codes within the range of 92920 92998 HCPCS Level II Code Ranges: All codes Ambulatory Surgery Data: 2013 Second Quarter Data Notes 17 Appendix 1 Procedures Collected January 2014

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: 2013 Second Quarter Data Notes 18 Appendix 2 Pennsylvania Regions January 2014

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: 2013 Second Quarter Data Notes 19 Appendix 2 Pennsylvania Regions January 2014

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 2013 Second Quarter Data Notes 20 Appendix 3 Pennsylvania County Codes January 2014

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: 2013 Second Quarter Data Notes 21 Appendix 4 State Codes January 2014

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 Inpatient (Plan of treatment under Part B Only)) 3 Outpatient (Plan of treatment under Part A, including DME under Part A) 4 Other (for medical and surgical services not under a plan of treatment) Second Digit = 4 (Religious Non-Medical) 1 Hospital 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 Ambulatory Surgery Data: 2013 Second Quarter Data Notes 22 Appendix 5 Type of Bill Explanation of Digits January 2014

Appendix 5 Type of Bill 6 Residential Facility 9 Other 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 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: 2013 Second Quarter Data Notes 23 Appendix 5 Type of Bill Explanation of Digits January 2014