Military Health System

Two (2) alphanumeric characters.

Code indicating patient status as of the end date of care on the TED record.

Discharged

Transferred

Discharged/transferred to SNF

Discharged/transferred to ICF

Discharged/transferred to another type of institution (including distinct parts of institutions) (definition not valid for discharges on or after 04/01/2008)

Discharged/transferred to a designated cancer center or children’s hospital (definition effective for discharges on or after 04/01/2008)

Discharged/transferred to home under care of organized home health service organization

Left against medical advice or discontinued care

Discharged/transferred to home under care of a home IV provider (not valid for discharges on or after 10/01/2005)

Expired (or did not recover - Christian Science Patient)

Discharged/transferred to court/law enforcement

Still patient (remaining)

Expired at home

Expired in a medical facility, such as a hospital, SNF, ICF, or freestanding hospice

Expired place unknown

Discharged/transferred to a federal health care facility

Discharged to Hospice - Home

Discharged to Hospice - Medical Facility

Discharged/transferred to a hospital-based Medicare approved swing bed

Discharged/transferred to an IRF including Rehabilitation Distinct Part Units of a hospital

Discharged/transferred to a LTC hospital

Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare

Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital

Discharged/transferred to a CAH

Discharged/transferred to a designated disaster alternative care site (Effective 10/01/2013)

Discharged/transferred to another type of health care institution not defined elsewhere in this code list (definition effective for discharges on or after 04/01/2008)

Discharged to home or self care with a planned acute care hospital inpatient readmission (Effective 10/01/2013)

Discharged/transferred to a short-term general hospital for inpatient care with a planned acute care hospital inpatient readmission (Effective 10/01/2013)

Discharged/transferred to a SNF with Medicare certification with a planned acute care hospital inpatient readmission (Effective 10/01/2013)

Discharged/transferred to a facility that provides custodial or supportive care with a planned acute care hospital inpatient readmission (Effective 10/01/2013)

Discharged/transferred to a designated cancer center or children’s hospital with a planned acute care hospital inpatient readmission (Effective 10/01/2013)

Discharged/transferred to home under care of organized home health service organization with a planned acute care hospital inpatient readmission (Effective 10/01/2013)

Discharged/transferred to court/law enforcement with a planned acute care hospital inpatient readmission (Effective 10/01/2013)

Discharged/transferred to a federal health care facility with a planned acute care hospital inpatient readmission (Effective 10/01/2013)

Discharged/transferred to a hospital-based Medicare approved swing bed with a planned acute care hospital inpatient readmission (Effective 10/01/2013)

Discharged/transferred to an IRF including rehabilitation distinct part units of a hospital with a planned acute care hospital inpatient readmission (Effective 10/01/2013)

Discharged/transferred to a Medicare certified LTC with a planned acute care hospital readmission (Effective 10/01/2013)

Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare with a planned acute care hospital readmission (Effective 10/01/2013)

Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital with a planned acute care hospital readmission (Effective 10/01/2013)

Discharged/transferred to a CAH with a planned acute care hospital readmission (Effective 10/01/2013)

Discharged/transferred to another type of health care institution not defined elsewhere in this code list with a planned acute care hospital readmission (Effective 10/01/2013)

N/A

Nine (9) alphanumeric characters.

U.S. Postal zip code or foreign country code for patient’s legal residence at the time service was rendered and must not be the zip code of a P.O. Box.

Must be a valid five or nine digit zip code. If only five digits, left justify and blank fill. If foreign country, must be three character foreign country code, left justify and blank fill. Refer to Addendum A.

N/A

Two (2) alphanumeric characters.

The code that represents the level of pay. (The combination of pay plan code and pay grade code represents the sponsor’s pay category.) Download field from DEERS.

Unknown

Used when pay plan is civil service

Used when pay plan is cadet

Used when pay plan is warrant office

Used when pay plan is enlisted

Used when pay plan is officer

N/A

Five (5) alphanumeric characters.

The code that represents the type of pay category. (The combination of pay plan code and pay grade code represents the sponsor’s pay category.) Download field from DEERS.

For valid values refer to Addendum J.

N/A

Four (4) alphanumeric characters.

This code identifies and distinguishes MTF/eMSM/Clinic enrollments from network enrollments. The code designations vary based on type of Prime enrollment and begin work dates of new programs. The codes also vary based on the individual requirements of enrolling platforms used by the MCS regions. Download field from DEERS using PCM Enrolling Division DMIS-ID.

N/A

N/A

Eight (8) alphanumeric characters, YYYYMMDD.

The date when a human being was born. Download field from DEERS.

4 digit calendar year

2 digit calendar month

2 digit calendar day

N/A

Ten (10) alphanumeric characters.

The cadency name (i.e., Sr., Jr., III, etc.) of the patient. Download field from DEERS.

N/A

N/A

Twenty-five (25) alphanumeric characters.

First name of patient. Download field from DEERS.

N/A

N/A

Nine (9) alphanumeric characters.

The identifier that represents a human being. This attribute will usually contain the person’s SSN. Download field from DEERS.

N/A

N/A

Nine (9) alphanumeric characters.

The identifier that represents a person who is a sponsor. This attribute will usually contain the sponsor’s SSN. Download field from DEERS.

N/A

N/A

One (1) alphanumeric character.

The code that represents a specific kind of person identifier. Download field from DEERS.

Special nine digit code created for individuals (i.e., babies) who do not have or have not provided an SSN when the record is added to DEERS (dependents only).

Special nine digit code created for foreign military and nationals.

TIN

Special nine digit code created for U.S. military personnel from Service Numbers before the switch to SSNs.

Special nine digit code created for a DoD contractor who refused to give his or her SSN to RAPIDS. The associated PN_ID will begin with 99.

SSN

Not applicable

N/A

One (1) alphanumeric character.

The code that represents a specific kind of person identifier. Download field from DEERS.

Special nine digit code created for individuals (i.e., babies) who do not have or have not provided an SSN when the record is added to DEERS (dependents only).

Special nine digit code created for foreign military and nationals.

TIN

Special nine digit code created for U.S. military personnel from Service Numbers before the switch to SSNs.

Special nine digit code created for a DoD contractor who refused to give his or her SSN to RAPIDS. The associated PN_ID will begin with 99.

SSN

Not applicable

N/A

Thirty-five (35) alphanumeric characters.

Last name of patient. Download field from DEERS.

N/A

N/A

Twenty-five (25) alphanumeric characters.

Middle name of patient. Download field from DEERS.

N/A

N/A

Group

Name of patient. Download field from DEERS.

N/A

N/A

One (1) alphanumeric character.

Code defining sex of patient. Download field from DEERS.

Female

Male

Unknown

N/A

Thirteen (13) alphanumeric characters.

The identifying number of the referring physician. This field will report the NPI or PROVIDER TAXPAYER NUMBER and PROVIDER SUB-IDENTIFIER as applicable.

N/A

N/A

Two (2) alphanumeric characters.

Code to indicate where the health care was provided.

For valid values refer to Addendum F, Figure 2.F-2.

N/A

One (1) alphanumeric character.

Code indicating the source of the referral for this admission.

1

Physician Referral

The patient was admitted to this facility upon the recommendation of his or her personal physician. (Discontinued effective 10/01/2007.)

1

Non-Health Care Facility Point of Origin

The patient was admitted to this facility upon order of a physician or self-referral. (Effective 10/01/2007.)

2

Clinic Referral

The patient was admitted to this facility upon recommendation of this facility’s clinic physician.

3

HMO Referral

The patient was admitted to this facility as a transfer from a freestanding or non-freestanding clinic. Discontinued effective 10/01/2007.)

4

Transfer from a Hospital (Different Facility)

The patient was admitted to this facility as a hospital transfer from a different acute care facility where he or she was an inpatient.

5

Transfer from a SNF or ICF

The patient was admitted to this facility as a transfer from a SNF or ICF where he or she was a resident.

6

Transfer from another Health Care Facility

The patient was admitted to this facility as a transfer from another type of health care facility not defined elsewhere in this code list.

7

Emergency Room

The patient was admitted to this facility after receiving services in this facility’s emergency department. (Discontinued effective 07/01/2010).

8

Court/Law Enforcement

The patient was admitted to this facility upon the direction of a court of law, or upon the request of a law enforcement agency representative.

9

Information Not Available

The means by which the patient was admitted to this hospital is not known.

A

Transfer from a CAH

The patient was admitted to this facility as a transfer from a CAH where he or she was an inpatient. (Discontinued effective 10/01/2007.)

B

Transfer from Another HHA

The patient was admitted to this HHA as a transfer from another HHA. (Discontinued effective 07/01/2010).

C

Readmission to the Same HHA

The patient was readmitted to this HHA within the existing 60 day payment. (Discontinued effective 07/01/2010).

D

Transfer from Hospital Inpatient in the same facility resulting in a separate claim to the payer

The patient was admitted to this facility as a transfer from Hospital Inpatient within this facility resulting in a separate claim to the payer.

E

Transfer from ASC

The patient was admitted to this facility as a transfer from an ASC. (Effective 10/01/2007.)

F

Transfer from Hospice and is under a Hospice Plan of Care or enrolled in a Hospice Program

The patient was admitted to this facility as a transfer from hospice. (Effective 10/01/2007.)

1

Normal Delivery

A baby delivered without complications. (Discontinued effective 10/01/2007.)

2

Premature Delivery

A baby delivered with time and/or weight factors qualifying it for premature status. (Discontinued effective 10/01/2007.)

3

Sick Baby

A baby delivered with medical complications, other than those relating to premature status. (Discontinued effective 10/01/2007.)

4

Extramural Birth

A newborn born in a non-sterile environment. (Discontinued effective 10/01/2007.)

5

Born Inside This Hospital

A baby born inside this hospital. (Effective 10/01/2007.)

6

Born Outside This Hospital

A baby born outside this hospital. (Effective 10/01/2007.)

N/A

Two (2) alphanumeric characters.

Code indicating the pricing methodology used in determining the amount allowed for the service(s)/supplies. Left justify and blank fill.

No special rate

Discount rate agreement

TRICARE Diagnosis Related Group (DRG) reimbursement with Short Stay Outlier

TRICARE DRG reimbursement with Cost Outlier

TRICARE DRG reimbursement with No Outlier

Hospital-specific Psychiatric per diem rate

Region-specific Psychiatric per diem rate

Per diem rate

HVBP Adjustment Factor

Supplemental Health Care Program (SHCP) claim or active duty member TPR claim paid outside normal limits

Medicare Reimbursement Rate

Critical Access Hospital (CAH) Reimbursement

CAH Inpatient Rehabilitation Facility (IRF) Reimbursement (Effective 10/01/2018)

CAH Psychiatric Hospital per diem rate (Effective 10/01/2018)

Cost-To-Charge Ratio (CCR) (Effective 01/01/2014)

COVID-19 Adjustment Factor

Discounted DRG

Standard Long-Term Care Hospital (LTCH) Reimbursement (Effective 10/01/2018)

TRICARE IRF Reimbursement (Effective 10/01/2018)

Site-Neutral LTCH Reimbursement (Effective 10/01/2018)

Pricing not applicable (denied service/supplies and allowed drugs)1

Priced Manually2

Prevailing charge (state)

Conversion amount (state)

Paid as billed

Paid on negotiated rate

National prevailing charge

National conversion factor

Ambulatory surgery facility payment rate

Discounted ambulatory surgery facility payment rate

Ambulatory surgery-paid as billed

Claim Auditing Software-added procedure, priced manually

Claim Auditing Software-added procedure, prevailing charge (State)

Claim Auditing Software-added procedure, conversion factor (Contractor)

Claim Auditing Software-added procedure, paid as billed

Claim Auditing Software-added procedure, paid on negotiated rate

Claim Auditing Software-added procedure, national prevailing charge

Claim Auditing Software-added procedure, national conversion factor

Claim Auditing Software-added procedure, ambulatory surgery facility payment rate

Claim Auditing Software-added procedure, discounted ambulatory surgery facility payment rate

Claim Auditing Software-added procedure, ambulatory surgery-paid as billed

Claim Auditing Software-added procedure, allowed as billed but paid less than billed

SHCP or active duty member TPR claim paid outside normal limits

Medicare Reimbursement Rate

Priced over CMAC (Effective 09/27/2001)

Blended Rate

CAH Reimbursement

Global Rate Agreement (used with corporate service providers only) (Effective 08/01/2003)

Per Diem Rate Agreement (used with corporate service providers only) (Effective 08/01/2003)

TRICARE Claim-added procedure, CMAC priced laboratory code

OPPS

OPPS with Cost Outlier

OPPS with Discount

Hospital-based Partial Hospitalization - paid as OPPS

N/A

Seven (7) alphanumeric characters.

The code that identifies the principal procedure performed during the period reported on the TED record as submitted on the UB-04/UB-92.

Use the most current procedure code edition (ICD-9-CM or ICD-10-PCS) as directed by DHA. Must provide the most detailed code. Do not code the decimal point.

N/A

Eight (8) alphanumeric characters.

Principal Treatment Diagnosis: The condition established, after study, to be the major cause for the patient to obtain medical care as submitted on the claim form or otherwise indicated by the provider.

POA Indicator: Diagnosis present at the time the order for inpatient admission occurs.

Principal Treatment Diagnosis (Positions 1 through 7): Use the most current diagnosis code edition (ICD-9-CM or ICD-10-CM), as directed by DHA. Must provide the most detailed code. Do not code the decimal point.

POA Indicator (Position 8):

Valid POA values are:

Not reported

Unreported/Not Used - Exempt from POA reporting

No - Not present at time of admission

Unknown - Documentation insufficient to determine if the condition was present at time of admission

Clinically Undetermined - The provider is unable to clinically determine if the condition was present at time of admission

Yes - Present at time of admission

N/A

Five (5) alphanumeric characters.

The code that identifies the procedure performed or describes the care received as submitted on the claim form.

Refer to Physician’s Current Procedure Terminology, 4th Edition1 (CPT-4) or Healthcare Common Procedure Coding System (HCPCS) National Level II Medicare Codes or DHA approved codes (Addendum E, Figure 2.E-2). For Dental Services, use HCPC or ADA Dental procedure codes.

N/A

Four (4) occurrences of two (2) alphanumeric characters per occurrence/line item.

Two digit code which provides the means by which the health care professional can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code. (Refer to Physician’s Current Procedure Terminology, 4th Edition, (CPT-4) or Healthcare Common Procedure Coding System (HCPCS) National Level II Medicare Codes.)

Must be 21-27, 32, 33, 47, 50-59, 62, 63, 66, 73-82, 90-93, 95-97, 99, 0A-0P, 0Z, 1A-1J, 1Z, 2A-2O, 2Q-2T, 2Z, 3A-3I, 3K, 3Z, 4A-4U, 4Z, 5A-5O, 5Z, 6A-6F, 6Z, 7A-7F, 7Z, 8A-8C, 8P, 8Z, 9A-9D, 9L-9Q, 9Z, A1-A9, AA, AB, AD-AK, AM, AO-AZ, BA, BL, BO-BR, BU, CA-CO, CQ-CT, DA, DE, DG-DJ, DN, DP, DR, DS, DX, E1-E4, EA-EE, EG-EJ, EM, EN, EP, ER-ET, EX, EY, F1-F9, FA-FC, FP-FT, FX, FY, G0-G9, GA-GC, GE-GZ, H9, HA-HZ, ID, IE, IG-IJ, IN, IR, IS, IX, J1-J5, JA-JL, JN, JP, JR, JS, JW, JX, K0-K4, KA-KZ, L1, LC, LD, LL, LM, LR-LU, M2, MA-MH, MR, MS, N1-N3, NB, ND, NE, NG-NJ, NN, NP, NR-NU, NX, P1-P6, PA-PE, PG-PJ, PL-PP, PR-PT, PX, Q0-Q9, QA-QH, QJ-QZ, RA-RE, RG-RJ, RN, RP-RT, RX, SA-SN, SQ-SY, T1-T9, TA-TK, TL-TN, TP-TW, U1-U9, UA-UH, UJ-UK, UN, UP-US, V1- V9, VM, VP, X1-X5, XD, XE, XG-XJ, XN, XP, XR, XS, XU, or blank.

N/A

Group

Field containing multiple elements that describe processing related to the TED record.

N/A

N/A

Ten (10) alphanumeric characters.

Standard unique health identifier for individual providers, including but not limited to those (human beings) who provide care such as physicians, nurse practitioners, dentists, chiropractors, pharmacists, and physical therapists.

N/A

N/A

One (1) alphanumeric character.

Code indicating whether the provider is a network or non-network provider.

Network Provider

Non-Network Provider

N/A

Ten (10) alphanumeric characters.

Standard unique health identifier for organizational providers, including but not limited to non-person providers such as hospitals, HHAs, clinics, laboratories, suppliers of DME, pharmacies, and groups.

N/A

N/A

One (1) alphanumeric character.

Code indicating whether or not the provider accepted assignment of benefits for services rendered.

No

Yes

N/A

Ten (10) alphanumeric characters.

Code describing the provider’s specialty.

Refer to http://www.wpc-edi.com/reference/ for Provider Specialty Codes. Refer to Addendum C, Figure 2.C-1 as a reference when assigning Provider Major Specialty Codes to Outpatient Hospital Non-Institutional TED records.

N/A

Three (3) alphanumeric characters.

Code assigned to identify the state or foreign country in which the care was received. State Code must be left justified and blank fill to right.

Addendums A and B.

N/A

Four (4) alphanumeric characters.

Identification number that uniquely identifies multiple providers using the same TIN.

Refer to Section 2.10, ELN 3-010.

N/A

Nine (9) alphanumeric characters.

The IRS TIN assigned to the institution/provider supplying the care.

For institutions must be nine digit EIN. For individual providers, should be the nine digit EIN or SSN, if available. If not available, report the contractor-assigned number. (Refer to Section 2.10, ELN 3-005). Report all nines for transportation services.

N/A

Nine (9) alphanumeric characters.

Location of provider’s business office where care is usually provided.

Must be a valid five or nine digit zip code. If only five digits, left justify and blank fill. If a foreign country, must be three character foreign country code, left justify and blank fill. Refer to Addendum A.

N/A