[DM/URSA-CORE] Data Mart for URSA-CORE Encounters

Object Description

One row per encounter that meets the criteria of one or more of the URSA-CORE encounter types including; hospital inpatient admissions, hospital observation stays, emergency department visits, hospital outpatient surgery encounters, other hospital outpatient department encounters, clinician office visits, ambulatory surgical center encounters, SNF encounters, or birthing center encounters.

Metadata

• Table Name: ursa.dm_ursa_core_012
• Layer: DATA_MART
• Object Type: Single Stack
• Temporal Class: Event
• Case ID: Encounter ID
• Event Date: Encounter Start Date
• Primary Key: Encounter ID

Published Fields

• Data Model Keys

  • Encounter ID -- The internal database identifier (used, e.g., for joins and primary keys) for the encounter. (See also [URSA-CORE] Encounter)
  • Patient ID -- The internal database identifier (used, e.g., for joins and primary keys) for the patient. This value is typically mastered, i.e., all records for the same patient, regardless of the source data system from which that record originated, should have the same Patient ID value. (Note that while the mastered Patient ID value might resemble a local identifier used in one of the upstream data sources, this does not indicate any special priority of that source system in determining the characteristics of the patient.) (See also [URSA-CORE] Patient)
  • Encounter Primary Payor ID -- Data model key for the primary payor documented in the billing for an encounter.
  • Encounter Primary Plan ID -- Data model key for the primary plan documented in the billing for an encounter.
  • Facility Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the facility provider. (See also [URSA-CORE] Facility Provider)
  • Attending Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the attending provider. (See also [URSA-CORE] Attending Provider)
  • Service Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the service provider. (See also [URSA-CORE] Service Provider)
  • Provider Group Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the provider group. (See also [URSA-CORE] Provider Group)
  • Primary HCPCS Procedure Provider ID

• Date Fields

  • Encounter Start Date
  • Encounter End Date

• Encounter Fields

  • Encounter LOS in Elapsed Midnights
  • Encounter LOS in Distinct Calendar Days
  • Is Multi-Day Encounter
  • Is Single-Day Encounter
  • Ursa Encounter Type Tier 1 Category
  • Ursa Encounter Type Tier 2 Category
  • Is Surgery Encounter -- Indicates an encounter in which the patient underwent surgery; identified by the presence, among the documents associated with an encounter, of a surgical HCPCS code or a revenue center code for operating room setting care.
  • Ursa Surgery Encounter Type Category
  • Is Any Hospital Encounter Type -- True if the URSA-CORE meets any of the criteria for one or more of the following encounter types: (1) Emergency Department Visits without Admissions, (2) Hospital Observation Stays without Admission, (3) Hospital Inpatient Admissions, (4) Hospital Outpatient Surgery Encounters, or (5) Other Hospital Outpatient Department Encounters.
  • Is Hospital Inpatient Admission Encounter
  • Is Hospital Observation Stay Parent Encounter
  • Is Emergency Department Visit Parent Encounter
  • Is Ambulatory Surgical Center Encounter
  • Is Hospital Outpatient Surgery Encounter
  • Is Other Hospital Outpatient Encounter
  • Is Clinician Office Visit Encounter
  • Is Primary Care Clinician Office Visit -- A Clinician Office Visit encounter with a primary care provider or in which primary care services were delivered; operationally defined by the presence of one or more of the following: (1) a service provider or attending provider identified as a primary care provider or with a qualifying primary NUCC taxonomy code; or (2) a qualifying HCPCS code for preventive and/or primary care services. (See also [URSA-CORE] Clinician Office Visit)
  • Is Urgent Care Visit -- Indicates the encounter had one or more claim document with a HCPCS, Revenue Center Code, or Place of Service Code specific to Urgent Care Facility claim filing.
  • Is SNF Encounter
  • Is Home Health Care Visit Encounter
  • Is Birthing Center Encounter

• Clinical Services Fields

  • Primary HCPCS Procedure HCPCS Code
  • Primary HCPCS Procedure Short Description
  • Primary HCPCS Procedure AHRQ CCS Single-Level Procedure Category Code
  • Primary HCPCS Procedure AHRQ CCS Single-Level Procedure Category Description

• Diagnosis Fields

  • Principal Discharge Diagnosis ICD-10-CM Code
  • Principal Discharge Diagnosis ICD-10-CM Description
  • Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Code
  • Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Description
  • Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Code
  • Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Description
  • Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Code
  • Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Description
  • Principal Discharge Diagnosis WHO ICD-10 Chapter Description
  • Principal Discharge Diagnosis WHO ICD-10 Block Description

• Billing and Claims Fields

  • MS-DRG Code -- The standard 3-digit Medicare Severity Diagnosis Related Group code; MS-DRG codes should include leading zeros.
  • MS-DRG Description -- The natural language description of a standard 3-digit Medicare Severity Diagnosis Related Group code.
  • MS-DRG MDC Code
  • MS-DRG MDC Code Description
  • Is CMS DRG Medical-Surgical Type Surgical
  • Is CMS DRG Medical-Surgical Type Medical
  • APR-DRG Code -- The standard 3-digit All Patient Refined Diagnosis Related Group code; APR-DRG codes should include leading zeros, and do not include the Severity of Illness or Risk of Mortality modifiers.
  • APR-DRG Description -- The natural language description of a standard 3-digit All Patient Refined Diagnosis Related Group code. (See also [URSA-CORE] APR-DRG Code)
  • APR-DRG MDC Code -- The two-digit numeric code representing the Major Diagnostic Category for a given DRG based on condition type and body region; 01 = Nervous system, 02 = Eye, 03 = Ear/Nose/Throat, 04 = Respiratory System, etc. (See also [URSA-CORE] MDC Description)
  • APR-DRG MDC Description -- The natural language description of the two-digit Major Diagnostic Category (MDC) Code that classifies DRGs based on condition type and body region; 01 = Nervous system, 02 = Eye, 03 = Ear/Nose/Throat, 04 = Respiratory System, etc. (See also [URSA-CORE] MDC Code)
  • Is APR-DRG Medical Surgical Type Surgical -- Indicates the APR-DRG has been classified as a surgical code.
  • APR-DRG Severity of Illness Code -- The standard 1-digit Severity of Illness modifier for an All Patient Refined Diagnosis Related Group code; sometimes abbreviated as SOI.
  • APR-DRG Risk of Mortality Code -- The standard 1-digit Risk of Mortality modifier for an All Patient Refined Diagnosis Related Group code; sometimes abbreviated as ROM.
  • CMS Admit Source Code -- The standard 1-character CMS Admit Source code; e.g., 1 = Physician Referral, 2 = Clinic Referral, etc.
  • CMS Admit Source Description -- The natural language description of a standard CMS Admit Source code. (See also [URSA-CORE] CMS Admit Source Code)
  • CMS Admit Type Code -- The standard single-digit CMS inpatient admission type code found on Inpatient and Skilled Nursing Facility claims; ; 1 = Emergency, 2 = Urgent, 3 = Elective, 4 = Newborn, 5 = Trauma Center, 9 = Information Not Available.
  • CMS Admit Type Description -- The natural language of a standard CMS Admit Type or Type of Admission Code; 1 = Emergency, 2 = Urgent, 3 = Elective, 4 = Newborn, 5 = Trauma Center, 9 = Information Not Available. (See also [URSA-CORE] CMS Admit Type Code)
  • CMS Patient Discharge Status Code -- The standard 2-digit CMS Patient Discharge Status code; 01 = Discharged to Home or Self Care, etc. Patient Discharge Status codes should include leading zeros.
  • CMS Patient Discharge Status Description -- The natural language description of a standard CMS Patient Discharge Status code. (See also [URSA-CORE] CMS Patient Discharge Status Code)
  • CMS Place of Service Code -- The standard CMS 2-digit Place of Service code; e.g., 01 = Pharmacy, 02 = Telehealth, etc.
  • CMS Place of Service Description -- The natural language description of a standard CMS Place of Service code (See also [URSA-CORE] CMS Place of Service Code)

• Provider Fields

  • Facility Provider Description
  • Facility Provider Taxonomy Code
  • Facility Provider Taxonomy Description
  • Facility Practice Address State Abbreviation
  • Facility Practice Address ZIP Code 5-Digit
  • Attending Provider Description
  • Attending Provider Taxonomy Code
  • Attending Provider Taxonomy Description
  • Service Provider Description
  • Service Provider Taxonomy Code
  • Service Provider Taxonomy Description
  • Provider Group Provider Description
  • Provider Group Taxonomy Code
  • Provider Group Taxonomy Description
  • Primary HCPCS Procedure Provider Description
  • Primary HCPCPS Procedure Provider Taxonomy Code
  • Primary HCPCPS Procedure Provider Taxonomy Description

• Financial Fields

  • Primary Plan Allowed Amount -- The maximum amount that the payor agrees to pay the provider for a service or product, typically governed by a contract. The Allowed Amount for a claim or billing record is calculated by adding the Contractual Adjustment Amount (which is typically negative) to the Charge Amount. Adding the total Non-Contractual Adjustment Amount to the Allowed Amount yields the Total Due Amount. On billing records, which may identify up to three plans responsible for payment, the Primary Plan Allowed Amount, Secondary Plan Allowed Amount, and Tertiary Plan Allowed Amount fields identify the amounts paid by the primary, secondary, and tertiary plans listed on the bill, respectively. (See also [URSA-CORE] Charge Amount, [URSA-CORE] Contractual Adjustment Amount, [URSA-CORE] Non-Contractual Adjustment Amount, [URSA-CORE] Total Due Amount)
  • Primary Plan Paid Amount -- The amount actually paid by the health plan to the provider for a service or product. Subtracting the plan paid amount from the total due amount typically yields the patient responsibility amount. On billing records, which may identify up to three plans responsible for payment, the Primary Plan Paid Amount, Secondary Plan Paid Amount, and Tertiary Plan Paid Amount fields identify the amounts paid by the primary, secondary, and tertiary plans listed on the bill, respectively; the total paid by any and all plans on a bill is identified by the Any Plan Paid Amount field.
  • Total Plan Paid Amount from All Plans
  • Patient Paid Amount -- The amount paid by the patient to the provider for health care services or products.

Foreign Keys

• pat_id → ursa.no_ursa_core_pat_001.pat_id
• enc_primary_payor_id → ursa.no_ursa_core_struct_004.payor_id
• enc_primary_plan_id → ursa.no_ursa_core_struct_005.plan_id
• facility_prov_id → ursa.no_ursa_core_prov_001.prov_id
• attending_prov_id → ursa.no_ursa_core_prov_001.prov_id
• enc_id → ursa.so_ursa_core_enc_020.enc_id
• service_prov_id → ursa.no_ursa_core_prov_001.prov_id
• primary_hcpcs_proc_prov_id → ursa.no_ursa_core_prov_001.prov_id
• prov_group_prov_id → ursa.no_ursa_core_prov_001.prov_id