[SO/URSA-PHU] Emergency Department Visit Parent Encounters Extension for URSA-PHU Concepts

Object Description

One record for each principal diagnosis code on an institutional or qualifying professional claim associated with an ED visit, including visits resulting in admission to observation and/or inpatient status; includes classification logic used in ED Optimization analytics.

Metadata

• Table Name: ursa.so_ursa_phu_enc_003
• Layer: SYNTHETIC_OBJECT
• 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)
  • 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)

• Date Fields

  • Encounter Start Date
  • Encounter End Date

• Encounter Fields

  • Preventable ED Visit Scenario Category
  • Is High Probability Preventable ED Visit
  • Is High Probability Preventable ED Visit Due to Preventable Condition
  • Is High Probability Preventable ED Visit Due to Inappropriate Setting
  • 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 Source Code -- The standard 1-character CMS Admit Source code; e.g., 1 = Physician Referral, 2 = Clinic Referral, etc.
  • 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 Place of Service Code -- The standard CMS 2-digit Place of Service code; e.g., 01 = Pharmacy, 02 = Telehealth, etc.

• Clinical Services Fields

  • Is Patient Admitted to Observation
  • Is Patient Admitted to Hospital Inpatient

• Diagnosis Fields

  • Principal Discharge Diagnosis ICD-9-CM Code
  • Principal Discharge Diagnosis ICD-9-CM Description
  • Principal Discharge Diagnosis ICD-10-CM Code
  • Principal Discharge Diagnosis ICD-10-CM Description
  • Is Principal Diagnosis NYUEDA Injury
  • Is Principal Diagnosis NYUEDA Psych
  • Is Principal Diagnosis NYUEDA Alcohol
  • Is Principal Diagnosis NYUEDA Drug
  • Is Principal Diagnosis High Probability Preventable Condition

• 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.

• Validation Only Fields

  • Percentage NYUEDA Appropriate for ED And Not Preventable
  • Percentage NYUEDA Appropriate for ED But Preventable
  • Percentage NYUEDA Emergent But Primary Care Treatable
  • Percentage NYUEDA Non-Emergent
  • High-Intensity Evaluation and Management HCPCS Code

Foreign Keys

• enc_id → ursa.so_ursa_core_enc_003.enc_id
• pat_id → ursa.no_ursa_core_pat_001.pat_id
• facility_prov_id → ursa.no_ursa_core_prov_001.prov_id