{"data":{"id":"us-va/12vac5-217-20","jurisdiction":"us-va","citation":"12VAC5-217-20","heading":"Reporting requirements for patient level data elements","body":"Each inpatient hospital shall submit, in an electronic data format, a complete filing of each patient level data element listed in the table in this section for each hospital inpatient, including a separate record for each infant, if applicable.\n\nTable 1\n\nData Element\n\n1. Provider Number\n\nEnter the Medicare Provider Number\n\n2. Provider NPI\n\n3. Patient Control Number\n\n4. Discharge Date\n\nDischarge Statement Covers Period Through Date in MMDDYYYY format\n\n5. Patient Zip Code\n\nZip Code of Patient Address\n\n6. Patient Date of Birth\n\nDate in MMDDYYYY format\n\n7. Patient Sex\n\nM, F, or U\n\n8. Admission Date and Hour\n\nDate in MMDDYYYY format, hour of admission in military time\n\n9. Admission Type\n\n10. Admission Source\n\n11. Patient Discharge Status\n\n12. Medical Record Number\n\n13. Revenue Center Code (up to 22)\n\n14. Revenue Center Units (up to 22)\n\n15. Revenue Center Charges (up to 22)\n\nDollars and cents with an implied decimal\n\n16. Total Charges\n\nDollars and cents with an implied decimal. If greater than $999,999.99, then use 99999999\n\n17. Payor Identifier (up to 3)\n\nEnter the Board of Health approved payor designation, which will be the nationally assigned payor ID, its successor, or English description of the payor\n\n18. Patient Relationship to Insured A\n\n19. Patient Social Security Number (SSN)\n\nEnter the nine-digit social security number of the patient. If a social security number has not been assigned, leave blank. The nine-digit social security number is not required for patients under four years of age\n\n20. Employment Status Code\n\nUse the following codes\n\n1 = Employed Full Time\n\n2 = Employed Part Time\n\n3 = Not Employed\n\n4 = Self-employed\n\n5 = Retired\n\n6 = On Active Military Duty\n\n9 = Unknown\n\n21. Employer Identifier\n\nEnter the federally approved EIN, or employer name\n\n22. Principal Diagnosis Code\n\nCodes set ICD-10 or their successors, omit decimal; eighth character is the Present On Admission value (Y, N, U, W, or 1)\n\n23. Other Diagnosis Code (up to 17)\n\nCodes set ICD-10 or their successors, omit decimal; eighth character is the Present On Admission value (Y, N, U, W, or 1)\n\n24. Admitting Diagnosis Code\n\nCodes set ICD-10 or their successors, omit decimal, eighth character is the Present On Admission value (Y, N, U, W, or 1)\n\n25. External Cause of Injury Code (up to 3)\n\nCodes set ICD-10 or their successors, omit decimal; eighth character is the Present On Admission value (Y, N, U, W, or 1)\n\n26. Principal Procedure Code\n\nCodes set ICD-10 or their successors, omit decimal\n\n27. Principal Procedure Date\n\nDate in MMDDYY format\n\n28. Other Procedure Codes (up to 5)\n\nCodes set ICD-10 or their successors, omit decimal\n\n29. Other Procedure Dates (up to 5)\n\nDate in MMDDYY format\n\n30. Attending Physician\n\nPhysician's Individual NPI\n\n31. Operating Physician\n\nPhysician's Individual NPI\n\n32. Other Physician Provider (up to 2)\n\nPhysician's Individual NPI\n\n33. Infant Birth Weight (in grams)\n\n34. Patient Race\n\nUse the following codes:\n\n0 = White\n\n1 = Black\n\n2 = Other, specified\n\n3 = Asian\n\n4 = American Indian\n\n5 = Hispanic - White\n\n6 = Hispanic - Black\n\n9 = Unknown, not recorded\n\n35. Patient Street Address\n\nEnter the valid patent's residence street number and street name. Do not include P.O. Box numbers\n\n36. Patient City or County\n\nEnter the valid patient's complete City or County of residence\n\n37. Patient Legal Status\n\nEnter the legal status of a psychiatric admission:\n\n1 = § 16.1-338 Parental admission of minors younger than 14 and nonobjecting minors 14 years of age or older\n\n2 = § 16.1-339 Parental admission of objecting minor 14 years of age or older\n\n3 = § 16.1-340.1 Involuntary temporary detention order of a minor\n\n4 = § 16.1-345 Involuntary commitment of a minor\n\n5 = § 37.2-805 Voluntary admission of an adult\n\n6 = § 37.2-809 Involuntary temporary detention order of an adult\n\n7 = § 37.2-904 Sexually violent predator","path":["Title 12. Health","Agency 5. Department of Health","Chapter 217. Regulations of the Patient Level Data System"],"source_url":"https://law.lis.virginia.gov/admincode/title12/agency5/chapter217/section20/","current_through":"2026 Regular Session (effective July 1, 2026)","vintage":"","retrieved_at":"2026-09-14T04:50:02Z","sha256":"1865c6c4809ddbff6bc32c918ffa907389d3cac03d48bf26112fe66f99c8a5b1","source_id":"us-va-vac","stale":false,"prev":"us-va/12vac5-217-15","next":"us-va/12vac5-217-40"},"notice":"GroundRules: Original legal text. Not legal advice."}