{"data":{"id":"us-va/12vac5-218-20","jurisdiction":"us-va","citation":"12VAC5-218-20","heading":"Reporting requirements for outpatient data elements","body":"Every reporting entity performing outpatient surgical procedures shall submit each patient level data element listed in the table in this section for each patient for which an outpatient surgical procedure is performed and for which the data element is collected on the standard claim form utilized by the reporting entity. Most of these data elements are currently collected from a Uniform Billing Form (UB-04) located in the latest publication of the Uniform Billing Manual prepared by the National Uniform Billing Committee or from the Centers for Medicare and Medicaid (CMS) Health Insurance Claim Form (CMS 1500). The Uniform Billing Form and the Uniform Billing Manual are located on the National Uniform Billing Committee's website at www.nubc.org. The Centers for Medicare and Medicaid Health Insurance Claim Form is available on the CMS website at www.cms.gov. Every reporting entity performing outpatient surgical procedures shall submit in an electronic data format. The nonprofit organization will develop detailed record layouts for use by reporting entities in reporting outpatient surgical data. This detailed record layout will be based upon the type of base electronic or paper-billing form utilized by the reporting entity. Outpatient surgical procedures reported shall be those adopted by the board as referred by the nonprofit organization. The nonprofit organization may recommend changes to the list of procedures to be reported not more than annually.\n\nData Element Name\n\nInstructions\n\nHospital Identifier\n\nHospitals and ambulatory care centers enter the six-digit   Medicare provider number, or when adopted by the board, the National Provider   Identifier or other number assigned by the board. Physicians, leave blank.\n\nOperating Physician or Oral and Maxillofacial Surgeon   Identifier\n\nEnter the nationally assigned physician identification   number, either the Uniform Physician Identification Number (UPIN), National   Provider Identifier (NPI) or its successor as approved by the board for the   physician identified as the operating physician for the principal procedure   reported.\n\nPayor Identifier\n\nEnter the board approved payor designation which will be the   nationally assigned PAYERID, its successor, or English description of the   payor.\n\nEmployer Identifier\n\nEnter the federally approved EIN, or employer name,   whichever is adopted by the board.\n\nPatient Identifier\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\nPatient Sex\n\nDate of Birth\n\nEnter the code in MM/DD/YYYY format.\n\nStreet Address\n\nCity or County\n\nZip Code\n\nEmployment Status Code\n\nStatus at Discharge\n\nAdmission Date\n\nAdmission/start of care date\n\nAdmission Hour\n\nHour of admission in military time 00-24\n\nAdmission Diagnosis\n\nCode sets- ICD 9 or CPT 4 or their successors to be   specified in detailed record layouts.\n\nPrincipal Diagnoses\n\nCode sets- ICD 9 or CPT 4 or their successors to be   specified in detailed record layouts.\n\nSecondary Diagnoses\n\nCode sets- ICD 9 or CPT 4 or their successors to be   specified in detailed record layouts.\n\nExternal Cause of Injury\n\n(E-code). Record all external cause of injury codes in   secondary diagnoses position after recording all treated secondary diagnoses.\n\nCo-morbid Condition Existing but not Treated\n\nEnter the code for any co-morbid conditions existing but not   treated. Code sets- ICD 9 or CPT 4 or their successors to be specified in   detailed record layouts.\n\nProcedures\n\nCode sets- ICD 9 or CPT 4 or their successors to be   specified in detailed record layouts.\n\nProcedure Dates\n\nRevenue Center Codes\n\nAs specified for UB-04 or its successor completion, not   available for CMS 1500 or its successor\n\nRevenue Center Units\n\nRevenue Center Charges\n\nTotal Charges","path":["Title 12. Health","Agency 5. Department of Health","Chapter 218. Rules and Regulations Governing Outpatient Health Data Reporting"],"source_url":"https://law.lis.virginia.gov/admincode/title12/agency5/chapter218/section20/","current_through":"2026 Regular Session (effective July 1, 2026)","vintage":"","retrieved_at":"2026-09-14T04:50:03Z","sha256":"584ac59bbf91db18c6626c613946ed8b664a5181af8b9389eb4a5814de74f1fa","source_id":"us-va-vac","stale":false,"prev":"us-va/12vac5-218-10","next":"us-va/12vac5-218-25"},"notice":"GroundRules: Original legal text. Not legal advice."}