Table 3 Modified nursing home rules, based on preliminary expert review
From: Validation of a method for identifying nursing home admissions using administrative claims
RULE | Description | NH status PROBABLE, POSSIBLE, or UNLIKELY, |
|---|---|---|
000001 | outpatient PROC only | POSSIBLE |
000010 | inpatient PROC only | UNLIKELY |
000011 | inpatient and outpatient PROC only | POSSIBLE |
000100 | outpatient POS and SPECIAL SERVICE or REST HOME PROC | PROBABLE* |
outpatient POS only | UNLIKELY* | |
000101 | outpatient POS and outpatient PROC | PROBABLE |
000110 | outpatient POS and inpatient PROC | PROBABLE |
000111 | outpatient POS and inpatient PROC and outpatient PROC | PROBABLE |
001000 | inpatient POS and REST HOME PROC | POSSIBLE† |
inpatient POS and SPECIAL SERVICE PROC | PROBABLE† | |
inpatient POS only | UNLIKELY† | |
001001 | inpatient POS and outpatient PROC | PROBABLE |
001010 | inpatient POS and inpatient PROC | PROBABLE |
001011 | inpatient POS and inpatient PROC and outpatient PROC | PROBABLE |
001100 | inpatient POS and outpatient POS | PROBABLE |
001101 | inpatient POS and outpatient POS and outpatient PROC | PROBABLE |
001111 | inpatient POS and outpatient POS and inpatient PROC and outpatient PROC | PROBABLE |
010000 | outpatient PROVIDER only | UNLIKELY |
010001 | outpatient PROVIDER and outpatient PROC | POSSIBLE |
010010 | outpatient PROVIDER and inpatient PROC | PROBABLE |
010100 | outpatient PROVIDER and outpatient POS | PROBABLE |
010101 | outpatient PROVIDER and outpatient POS and outpatient PROC | PROBABLE |
010110 | outpatient PROVIDER and outpatient POS and inpatient PROC | PROBABLE |
011010 | outpatient PROVIDER and inpatient POS and inpatient PROC | PROBABLE |
011111 | outpatient PROVIDER and inpatient POS and outpatient POS and inpatient PROC and outpatient PROC | PROBABLE |
100000 | inpatient PROVIDER only | PROBABLE |
100001 | inpatient PROVIDER and outpatient PROC | PROBABLE |
100010 | inpatient PROVIDER and inpatient PROC | PROBABLE |
100011 | inpatient PROVIDER and inpatient PROC and outpatient PROC | PROBABLE |
100100 | inpatient PROVIDER and outpatient POS | PROBABLE |
100101 | inpatient PROVIDER and outpatient POS and outpatient PROC | PROBABLE |
101000 | inpatient PROVIDER and inpatient POS | PROBABLE |
101001 | inpatient PROVIDER and inpatient POS and outpatient PROC | PROBABLE |
101010 | inpatient PROVIDER and inpatient POS and inpatient PROC | PROBABLE |
101011 | inpatient PROVIDER and inpatient POS and inpatient PROC and outpatient PROC | PROBABLE |
110000 | inpatient PROVIDER and outpatient PROVIDER | PROBABLE |
110100 | inpatient PROVIDER and outpatient PROVIDER and outpatient POS | PROBABLE |
110101 | inpatient PROVIDER and outpatient PROVIDER and outpatient POS and outpatient PROC | PROBABLE |
111000 | inpatient PROVIDER and outpatient PROVIDER and inpatient POS | PROBABLE |
111010 | inpatient PROVIDER and outpatient PROVIDER and inpatient POS and inpatient PROC | PROBABLE |
111100 | inpatient PROVIDER and outpatient PROVIDER and inpatient POS and outpatient POS | PROBABLE |
111101 | inpatient PROVIDER and outpatient PROVIDER and inpatient POS and outpatient POS and outpatient PROC | PROBABLE |
111111 | inpatient PROVIDER and outpatient PROVIDER and inpatient POS and outpatient POS and inpatient PROC and outpatient PROC | PROBABLE |