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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
  1. POS = place of service; PROC = procedure code
  2. *If claim had one of the following procedure codes; 99199, 99321, 99322, 99323, 99331, 99332, 99333, it was classified on "PROBABLE" otherwise it was classified on "UNLIKELY".
  3. If claim had one of the following procedure codes; 99321, 99322, 99323, 99331, 99332, 99333, it was classified on "POSSIBLE". If claim had 99199, then it was classified on "PROBABLE" otherwise "UNLIKELY".