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Release Notes:
Data Element
Version 2010A1

Data Element Name: Point of Origin for Admission or Visit
Collected For: All Records , (used in algorithm for AMI-1, AMI-6, AMI-7, AMI-7a, AMI-8, AMI-8a, AMI-9, PN-1, PN-3a, PN-5, PN-5b, PN-5c, PN-6, PN-6a, PN-6b
Definition:A code indicating the point of patient origin for this admission.
Suggested Data Collection Question:What was the point of origin for this admission?
Format:
Length:1
Type:Alphanumeric
Occurs:1
Allowable Values:

1     Non-Health Care Facility Point of Origin
The patient was admitted to this facility upon order of a physician.
Usage Note: Includes patients coming from home, a physician’s office, or workplace

2    Clinic
The patient was admitted to this facility as a transfer from a freestanding or non-freestanding clinic.

3   Reserved for assignment by the NUBC
(Discontinued effective 10/1/2007.)

4    Transfer From a Hospital (Different Facility)
The patient was admitted to this facility as a hospital transfer from an acute care facility where he or she was an inpatient or outpatient.
Usage Note: Excludes Transfers from Hospital Inpatient in the Same Facility (See Code D).

5    Transfer from a Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF)
The patient was admitted to this facility as a transfer from a SNF or ICF where he or she was a resident.

6    Transfer from another Health Care Facility
The patient was admitted to this facility as a transfer from another type of health care facility not defined elsewhere in this code list.

7    Emergency Room
The patient was admitted to this facility after receiving services in this facility’s emergency room.
Usage Note: Excludes patients who came to the emergency room from another health care facility.

8    Court/Law Enforcement
The patient was admitted to this facility upon the direction of court of law, or upon the request of a law enforcement agency.
Usage Note: Includes transfers from incarceration facilities.

9    Information not Available
The means by which the patient was admitted to this hospital is unknown.

A   Reserved for assignment by the NUBC.
(Discontinued effective 10/1/2007.)

D    Transfer from One Distinct Unit of the Hospital to another Distinct Unit of the Same Hospital Resulting in a Separate Claim to the Payer
The patient was admitted to this facility as a transfer from hospital inpatient within this hospital resulting in a separate claim to the payer.
Usage Note: For purposes of this code, “Distinct Unit” is defined as a unique unit or level of care at the hospital requiring the issuance of a separate claim to the payer. Examples could include observation services, psychiatric units, rehabilitation units, a unit in a critical access hospital, or a swing bed located in an acute hospital.

E    Transfer from Ambulatory Surgery Center
The patient was admitted to this facility as a transfer from an ambulatory surgery center.

F    Transfer from Hospice and is Under a Hospice Plan of Care or Enrolled in a Hospice Program
The patient was admitted to this facility as a transfer from hospice.

Code Structure for Newborn (Used For PR-2 Only)

1 – 4   Reserved for assignment by the NUBC.
(Discontinued effective 10/1/2007)

5    Born Inside the Hospital
A baby born inside this Hospital

6    Born Outside this Hospital
A baby born outside this Hospital

Note:
CMS and The Joint Commission are aware that there are additional UB-04 allowable values for this data element; however, they are not used for the national quality measure sets at this time.

Notes for Abstraction:
  • The intent of this data element is to focus on patients’ place or point of origin rather than the source of a physician order or referral.
  • The point of origin is the direct source for the particular facility.
    Example 1:
    A SNF patient has chest pain is taken to the emergency department of Hospital A where it is determined that she is suffering an acute myocardial infarction. The patient is then transferred to Hospital B for admission as an inpatient. The Point of Origin for Hospital A would be 5 – Transfer from a Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF); the point of origin code for Hospital b would be 4 – Transfer from a Hospital.
    Example 2:
    An auto accident victim was taken to the emergency department of Hospital A by EMTs, stabilized, then transferred to Hospital B where he receives additional treatment in the ED, and then is admitted as an inpatient to Hospital B. The Point of Origin code for Hospital A is 7 – Emergency Room; the point of origin for Hospital B would be 4 – Transfer from a Hospital.
  • The emergency room code is limited to patients who receive unscheduled emergency services in the ER not originating from another health care facility. As in the auto accident example above, a victim brought to the ER would be coded as 7 since the patient was not previously at any other kind of health care facility. Code 7 also includes self-referrals in emergency situations that require immediate medical attention.

Usage Notes/Cases:

I.   Transfers – From an Another Facility
Overall Scenario
While at another acute care hospital/facility, the patient is seen by the emergency room physicians. The patient is then transferred to our facility through the emergency room.

  • The Point of Origin code would be Code 4 – Transfer from a Hospital (Different Facility) due to the patient being seen at the other acute care facility’s emergency room.
  • If the decision to admit was not made by the other facility’s emergency room personnel and instead was made by our facilities emergency room doctor, the Point of Origin code would still be 4. Even though the decision to admit was not made by the other facility, the patient was still seen by the other facility’s emergency room personnel and a decision to transfer was made by them.
  • The patient is seen by the other facility’s emergency room physician; the patient arrives at our emergency room, but receives no additional emergency room care at our facility. Instead, the patient is transferred immediately to the Heart Catheterization Department of our facility, the Point of Origin code would still be 4. Since the patient is seen by a different hospital’s emergency room personnel, the decision to transfer the patient is first made by the other facility. The arrival of the patient at the receiving hospital’s emergency room and subsequent transfer to the Heart Catheterization Department is secondary to the transfer from the previous facility transfer.

II.    Transfers – Skilled Nursing Facility
Overall Scenario
A resident from a skilled nursing facility is taken to an acute care hospital for medical care.

  • The Point of Origin code would be Code 5 – Transfer from a Skilled Nursing Facility.
  • The patient’s family stopped by to pick-up the patient for a routine doctor’s office visit (regularly scheduled); but while at the doctor’s office the doctor sends the patient to the emergency room of the acute care hospital. The Point of Origin code would be 5 as the original Point of Origin is the skilled nursing facility. The subsequent visit to the doctor’s office (or even the emergency room of the hospital) is secondary to the events that took place earlier that day

III.   Transfer by Law Enforcement or Court
Overall scenario
A patient arrives at the health care facility accompanied by police.

  • The Point of Origin code would be Code 8 – Court/Law Enforcement as the patient is under the supervision of law enforcement
  • If the patient was simply transported by law enforcement to our facility, the patient is neither under arrest nor serving any jail time, then the Point of Origin code would be 7 – Emergency Room. Law enforcement is simply transporting the patient for emergency/urgent care treatment. The patient is not incarcerated (that is, neither under arrest nor serving any jail time).
Suggested Data Sources:
  • Emergency department record
  • History and physical
  • Face sheet
  • Progress notes
  • Nursing admission notes
  • UB-04, Field Location: 15
Additional Notes:
Guidelines for Abstraction:
Inclusion Exclusion
  • None
  • None

Point of Origin for Admission or Visit
Specifications Manual for Joint Commission National Quality Core Measures (2010A1)
Discharges 04-01-10 (2Q10) through 09-30-10 (3Q10)