• 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 experiences sudden right-sided numbness and weakness of the extremities and is taken to the emergency department of Hospital A where it is determined that she is suffering an acute ischemic stroke. 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 acute ischemic stroke patient was taken to the emergency department of Hospital A by EMTs, 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 ED not originating from another health care facility. As in the example above, a patient brought to the ED 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 Stroke Unit 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 Stroke Unit 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).

• Emergency department record
• History and physical
• Face sheet
• Nursing admission assessment
• Progress notes
• UB-04, Field Location: 15