Profile Definitions and Methodology

The presence of a clinical service is determined using data from a hospital's most recent Medicare Cost Report, Medicare inpatient claims data, Medicare outpatient claims data, and other sources.

The following specifications are based on the most common procedures within a clinical service and may not include less common procedures (i.e. the presence of the more common procedures was used to test for the presence of a service).  Due to AMA copyright restrictions CPT procedure codes for outpatient services are not published on the website.  They are, however, available to AHD subscribers upon request.

The following is a list of all services that may be reported for a hospital:

Cardiovascular Services
	Cardiac Rehab	More than ten Medicare outpatient claims for outpatient cardiac rehabilitation
	Cardiac Cath Lab	More than ten Medicare outpatient claims for left heart catheterization AND/OR more than ten Medicare inpatient claims for left or combined right and left heart catheterization (ICD 37.22-37.23)
	Coronary Interventions	More than ten Medicare inpatient claims for removal of coronary artery obstruction and insertion of stent(s) (ICD 36.0x and 00.66)
	Cardiac Surgery	More than ten Medicare inpatient claims for bypass anastomosis for heart revascularization (ICD 36.1x)
	Electrophysiology	More than ten Medicare inpatient or outpatient claims for comprehensive electrophysiologic evaluation (ICD 37.26 or selected CPT codes)
	Vascular Surgery	More than ten Medicare inpatient claims for resection of vessel with replacement (ICD 38.44-38.45) and/or aortic-iliac-femoral bypass (ICD 39.25)
	Vascular Intervention	More than ten Medicare outpatient claims for percutaneous transluminal balloon angioplasty.
Emergency Services
	Emergency Department	More than 50 emergency department visits (based on estimated volumes reported elsewhere on the hospital profile).
	ACS/COT Approved Trauma Program	Verification status provided by The American College of Surgeons (ACS) Committee on Trauma (COT) Verification Program.
Neurosciences
	Electroencephalography (EEG)	More than ten Medicare outpatient claims for routine EEG and/or special EEG tests.
	Sleep Studies	More than ten Medicare outpatient claims for sleep testing AND/OR more than ten Medicare inpatient claims for polysomnogram (ICD 89.17)
Oncology Services
	Radiation Therapy	More than ten Medicare outpatient claims for delivery of radiation therapy (6-19 MeV)
	Chemotherapy	More than ten Medicare outpatient claims for chemotherapy (HCPCS C8953-C8955. J9000, J9999, and/or selected CPT codes)
	ACS/CoC Approved Cancer Program	Approval status provided by The American College of Surgeons (ACS) Commission on Cancer (CoC) Approvals Program.
Orthopedic Services
	Arthroscopy	More than ten Medicare outpatient claims for arthroscopy with meniscectomy (medial or lateral)
	Joint Replacement	More than ten Medicare inpatient claims for total hip replacement (ICD 81.51) and more than ten Medicare inpatient claims for total knee replacement (ICD 81.54).
	Spine Surgery	More than ten Medicare inpatient claims for spinal fusion (ICD 81.00-81.08), refusion of spine (ICD 81.30-81.39), and/or certain other procedures on spine (ICD 81.63-81.66)
Organ Transplant (Medicare certified)
	Heart	Medicare certification date as reported in the hospital's most recent cost report (W/S S-2, line 23.02, column 2)
	Intestinal	Medicare certification date as reported in the hospital's most recent cost report (W/S S-2, line 23.06, column 2)
	Kidney	Medicare certification date as reported in the hospital's most recent cost report (W/S S-2, line 23.01, column 2)
	Liver	Medicare certification date as reported in the hospital's most recent cost report (W/S S-2, line 23.03, column 2)
	Lung	Medicare certification date as reported in the hospital's most recent cost report (W/S S-2, line 23.04, column 2)
	Pancreas	Medicare certification date as reported in the hospital's most recent cost report (W/S S-2, line 23.05, column 2)
Radiology / Nuclear Medicine / Imaging
	Computed Tomography (CT) Scanner	More than ten Medicare outpatient claims for CT of head or brain, pelvis, or abdomen
	Computed Tomography Angiography (CTA)	More than ten Medicare outpatient claims for CTA of chest, abdomen, pelvis, or neck
	Intensity-Modulated Radiation Therapy (IMRT)	More than ten Medicare outpatient claims for IMRT
	Magnetic Resonance Angiography (MRA)	More than ten Medicare outpatient claims for MRA of abdomen (HCPCS C8900-C8902), chest (HCPCS C8909-C8911). or lower extremity (HCPCS C8912-C8914)
	Magnetic Resonance Imaging (MRI)	More than ten Medicare outpatient claims for MRI of brain or spinal canal
	Positron Emission Tomography (PET)	More than ten Medicare outpatient claims for PET imaging of heart, brain, and/or tumor (selected CPT codes)
	Single Photon Emission Computerized Tomography (SPECT)	More than ten Medicare outpatient claims for SPECT single or multiple studies
Rehabilitation Therapies
	Speech Therapy	More than ten Medicare outpatient claims for aural rehabilitation
	Physical Therapy	More than ten Medicare outpatient claims for therapeutic exercises to develop strength, endurance, range of motion, and flexibility.
Wound Care
	Hyperbaric Oxygen	More than ten Medicare outpatient claims for hyperbaric oxygen (HCPCS C1300)
	Wound Care	More than ten Medicare outpatient claims for removal of devitalized tissue from wounds (selected CPT codes)
Other Services
	Hemodialysis	More than ten Medicare inpatient claims for hemodialysis (ICD 39.95)
	Home Health	Hospital-based home health agency per the hospital's most recent cost report (W/S S-2, line 18, column 2 or 3)
	Hospice	Hospital-based hospice per the hospital's most recent cost report (W/S S-2, line 12, column 2 or 3)
	Inpatient Surgery	More than ten Medicare inpatient claims for surgical DRGs
	Lithrotripsy (ESWL)	More than ten Medicare outpatient claims for extracorporeal shock wave lithotripsy
	Obstetrics	More than 50 births (based on estimated volumes reported elsewhere on the hospital profile).
Subprovider Units
	Psychiatric	Beds designated in a psychiatric distinct part unit (DPU) per the hospital's most recent cost report (W/S S-3, part 1, line 14.x, column 1)
	Rehabilitation	Beds designated in a rehabilitation distinct part unit (DPU) per the hospital's most recent cost report (W/S S-3, part 1, line 14.x, column 1)
	Skilled Nursing (SNF)	Designated skilled nursing beds per the hospital's most recent cost report (W/S S-3, part 1, line 15, column 1)
	Nursing Facility (NF)	Designated nursing facility beds per the hospital's most recent cost report (W/S S-3, part 1, line 16, column 1)
	Swing Beds - SNF	Designated SNF swing bed revenue per the hospital's most recent cost report (W/S G-2, line 4, column 3)
	Swing Beds - NF	Designated NF swing bed revenue  per the hospital's most recent cost report (W/S G-2, line 5, column 3)
Special Care
	Intensive Care Unit (ICU)	Beds designated in an ICU per the hospital's most recent cost report (W/S S-3, part 1, line 6, column 1)
	Coronary Intensive Care (CCU)	Beds designated in a CCU per the hospital's most recent cost report (W/S S-3, part 1, line 7, column 1)
	Burn Intensive Care (BICU)	Beds designated in a BICU per the hospital's most recent cost report (W/S S-3, part 1, line 8, column 1)
	Surgical Intensive Care (SICU)	Beds designated per the hospital's most recent cost report (W/S S-3, part 1, line 9, column 1)
	Psychiatric Intensive Care	Beds designated per the hospital's most recent cost report (W/S S-3, part 1, line 10.05, column 1)
	Pediatric Intensive Care	Beds designated per the hospital's most recent cost report (W/S S-3, part 1, line 10.10, column 1)
	Neonatal Intensive Care	Beds designated per the hospital's most recent cost report (W/S S-3, part 1, line 10.15, column 1)
	Trauma Intensive Care	Beds designated per the hospital's most recent cost report (W/S S-3, part 1, line 10.20, column 1)
	Detox Intensive Care	Beds designated per the hospital's most recent cost report (W/S S-3, part 1, line 10.25, column 1)
	Premature Intensive Care	Beds designated per the hospital's most recent cost report (W/S S-3, part 1, line 10.30, column 1)