Agency Information Collection Activities: Submission to OMB for Review and Approval; Public Comment Request; National Practitioner Data Bank: Modification of the National Practitioner Data Bank Code Lists

CourtHealth Resources And Services Administration
Citation87 FR 95
Record Number2021-28377
Publication Date03 January 2022
Federal Register, Volume 87 Issue 1 (Monday, January 3, 2022)
[Federal Register Volume 87, Number 1 (Monday, January 3, 2022)]
                [Notices]
                [Pages 95-103]
                From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
                [FR Doc No: 2021-28377]
                -----------------------------------------------------------------------
                DEPARTMENT OF HEALTH AND HUMAN SERVICES
                Health Resources and Services Administration
                Agency Information Collection Activities: Submission to OMB for
                Review and Approval; Public Comment Request; National Practitioner Data
                Bank: Modification of the National Practitioner Data Bank Code Lists
                AGENCY: Health Resources and Services Administration (HRSA), Department
                of Health and Human Services.
                ACTION: Request for public comment on the National Practitioner Data
                Bank's (NPDB) Basis for action code lists for licensure and
                certification actions.
                -----------------------------------------------------------------------
                SUMMARY: HRSA, a sub-agency of the Department of Health and Human
                Services, is announcing a change in the NPDB Basis for Action Code
                Lists for Federal Licensure, and State Licensure or Certification
                Actions to individuals and entities authorized to report and request
                information from the NPDB. These changes will contain updated codes and
                code use guidance applicable to organizations submitting Federal
                Licensure, or State Licensure or Certification Actions. The code
                modifications and guidance are intended to provide improved report
                accuracy and promote a better understanding of the use and application
                of the basis of action codes available for report submission. The
                modifications are based in part upon recommendations made through a
                collaborative effort with NPDB industry partners: the Federation of
                State Boards of Physical Therapy, the National Council of State Boards
                of Nursing, the Federation of State Medical Boards, the Association of
                State and Provincial Psychology Boards, the National Board for
                Certification in Occupational Therapy, the Association of Social Work
                Boards, and the National Association of Boards of Pharmacy. Basis for
                Action codes help to accurately describe the basis for licensure
                actions reported. Basis for Action codes have no impact on the
                licensure action reported or the applicability of NPDB reporting
                criteria. New, modified, and retired codes have no impact on historical
                reporting. The coding of previously submitted reports will remain
                unchanged.
                DATES: Submit comments no later than February 2, 2022.
                ADDRESSES: Written and/or electronic comments should be submitted to
                [email protected] by February 2, 2022.
                [[Page 96]]
                FOR FURTHER INFORMATION CONTACT: David Loewenstein, Director, Division
                of Practitioner Data Bank, Bureau of Health Workforce, HRSA, (301) 443-
                2300, [email protected].
                SUPPLEMENTARY INFORMATION: The current published NPDB Code Lists are
                available on the NPDB website: https://www.npdb.hrsa.gov/hcorg/codes.jsp.
                 The NPDB is authorized by the Health Care Quality Improvement Act
                of 1986 (the Act), Title IV of Public Law 99-660, as amended (42 U.S.C.
                11101 et seq.). Further, two additional statutes expanded the scope of
                the NPDB--Section 1921 of the Social Security Act, as amended (42
                U.S.C. 1396r-2) and Section 1128E of the Social Security Act, as
                amended (42 U.S.C. 1320a-7e). Information collected under the Section
                1128E authority was consolidated within the NPDB pursuant to Section
                6403 of the Affordable Care Act, Public Law 111-148; this consolidation
                became effective on May 6, 2013.
                 Proposed NPDB Code Lists Modifications
                ----------------------------------------------------------------------------------------------------------------
                 Guideline or
                 Table Code Status Current code New/modified code explanation of Code use examples
                 description description status change and explanations
                ----------------------------------------------------------------------------------------------------------------
                 Non-Compliance With Requirements
                ----------------------------------------------------------------------------------------------------------------
                48........ 44.......... U......... Default on Health ................. Fails to meet Explanation: Use
                 Education Loan health education only if your
                 or Scholarship loan or state has this
                 Obligations. scholarship requirement.
                 obligations.
                48........ 35.......... U......... Drug Screening ................. Fails a drug Examples:
                 Violation. screening test. Failure
                 of a required
                 drug screen or
                 failure to
                 comply with the
                 requested drug
                 screen;
                 Sample
                 is adulterated,
                 invalid or
                 substituted;
                 Failure
                 of a drug screen
                 for employment.
                48........ A2.......... U......... Failure to Comply ................. Fails to meet the Examples:
                 With Continuing continuing Failure
                 Education or education or to complete
                 Competency competency state
                 Requirements. requirements for requirements;
                 renewal or If the
                 reinstatement. licensee
                 falsified
                 meeting the
                 requirements,
                 then also use
                 Code E3.
                48........ 31.......... M......... Failure to Comply Failure to comply Fails to comply Examples:
                 With Health and with health and with federal, Failure
                 Safety safety state, local, or to meet required
                 Requirements. requirements or institutional health tests or
                 state health safety inoculations.
                 code. requirements or DO NOT use for:
                 state health
                 codes. Violation of
                 infection
                 control, sterile
                 technique, and
                 isolation
                 requirements;
                 instead use Code
                 17.
                48........ 23.......... U......... Failure to ................. Interferes with Examples:
                 Cooperate With an investigation Failure
                 Board or disciplinary to respond or to
                 Investigation. proceeding by respond
                 withholding adequately to
                 information, board
                 deliberate investigation
                 misrepresentatio requests;
                 n of facts or Failure
                 attempts to to cooperate
                 suppress with the board
                 evidence. as a witness to
                 an
                 investigation.
                48........ 50.......... M......... Failure to Failure to Fails to meet Example:
                 Maintain Maintain or documentation Failure
                 Adequate or Provide Adequate requirements for to provide
                 Accurate Records. or Accurate maintaining adequate
                 Medical Records, patient care, documentation of
                 Financial financial or treatment/care
                 Records or Other other records. in the medical
                 Required record.
                 Information.
                48........ 45.......... R......... Failure to ................. Redundant code,
                 Maintain Records use code 50.
                 or Provide
                 Medical,
                 Financial or
                 Other Required
                 Information.
                48........ A3.......... R......... Failure to Meet ................. Use code A1......
                 Licensing Board
                 Reporting
                 Requirements.
                [[Page 97]]
                
                48........ A1.......... M......... Failure to Meet Failure to Meet Fails to meet Examples:
                 the Initial Licensure board specified Failure
                 Requirements of Requirements/ licensing to meet board
                 a License. Licensing Board requirements or requirements
                 Reporting provide other than
                 Requirements. requested/ threshold
                 required licensure
                 information. requirements;
                 NOTE: Do not Failure
                 report or to provide
                 include information
                 threshold required by the
                 criteria: the board (e.g.,
                 accepted minimum criminal
                 licensure conviction, loss
                 requirements of job due to
                 that are unprofessional
                 universally conduct,
                 applied without disciplinary
                 decision or action in
                 exception. another
                 Examples include jurisdiction,
                 academic change of
                 degrees, address etc.);
                 criminality, Failure
                 certifications, to report any
                 or training renewal and
                 hours or reinstatement
                 requirements. requirements;
                 Failure
                 to report
                 another health
                 care
                 professional as
                 required by
                 mandatory
                 reporting
                 obligations.
                 DO NOT use for:
                 Failure
                 to meet
                 threshold
                 criteria: the
                 accepted minimum
                 licensure
                 requirements
                 that are
                 universally
                 applied without
                 decision or
                 exception.
                 Examples include
                 academic
                 degrees,
                 criminality,
                 certifications,
                 or training
                 hours or
                 requirements;
                
                 Continuing
                 Competency
                 requirements;
                 instead use Code
                 A2;
                
                 Obtaining a
                 license but
                 failing to
                 disclose
                 required
                 information on
                 the application;
                 instead use Code
                 E4.
                48........ 37.......... M......... Failure to Pay Failure to Pay or Fails to meet Explanation: Use
                 Child Support/ Delinquent with child support only if your
                 Delinquent Child Child Support. responsibilities. state has this
                 Support. requirement.
                48........ 39.......... M......... License Disciplinary Grounds for Examples:
                 Revocation, Action Taken by action are based A
                 Suspension or another Federal, on action(s) licensee is
                 Other State or Local taken by another licensed in
                 Disciplinary Licensing state licensing, another
                 Action Taken by Authority. federal, or jurisdiction and
                 a Federal, State other authority. has final
                 or Local disciplinary
                 Licensing action by that
                 Authority. authority.
                 DO NOT use for:
                 Your own
                 jurisdiction's
                 disciplinary
                 action.
                48........ 29.......... U......... Practicing Beyond ................. Provides care not Examples:
                 the Scope of permitted under
                 Practice. the terms of a Performing
                 license or practice
                 within the interventions,
                 licensee's level whether advanced
                 of education, or not, without
                 training, required
                 knowledge, license,
                 skills, certification or
                 experience, or training;
                 demonstrated Failure
                 competency. to work with
                 adequate/
                 required
                 supervision.
                 DO NOT use for:
                
                 Substandard or
                 Inadequate Care
                 for incompetence
                 issues; instead
                 use Code F6;
                
                 Negligence for
                 not exercising
                 reasonable
                 judgement;
                 instead use Code
                 13.
                48........ 24.......... U......... Practicing With ................. Fails to renew Example:
                 an Expired license and Failure
                 License. continues to to renew license
                 practice. intentionally or
                 unintentionally
                 and continues to
                 practice.
                 DO NOT use for:
                 A new
                 graduate who
                 fails the exam
                 and continues to
                 practice under a
                 temporary
                 license which
                 expired on
                 getting exam
                 results; instead
                 use Code A4;
                 Someone
                 who has had
                 their license
                 revoked and
                 continues to
                 practice;
                 instead use Code
                 A4.
                48........ 25.......... R......... Practicing ................. Redundant code,
                 Without a use code A4.
                 License.
                48........ A4.......... U......... Practicing ................. Practices without Examples:
                 Without a Valid obtaining the Failure
                 License. proper to cease
                 authorization. practice after a
                 temporary
                 license or
                 permit has
                 expired;
                
                 Applicant or
                 licensee
                 practices after
                 passing the exam
                 but before
                 licensing
                 authority has
                 issued license.
                 DO NOT use for:
                 Someone
                 whose license
                 has expired;
                 instead use Code
                 24.
                [[Page 98]]
                
                48........ A6.......... U......... Violation of ................. Violation of Examples:
                 Federal or State federal or state Failure
                 Statutes, statutes, to meet alimony
                 Regulations or regulations or responsibilities
                 Rules. rules not ;
                 associated with Failure
                 the practice act. to report abuse
                 or other federal
                 or state
                 requirement.
                 DO NOT use for:
                
                 Violations of
                 the state
                 practice act;
                 Failure
                 to meet child
                 support; instead
                 use Code 37.
                48........ 36.......... U......... Violation of ................. Fails to meet Example:
                 Federal or State federal or state Failure
                 Tax Code. tax code to meet federal
                 responsibilities. or state tax
                 code
                 responsibilities
                 .
                 Explanation:
                 Use with
                 appropriate
                 criminal
                 conviction or
                 adjudication
                 code if
                 applicable.
                48........ 84.......... R......... Violation of ................. Redundant code,
                 State Health use code 31.
                 Code.
                48........ A5.......... U......... Violation of or ................. Fails to comply Example:
                 Failure to with a specific Failure
                 Comply With board order. to meet terms of
                 Licensing Board a board order.
                 Order.
                ----------------------------------------------------------------------------------------------------------------
                 Criminal Conviction or Adjudication
                ----------------------------------------------------------------------------------------------------------------
                49........ 19.......... U......... Criminal ................. Convicted of a Example:
                 Conviction. felony or
                 misdemeanor Convicted of a
                 crime. felony or
                 misdemeanor
                 crime.
                 Explanation:
                 Use this
                 code along with
                 the appropriate
                 code to describe
                 the underlying
                 violation of
                 law;
                 If there
                 is no
                 appropriate
                 code, describe
                 the criminal
                 conviction in
                 the narrative.
                49........ 18.......... U......... Deferred ................. Plea that avoids Explanation:
                 Adjudication. criminal Deferred
                 conviction by adjudication
                 meeting certain involves
                 probationary probation,
                 requirements. treatment
                 programs, and/or
                 some type of
                 community
                 supervision;
                 Use this
                 code along with
                 the appropriate
                 code to describe
                 the underlying
                 violation of
                 law;
                 If there
                 is no
                 appropriate
                 code, describe
                 the violation in
                 the narrative.
                49........ B1.......... U......... Nolo Contendere ................. Plea of no
                 Plea. contest, same
                 consequence as a
                 guilty plea.
                49........ I1.......... U......... Diverted ................. Pre-trial Explanation:
                 Conviction. sentencing that Pretrial
                 avoids criminal sentencing
                 conviction by includes
                 completing a participating in
                 court ordered a treatment or
                 intervention rehabilitation
                 program. program;
                 Use this
                 code along with
                 the appropriate
                 code to describe
                 the underlying
                 violation of
                 law;
                 If there
                 is no
                 appropriate
                 code, describe
                 the violation in
                 the narrative.
                ----------------------------------------------------------------------------------------------------------------
                 Confidentiality, Consent or Disclosure Violations
                ----------------------------------------------------------------------------------------------------------------
                50........ C3.......... U......... Breach of ................. Releases or Example:
                 Confidentiality. obtains patient
                 information Releasing or
                 without obtaining
                 appropriate patient
                 authorization. information
                 without
                 appropriate
                 authorization.
                50........ C2.......... U......... Failure to Comply ................. Fails to meet Examples:
                 With Patient requirements for Failure
                 Consultation consultation to consult with
                 Requirements. with other or refer to an
                 health care appropriate
                 providers or licensee when
                 refer when care is beyond
                 appropriate. the licensee's
                 level of
                 training, skill,
                 expertise or
                 license;
                 Failure
                 to keep a
                 referring source
                 informed of the
                 patient's
                 progress.
                50........ C1.......... U......... Failure to Obtain ................. Fails to meet Examples:
                 Informed Consent. informed consent Failure
                 requirements. to explain
                 procedures and
                 possible
                 complications;
                 Failure
                 to obtain
                 permission of
                 the patient to
                 evaluate and
                 treat; as well
                 as failure to
                 obtain parental
                 permission for a
                 minor.
                ----------------------------------------------------------------------------------------------------------------
                [[Page 99]]
                
                 Misconduct or Abuse
                ----------------------------------------------------------------------------------------------------------------
                51........ D4.......... U......... Abusive Conduct ................. Engages in the Example:
                 Toward Staff. maltreatment of Engaging
                 a colleague or in the
                 employee which maltreatment of
                 can include a colleague or
                 mental, physical employee (i.e.
                 and/or verbal mental, physical
                 abuse. and/or verbal
                 abuse).
                 DO NOT use for:
                 Sexual
                 abuse; instead
                 use Code D1.
                51........ D7.......... M......... Conduct Conduct Engages in Examples:
                 Evidencing Evidencing conduct that is Failure
                 Ethical Ethical or Moral unethical or to respect the
                 Unfitness. Unfitness. violates the beliefs and
                 ethical code of values of
                 conduct. patient without
                 prejudice;
                 Failure
                 to protect or
                 disregards the
                 rights, health,
                 safety of the
                 patient.
                51........ D6.......... R......... Conduct ................. Use Code D7......
                 Evidencing Moral
                 Unfitness.
                51........ 71.......... U......... Conflict of ................. Fails to disclose Examples:
                 Interest. information that Failure
                 presents a to-disclose
                 conflict of ownership;
                 interest. Failure
                 to provide
                 freedom of
                 choice.
                51........ D5.......... U......... Disruptive ................. Engages in Example:
                 Conduct. conduct which
                 interferes with Interferes with
                 or disrupts or disrupts
                 normal normal
                 operations in operations in
                 the patient care the patient care
                 setting or setting or
                 workplace. workplace.
                 DO NOT use for:
                 Patient
                 abuse; instead
                 use Code 14.
                51........ D3.......... U......... Exploiting a ................. Exploits a Examples:
                 Patient for professional Takes
                 Financial Gain. relationship advantage of the
                 with a patient patient
                 to benefit relationship by
                 financially selling products
                 beyond that that are not
                 which is needed for
                 reasonable for treatment or
                 the provision of could be
                 treatment. obtained for a
                 lower price;
                 Takes
                 advantage of the
                 patient
                 relationship by
                 inviting them
                 into business
                 opportunities.
                 DO NOT use for:
                
                 Excessive or
                 fraudulent
                 billing; instead
                 use Code 55.
                51........ 16.......... U......... Misappropriation ................. Uses a patient's Example:
                 of Patient or coworker's Using or
                 Property or property or the taking a
                 Other Property. property of a patient's or
                 facility without coworker's
                 approval or property or the
                 permission. property of a
                 facility without
                 approval or
                 permission.
                 Explanation:
                 Also use
                 Code 19 Criminal
                 Conviction if
                 there has been a
                 criminal
                 conviction.
                 DO NOT use for:
                
                 Diverting
                 medications from
                 a patient;
                 instead use Code
                 H6.
                51........ D2.......... M......... Non-Sexual Dual Non-Sexual Engages in a non- Examples:
                 Relationship or Boundary sexual
                 Boundary Violation. relationship, Excessive
                 Violation. behavior or personal
                 boundary disclosure,
                 violation that secrecy,
                 involves reversal of
                 exploitation or roles or actions
                 coercion of a that meet the
                 patient or needs of the
                 former patient licensee
                 and contains (borrowing
                 harmful or money);
                 potentially
                 harmful elements. Non[hyphen]sexua
                 l relationship
                 with a patient's
                 significant
                 other.
                51........ 14.......... U......... Patient Abuse.... ................. Engages in the Example:
                 maltreatment of Mental,
                 a patient which physical and/or
                 can include verbal abuse of
                 mental, physical a patient.
                 and/or verbal DO NOT use for:
                 abuse. Sexual
                 abuse or sexual
                 assault; instead
                 use Code D1.
                51........ D1.......... U......... Sexual Misconduct ................. Engages in Examples:
                 behavior that Sexual
                 exploits the exploitation of
                 practitioner- a patient;
                 patient
                 relationship in Workplace sexual
                 a sexual way, or harassment;
                 engages in Sexual
                 workplace sexual Assault;
                 harassment such Sexual
                 as unwelcome Abuse.
                 sexual advances
                 or conduct of a
                 sexual nature
                 which interferes
                 with the
                 performance of
                 another person's
                 job or creates
                 an intimidating,
                 hostile, or
                 offensive work
                 environment.
                51........ D8.......... R......... Other ................. Redundant code,
                 Unprofessional covered by other
                 Conduct, Specify. categories, or
                 use code 99.
                ----------------------------------------------------------------------------------------------------------------
                [[Page 100]]
                
                 Fraud, Deception, or Misrepresentation
                ----------------------------------------------------------------------------------------------------------------
                52........ E6.......... U......... Failure to ................. Fails to disclose Examples:
                 Disclose. information that Failure
                 is required by to disclose
                 the board. criminal or
                 disciplinary
                 history on a
                 license
                 application;
                 Failure
                 to disclose
                 revenues
                 generated from
                 selling
                 equipment or
                 other financial
                 relationships,
                 etc.
                52........ E3.......... U......... Filing False ................. Fabricates Examples:
                 Reports or patient, Failure
                 Falsifying medical, health, to provide
                 Records. employee, or accurate
                 other records. patient,
                 medical, health,
                 employee, or
                 other records;
                
                 Documenting
                 treatment that
                 did not occur.
                 Explanation: Use
                 this code in
                 conjunction with
                 A2 Failure to
                 Comply with
                 Continuing
                 Education or
                 Competency
                 Requirements for
                 falsifying
                 licensee
                 continuing
                 education or
                 competence
                 records.
                 DO NOT use for:
                 False
                 billing for care/
                 treatment;
                 instead use Code
                 56.
                52........ 5........... R......... Fraud--Unspecifie ................. Redundant code,
                 d. covered by other
                 fraud codes.
                52........ E4.......... U......... Fraud, Deceit or ................. Provides false, Examples:
                 Material altered or Provides
                 Omission in omitting false
                 Obtaining documents and documentation in
                 License or information when licensure
                 Credentials. applying for application
                 licensure. materials
                 (transcript,
                 letters, etc.);
                 Failure
                 to disclose
                 prior
                 disciplinary
                 action or
                 criminal
                 conviction on
                 application;
                
                 Falsifies
                 testing
                 materials
                 (cheating,
                 trafficking,
                 etc.).
                52........ 55.......... M......... Improper or Improper Billing Knowingly or Examples:
                 Abusive Billing Practices. intentionally
                 Practices. bills improperly. Knowingly uses
                 incorrect
                 treatment or
                 billing codes;
                 Charges
                 unreasonable
                 fees;
                
                 Intentionally
                 overbills.
                 DO NOT use for:
                
                 Conviction of
                 insurance fraud;
                 instead use Code
                 E1.
                52........ E1.......... U......... Insurance Fraud ................. Convicted of Examples:
                 (Medicare, Medicare,
                 Medicaid or Medicaid or Convicted of
                 Other Insurance). other insurance Medicare,
                 fraud. Medicaid or
                 other insurance
                 fraud.
                 Explanation:
                 Use in
                 conjunction with
                 Code 19 Criminal
                 Conviction.
                52........ E5.......... U......... Misleading, False ................. Uses misleading, Example:
                 or Deceptive false or False or
                 Advertising or deceptive misleading
                 Marketing. advertising or advertising
                 marketing related to
                 related to license.
                 services, DO NOT use for:
                 treatment, Failure
                 procedures or to correctly
                 care. identify
                 credentials;
                 instead use Code
                 81.
                52........ 81.......... U......... Misrepresentation ................. Fails to properly Example:
                 of Credentials. identify oneself Failure
                 with regards to to properly
                 education, identify
                 training, education,
                 knowledge, training,
                 experience, or knowledge,
                 skills. experience, or
                 skills.
                52........ E2.......... U......... Providing or ................. Orders or Examples:
                 Ordering provides
                 Unnecessary unnecessary Overutilization
                 Tests or tests, of tests/
                 Services. procedures, services;
                 treatment or
                 services. Providing
                 unnecessary
                 treatment.
                52........ 56.......... U......... Submitting False ................. Requests Example:
                 Claims. reimbursement
                 for services Intentionally
                 that did not billing for
                 occur or does interventions/
                 not reflect the care that did
                 actual treatment not occur.
                 provided. DO NOT use for:
                
                 Conviction for
                 insurance fraud;
                 instead use Code
                 E1;
                
                 Documenting
                 treatments/care
                 that did not
                 occur or
                 falsifying
                 patient records;
                 instead use Code
                 E3.
                ----------------------------------------------------------------------------------------------------------------
                 Unsafe Practice or Substandard Care
                ----------------------------------------------------------------------------------------------------------------
                53........ F8.......... U......... Failure to ................. Fails to provide Example:
                 Consult or Delay or delaying Failure
                 in Seeking proper to consult with
                 Consultation consultation or report to a
                 With Supervisor/ with supervisor supervisor/
                 Proctor. or proctor. ordering health
                 care provider/
                 proctor.
                [[Page 101]]
                
                53........ 53.......... R......... Failure to ................. Redundant code,
                 Provide use code 13.
                 Medically
                 Reasonable and/
                 or Necessary
                 Items or
                 Services.
                53........ F1.......... M......... Immediate Threat Immediate Threat Presents an Examples:
                 to Health or to Public. immediate risk
                 Safety. to health or Emergency or
                 safety; Board summary
                 uses emergency suspension of a
                 measures to license.
                 remove a Explanation:
                 practitioner Use in
                 from practice. combination with
                 a code that best
                 describes the
                 violation.
                53........ 17.......... U......... Inadequate or ................. Fails to conform Example:
                 Improper to recognized Failure
                 Infection standards or to follow
                 Control orders for policies or
                 Practices. infection procedures for
                 control. infection
                 control, sterile
                 technique or
                 isolation
                 requirements.
                 DO NOT use for:
                 Failure
                 to comply with
                 federal, state,
                 local or
                 institutional
                 safety
                 requirements or
                 state health
                 codes; instead
                 use Code 31.
                53........ FA.......... U......... Inappropriate ................. Refuses to treat Example:
                 Refusal to Treat. a patient due to Refusal
                 religious, moral to treat a
                 or other reasons. patient due to
                 religious, moral
                 or other
                 reasons.
                53........ 11.......... R......... Incompetence..... ................. Redundant code,
                 use F1 or F6.
                53........ 12.......... R......... Malpractice...... ................. Redundant code,
                 use specific
                 reason
                 associated with
                 malpractice.
                53........ 13.......... U......... Negligence....... ................. Fails to exercise Example:
                 the skill, care Failure
                 and learning to exercise
                 expected of a reasonable
                 reasonably judgment.
                 prudent health DO NOT use for:
                 care provider.
                 Competence
                 issue; instead
                 use Code F6.
                53........ F9.......... U......... Patient ................. Terminates care Example:
                 Abandonment. without adequate Deserts
                 notice of the or neglects a
                 professional patient with
                 relationship whom there is an
                 between a health established
                 care provider provider-patient
                 and a patient/ relationship
                 client at a time without making
                 when the patient reasonable
                 needs further arrangements for
                 care. the continuation
                 of care and
                 without
                 reasonable
                 notice.
                53........ 15.......... R......... Patient Neglect.. ................. Redundant code,
                 use 13.
                53........ F6.......... M......... Substandard or Substandard Care Fails to meet Example:
                 Inadequate Care. or Inadequate clinical Failure
                 Skill Level. standards of to provide
                 practice, unable competent care.
                 to practice DO NOT use for:
                 competently or
                 practicing with Practicing
                 insufficient beyond level of
                 skill. training;
                 instead use Code
                 29.
                53........ F7.......... R......... Substandard or ................. Redundant code,
                 Inadequate Skill use code F6.
                 Level.
                53........ F5.......... R......... Unable to ................. Redundant code,
                 Practice Safely. use code F2, F3,
                 or F4.
                53........ F2.......... M......... Unable to Unable to Unable to Example:
                 Practice Safely Practice Safely practice safely Failure/
                 by Reason of by Reason of by reason of inability to
                 Alcohol or Other Substance Use. substance use. practice safely
                 Substance Abuse. by reason of
                 substance use.
                53........ F4.......... M......... Unable to Unable to Unable to Example:
                 Practice Safely Practice Safely practice safely Failure/
                 by Reason of by Reason of by reason of inability to
                 Physical Illness Physical physical practice safely
                 or Impairment. Impairment. impairment. by reason of
                 physical
                 impairment.
                53........ F3.......... M......... Unable to Unable to Unable to Example:
                 Practice Safely Practice Safely practice safely Failure/
                 by Reason of by Reason of by reason of inability to
                 Psychological Psychological psychological practice safely
                 Impairment or Impairment. impairment. by reason of
                 Mental Disorder. psychological
                 impairment.
                53........ To be N......... N/A.............. Incorrect Site Procedure Example:
                 determined. Procedure. performed on the
                 wrong side or Performing an
                 site of the invasive
                 body, wrong procedure on
                 surgical wrong side of
                 procedure the body;
                 performed.
                 Performing a non-
                 invasive
                 procedure on the
                 wrong side of
                 the body, i.e.
                 taking blood
                 pressure on the
                 side of an
                 arteriovenous
                 fistula.
                [[Page 102]]
                
                53........ To be N......... N/A.............. Foreign Body Leaves an item(s) Example:
                 determined. Retained inside a patient Retained
                 Inappropriately after a foreign body
                 in a Patient. procedure that refers to any
                 should not be item or foreign
                 there. object related
                 to any operative
                 or invasive
                 procedure that
                 is left inside a
                 patient. Common
                 items include
                 sponges and
                 towels;
                 retractors,
                 unretrieved
                 device
                 components or
                 fragments, parts
                 of trocars,
                 guidewires,
                 catheters, and
                 pieces of
                 drains; needles
                 and other
                 sharps.
                53........ To be N......... N/A.............. Wrong Patient.... Procedure or Example:
                 determined. treatment
                 performed on the Performing an
                 wrong patient. invasive
                 procedure on the
                 wrong patient;
                
                 Performing a non-
                 invasive
                 procedure on the
                 wrong patient
                 i.e. ambulating
                 the wrong
                 patient.
                ----------------------------------------------------------------------------------------------------------------
                 Improper Supervision or Allowing Unlicensed Practice
                ----------------------------------------------------------------------------------------------------------------
                54........ G2.......... U......... Allowing or ................. Allows or assists Example:
                 Aiding someone practice
                 Unlicensed without a Knowingly allows
                 Practice. license. unlicensed
                 practice.
                54........ G1.......... U......... Improper or ................. Fails to Example:
                 Inadequate supervise Failing
                 Supervision or adequately or to supervise
                 Delegation. properly those adequately or
                 assigned to you. properly those
                 assigned to you.
                ----------------------------------------------------------------------------------------------------------------
                 Improper Prescribing, Dispensing, Administering Medication/Drug Violation
                ----------------------------------------------------------------------------------------------------------------
                55........ H6.......... U......... Inappropriate ................. Diverts Example:
                 Acquisition or prescription Removing
                 Diversion of medication from a prescribed
                 Controlled a patient or a medication from
                 Substance. healthcare a patient's
                 facility with inventory,
                 intent to sell, unused portion,
                 distribute or waste, trash or
                 consume for healthcare
                 personal misuse. facility
                 inventory for
                 self or someone
                 other than the
                 patient.
                55........ H5.......... U......... Error in ................. Makes an error Examples:
                 Prescribing, when Giving
                 Dispensing or prescribing, the wrong
                 Administering dispensing, or medication;
                 Medication or administering Giving
                 Sedation. medications. medication to
                 the wrong
                 patient;
                 Giving
                 the wrong dosage
                 of medication;
                 Improper
                 storage of
                 medication.
                55........ H1.......... M......... Narcotics Drug Drug Violation or Controlled Examples:
                 Violation or Other Violation substance
                 Other Violation of Drug Statutes. violation Controlled
                 of Drug Statutes. regardless of substance
                 conviction. violation
                 regardless of
                 conviction.
                 Explanation:
                 If there
                 is a conviction,
                 also use Code 19
                 Criminal
                 Conviction.
                55........ H4.......... U......... Inappropriate or ................. Administers Example:
                 Unauthorized medications Failure
                 Administration improperly or to administer
                 of Medication or without the medications
                 Sedation. appropriate properly or
                 prescription or without the
                 medication order. appropriate
                 prescription/
                 order.
                55........ H3.......... U......... Inappropriate or ................. Dispenses Example:
                 Unauthorized medication Failure
                 Dispensing of improperly or to obtain
                 Medication. without the authorization or
                 appropriate prescription to
                 authorization. dispense
                 medication.
                55........ H2.......... U......... Inappropriate or ................. Improper Examples:
                 Unauthorized prescribing or Forging
                 Prescribing of attempting to signature on
                 Medication. prescribe order/
                 without prescription;
                 authority or Altering
                 altering an order/
                 medication order. prescription;
                 Failure
                 to obtain
                 prescriber
                 authorization or
                 signature.
                ----------------------------------------------------------------------------------------------------------------
                 Other
                ----------------------------------------------------------------------------------------------------------------
                56........ 99.......... U......... Other--Not ................. Use only if no
                 Classified, other code is
                 Specify. applicable.
                ----------------------------------------------------------------------------------------------------------------
                Table Key:
                [ssquf] Table # and name as it appears in published NPDB Code Lists.
                [ssquf] Code # as it appears in published NPDB Code Lists. NOTE: Code number is subject to change with the next
                 published version.
                [ssquf] Status: Unchanged (U), Modified (M), Retired (R), New (N).
                [ssquf] Current Code Description.
                [ssquf] New or Modified Code Description.
                [ssquf] Guideline: a new category of information to help explain the code.
                [ssquf] Code use examples and explanations: a new category of information to show how to apply the code.
                [[Page 103]]
                Diana Espinosa,
                Acting Administrator.
                [FR Doc. 2021-28377 Filed 12-30-21; 8:45 am]
                BILLING CODE 4165-15-P
                

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