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Opioid-Related Emergency Department Visits

For questions about this data, send email to thcichelp@dshs.texas.gov or call (512) 776-7261

Data Source: Texas Health Care Information Collection (THCIC)

Data Source for Data Table Builder (Emergency Department Visits, 2016-19):

The Texas Health Care Information Collection (THCIC) (now called Texas Health Care Information Collection program) was created by Chapter 108 of the Texas Health and Safety Code (THSC) and is responsible, under Sections 108.011 through 108.0135, for collecting hospital discharge data from all state licensed hospitals except those that are statutorily exempt from the reporting requirement. The rule requirements for hospital inpatient data collection and reporting are listed under 25 Texas Administrative Code, Sections 421.1-421.9.

This opioid-related emergency department visits module offers aggregated data that are based upon data from both the Inpatient and Outpatient Public Use Data Files (PUDF), also known as the DSHS Hospital Discharge Data (HDD). These files contain visit-level information. Each visit is identified as a record ID which masks the identification of the individual patient. Data were retrieved from patients who were seen in a hospital-based emergency department (ED) and who were also seen either at a hospital (inpatient) or other medical provider (outpatient). The data do not include free-standing emergency centers licensed under Health and Safety Code, Chapter 254. Records are not limited by the length of hospital stay and represent only those discharged alive to home or another facility. Data for this module are derived from information collected from individuals who reside in Texas (Patient State Code TX) and do not include visits from those who reside outside of Texas but received care in Texas.

Measure Information:

Emergency Department Visit: The determination of an emergency department visit is based on the use of Revenue Codes indicating emergency department service line charges (‘0450’, ‘0451’, ‘0452’, ‘0456’, and ‘0459’). These codes are used for payment determination and are generally more accurate than type of admission or source of admission codes. Each visit record is linked by Record identifying number to the inpatient and outpatient detail files to obtain visit-specific diagnoses and demographic information.

Non-Fatal Visit: The determination of a non-fatal visit is based on the use of the patient status code (i.e., individuals without a patient status code of death: ‘20’, ‘40’, ‘41’, or ‘42’; individuals with a missing patient status code were excluded).

Patient County: County of patients’ residence in Texas. Visits where the county of residence was not recorded, unknown or suppressed due to small sample size are included in the statewide statistics. Therefore, in some years, the statewide total will be greater than the sum of the county totals.

Race/Ethnicity: The patient’s race and ethnicity are combined. Hispanic race/ethnicity includes patients who identify themselves as Hispanic regardless of race. The rest are grouped into non-Hispanic categories of White, Black, and Other.

Opioid Category: The categorization of non-fatal emergency department visits involving opioids is based on guidance from Centers for Disease Control and Prevention (2018) using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). Visits containing opioid diagnoses in any of 25 diagnosis fields (Principal and Other) are defined as non-fatal acute poisoning due to the effects of opioids, regardless of intent (e.g., intentional, unintentional, or undetermined). The Admitting Diagnosis field was not used.

“Any Opioid” cases are those visits which include a ICD-10-CM diagnosis of poisoning from any diagnosis field of T40.0X (by opium), T40.1X (by Heroin), T40.2X (by other opioids), T40.3X (by methadone), T40.4X (by synthetic narcotics), T40.60 (by unspecified narcotics), or T40.69 (by other narcotics) in which the “X” could include a 6th character of 1 (unintentional), 2 (intentional self-harm), 3 (assault) or 4 (undetermined) and a 7th character of “A” or “ ” (i.e., missing a 7th character).

Each combination of opioid use has the same coding pattern as for “Any Opioid” in the 6th and 7th position of the ICD-10-CM code, including Non-Heroin (T40.0X, T40.2X, T40.3X, T40.4X, T40.60, T40.69) and Commonly Prescribed Opioids (Natural, semi-synthetic and synthetic opioids including methadone, T40.2X, T40.3X, T40.4X).

The Heroin and Non-Heroin Opioids categories are mutually exclusive; any visit involving heroin was coded as Heroin, regardless of whether opioids other than heroin were also involved. Visits coded as Commonly Prescribed Opioids may also involve heroin, so users should avoid adding totals using the Commonly Prescribed Opioids category.

Note regarding 2015-2019 data:

Beginning October 1, 2015, the United States transitioned from the Ninth Revision of the International Classification of Diseases, Clinical Modification (ICD-9-CM) to the Tenth Revision (ICD-10-CM). The Tenth Revision significantly expanded the procedure and diagnosis codes, including those related to opioids. For more information about the ICD-10 Transition, please visit: https://www.dshs.state.tx.us/ICD-10/

2015 data is unavailable due to a methodology change that year.

Additional Information:

https://www.cdc.gov/drugoverdose/index.html Centers for Disease Control and Prevention (2018). CDC’s Opioid Overdose Indicator Support Toolkit: Guidance for building and reporting on opioid-related mortality, morbidity, and PDMP indicators (version 3.0).

For more information about the data, please visit: https://www.dshs.texas.gov/thcic/
For more information about this module, please contact CHS-Info@dshs.texas.gov