Data Source

Texas Health Care Information Collection (THCIC)

Data Source for Data Table Builder (Emergency Department Visits, 2016-Most Current Year)

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). Freestanding Emergency Medical Care Facilities (FEMCF) data are included starting on 2020 Q4, under the amended rules in 25 TAC, Sections 421.71-421.79. 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: For inpatient encounters, any visit that contains the revenue codes '0450', '0451', '0452', '0456', or '0459' is considered an emergency department visit. For outpatient encounters, visits must include one of these revenue codes, or have taken place in a free-standing emergency medical care facility (FEMCF); outpatient professional visits and ambulatory surgical center visits are 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), T40.41X (by fentanyl), T40.42X (by tramadol), or T40.49X (by other synthetic opioids), 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).

"Fentanyl" cases are visits classified by ICD-10-CM diagnosis of poisoning from any diagnosis field of T40.41 and includes fentanyl or fentanyl analogs. This code specific to Fentanyl was a new addition in October 2020.

"Heroin" cases are visits classified by ICD-10-CM diagnosis of poisoning from any diagnosis field of T40.1X.

"Non-Heroin Opioid" cases are visits classified by ICD-10-CM diagnosis of poisoning from any diagnosis field of T40.0X (by opium), T40.2X (by other opioids), T40.3X (by methadone), T40.4X (by synthetic narcotics), T40.41X (by fentanyl), T40.42X (by tramadol), or T40.49X (by other synthetic opioids), T40.60 (by unspecified narcotics), or T40.69 (by other narcotics).

"Synthetic Opioid" cases are visits classified by ICD-10-CM code T40.4X and includes fentanyl, fentanyl analogues, tramadol, and other synthetic narcotics; and excludes methadone.

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.

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.

Fentanyl visits are also included in the Synthetic Opioids category, so users should avoid adding totals between those categories.

Population Estimates: Data are from the 2018 Texas Demographer State Projection 1.0 Migration Scenario Projections: https://demographics.texas.gov/Projections/2018/

Note regarding years 2015 - most current 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-CM 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