[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]


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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.

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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.

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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