ARC 2655C - Iowa Administrative Rules

Adopted and Filed

Central registry for brain and spinal cord injuries, amendments to ch 21

Untitled document

ARC 2655C

PUBLIC HEALTH DEPARTMENT[641]

Adopted and Filed

Pursuant to the authority of Iowa Code section 135.22, the Department of Public Health hereby amends Chapter 21, "Central Registry for Brain and Spinal Cord Injuries," Iowa Administrative Code.

Required reportable conditions were revised in Iowa Code section 135.22 to align with a rule for eligibility for the home- and community-based services waiver for persons with brain injury under the medical assistance program. These amendments update these reportable conditions. As a result, the current hospital reporting structure does not meet these revised requirements. The Department receives information from the Iowa Hospital Association through the In Patient Out Patient (IPOP) database, which contains all the required components needed from the hospitals. These amendments remove the old injury reporting method and replace it to align with hospital reporting requirements for IPOP. This change will result in no additional burden on hospital reporting and will provide the Department with the necessary data to be compliant with Iowa Code section 135.22. The amendments also strike the word "traumatic" in reference to brain injury to align with the Iowa Code. Additional amendments reflect the reportable conditions for brain and spinal cord injury to transition to the International Classification of Diseases, 10th Revision, Clinical Modification.

Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 2447C on March 16, 2016. A public hearing was held on April 5, 2016. The Department received one comment during the public hearing from Tom Brown, chair of the Advisory Council on Brain Injuries, supporting the proposed amendments. The adopted amendments are not identical to those published under Notice. The definition of "reportable case" was revised to add clarity, and a reference to rule 641—21.7(135) was added to Item 2 to correct an omission from the Notice. No other changes were made.

The Iowa Department of Public Health adopted these amendments on July 13, 2016.

After analysis and review of this rule making, no impact on jobs has been found.

These amendments are intended to implement Iowa Code section 135.22.

These amendments will become effective September 7, 2016.

The following amendments are adopted.

Item 1. Amend rule 641—21.1(135) as follows:

641—21.1(135) Purpose. This chapter describes the central registry for brain and spinal cord injuries. Data from the registry shall be utilized to facilitate prevention strategies and the provision of appropriate rehabilitative services by the department and other state agencies.

Item 2. Strike "agency" and "agency's" wherever they appear in rules 641—21.2(135) and 641—21.4(135), subrule 21.6(1), the introductory paragraph of subrule 21.6(2), and paragraphs 21.6(2)"a" to "d" and "g," and rule 641—21.7(135) and insert "department" or "department's" in lieu thereof, as the context requires.

Item 3. Amend rule 641—21.2(135), definitions of "Brain injury" and "Reportable case," as follows:

"Brain injury" means any clinically evident brain damage resulting from trauma or anoxia which temporarily or permanently impairs a person's physical or cognitive functions clinically evident damage to the brain resulting directly or indirectly from trauma, infection, anoxia, vascular lesions, or tumor of the brain, not primarily related to a degenerative disease or aging process, which temporarily or permanently impairs a person's physical, cognitive, or behavioral functions and is diagnosed by a physician.

"Reportable case" means a person who is admitted or transferred to a hospital with a diagnosis of acute traumatic brain or spinal cord injury or a person who is pronounced dead in the emergency department of a hospital with an acute traumatic brain or spinal cord injury discharged from an Iowa hospital for an inpatient acute care, medical rehabilitation, skilled nursing care, or outpatient care visit with a diagnosis of acute brain or spinal cord injury.

Item 4. Amend rule 641—21.3(135), introductory paragraph, as follows:

641—21.3(135) Reportable brain and spinal cord injuries. The brain and spinal cord injuries listed below are required to be reported to the Iowa Department of Public Health, Division of Health Protection, Lucas State Office Building, Des Moines, Iowa 50319-0075, or its designee, as part of a statewide population-based registry.

Item 5. Rescind subrule 21.3(1) and adopt the following new subrule in lieu thereof:

21.3(1) Brain injuries.

a. Reportable cases of brain injuries are those that are identified by the following codes from the International Classification of Diseases, 9th Revision, Clinical Modification, or the International Classification of Diseases, 10th Revision, Clinical Modification:

	International Classification of Diseases, 9th Revision, Clinical Modification		International Classification of Diseases, 10th Revision, Clinical Modification
191.00	Malignant neoplasms of brain, cerebrum	C71.0	Malignant neoplasm of cerebrum, except lobes and ventricles
191.10	Malignant neoplasms of brain, frontal lobe	C71.1	Malignant neoplasm of frontal lobe
191.02	Malignant neoplasms of brain, temporal	C71.2	Malignant neoplasm of temporal
191.30	Malignant neoplasms of brain, parietal lobe	C71.3	Malignant neoplasm of parietal lobe
191.40	Malignant neoplasms of brain, occipital lobe	C71.4	Malignant neoplasm of occipital lobe
191.50	Malignant neoplasms of brain, ventricles	C71.5	Malignant neoplasm of cerebral ventricle
191.60	Malignant neoplasms of brain, cerebellum	C71.6	Malignant neoplasm of cerebellum
191.70	Malignant neoplasms of brain, brain stem	C71.7	Malignant neoplasm of brain stem
191.80	Malignant neoplasms of brain, other part of brain, includes midbrain, peduncle, and medulla oblongata	C71.8	Malignant neoplasm of overlapping sites of brain
192.00	Malignant neoplasms of brain, cranial nerves	C72.50	Malignant neoplasm of unspecified cranial nerve
192.00	Malignant neoplasms of brain, cranial nerves	C72.59	Malignant neoplasm of other cranial nerves
192.10	Malignant neoplasms of brain, cerebral meninges	C70.0	Malignant neoplasm of cerebral meninges
198.30	Secondary malignant neoplasm of brain	C79.31	Secondary malignant neoplasm of brain
198.40	Secondary malignant neoplasm of other parts of the nervous system, includes cerebral meninges	C79.32	Secondary malignant neoplasm of cerebral meninges
198.40		C79.49	Secondary malignant neoplasm of other parts of nervous system
225.00	Benign neoplasm of brain and other parts of the nervous system, brain	D33.2	Benign neoplasm of brain, unspecified
225.10	Benign neoplasm of brain and other parts of the nervous system, cranial nerves	D33.3	Benign neoplasm of cranial nerves
225.20	Benign neoplasm of brain and other parts of nervous system, cerebral meninges	D32.0	Benign neoplasm of cerebral meninges
225.20		D32.9	Benign neoplasm of meninges, unspecified
323.01-323.9	Encephalitis, myelitis and encephalomyelitis	G04.00-G05.4	Encephalitis, myelitis and encephalomyelitis
324.00	Intracranial and intraspinal abscess	G06.0	Intracranial abscess and granuloma
324.00	Intracranial and intraspinal abscess	G06.1	Intraspinal abscess and granuloma
348.10	Anoxic brain damage	G93.1	Anoxic brain damage, not elsewhere classified
430.00	Subarachnoid hemorrhage	I60.00-I60.8	Nontraumatic subarachnoid hemorrhage
431.00	Intracerebral hemorrhage	I61.0-I61.9	Nontraumatic intracerebral hemorrhage
432.00	Other and unspecified intracranial hemorrhage	I62.1	Nontraumatic extradural hemorrhage
433.00	Occlusion and stenosis of precerebral arteries	I65.01-I65.9	Occlusion and stenosis of precerebral arteries, not resulting in cerebral infarction
434.00	Occlusion of cerebral arteries	I66.01-I66.9	Occlusion and stenosis of cerebral arteries, not resulting in cerebral infarction
435.00	Transient cerebral ischemia	G45.0-G45.9	Transient cerebral ischemic attacks and related syndromes
436.00	Acute, but ill-defined, cerebrovascular disease	I67.89	Other cerebrovascular disease
436.00	Acute, but ill-defined, cerebrovascular disease	I67.9	Cerebrovascular disease, unspecified
437.00	Other and ill-defined cerebrovascular disease	I67.89	Other cerebrovascular disease
437.00	Other and ill-defined cerebrovascular disease	I67.9	Cerebrovascular disease, unspecified
800.00-800.99	Fracture of vault of skull	S02.0X XA;S02.0X XB	Fracture of vault of skull
801.00-801.99	Fracture of base of skull	S02.1-S02.19	Fracture of base of skull
803.00-803.99	Other and unqualified skull fractures	S02.91 XA	Unspecified fracture of skull
804.00-804.99	Multiple fractures involving skull or face with other bones	S02.91 XA	Unspecified fracture of skull
850.00-850.99	Concussion	S06.0X 0A-S06.0X 9A	Concussion
851.00-851.99	Cerebral laceration and contusion	S06.31-S06.33	Contusion and laceration of cerebrum
852.00-852.59	Subarachnoid, subdural, and extradural hemorrhage following injury	S06.4; S06.5; S06.6	Traumatic epidural, subdural, and subarachnoid hemorrhage
853.00-853.19	Other and unspecified intracranial hemorrhage following injury	S06.36	Traumatic hemorrhage of cerebrum, unspecified
854.00-854.19	Intracranial injury of other and unspecified nature	S06.8-S06.9	Other specified intracranial injuries and unspecified intracranial injuries

b. Reportable cases of brain injury are those that are identified by the following codes from the International Classification of Diseases, 9th Revision, Clinical Modification, or the International Classification of Diseases, 10th Revision, Clinical Modification, only to the extent the injury or condition resulted in a brain injury.

	International Classification of Diseases, 9th Revision, Clinical Modification		International Classification of Diseases, 10th Revision, Clinical Modification
960-979	Poisoning by drugs, medicinal and biological substances	T41-T44	Poisoning by, adverse effect of and underdosing of drugs and gases
980-989	Toxic effects of substances	T51; T58	Toxic effect of alcohol; toxic effect of carbon monoxide
990-995	Effects of external causes	T71	Asphyxiation
994.7	Asphyxiation and strangulation	T71	Asphyxiation
994.1	Drowning and nonfatal submersion	T75.1X XA	Unspecified effects of drowning and nonfatal submersion
995.50-995.59	Child maltreatment syndrome	T74.1; T74.4	Physical abuse, confirmed; shaken infant syndrome
995.80-995.89	Adult maltreatment syndrome	T74.1; T74.4	Physical abuse, confirmed; shaken infant syndrome

Item 6. Rescind subrule 21.3(2) and adopt the following new subrule in lieu thereof:

21.3(2) Spinal cord injuries. Reportable cases of spinal cord injuries are those that are identified by the following codes from the International Classification of Diseases, 9th Revision, Clinical Modification, or the International Classification of Diseases, 10th Revision, Clinical Modification:

a. Fracture.

(1)International Classification of Diseases, 9th Revision, Clinical Modification:

806.00-806.9

Fracture of vertebral column with spinal cord injury

(2)International Classification of Diseases, 10th Revision, Clinical Modification:

S12.000A	Unspecified displaced fracture of the first cervical vertebra, initial encounter for closed fracture
S12.000B	Unspecified displaced fracture of first cervical vertebra, initial encounter for open fracture
S12.001A	Unspecified nondisplaced fracture of first cervical vertebra, initial encounter for closed fracture
S12.001B	Unspecified nondisplaced fracture of first cervical vertebra, initial encounter for open fracture
S12.100A	Unspecified displaced fracture of second cervical vertebra, initial encounter for closed fracture
S12.100B	Unspecified displaced fracture of second cervical vertebra, initial encounter for open fracture
S12.101A	Unspecified nondisplaced fracture of second cervical vertebra, initial encounter for closed fracture
S12.101B	Unspecified nondisplaced fracture of second cervical vertebra, initial encounter for open fracture
S12.200A	Unspecified displaced fracture of third cervical vertebra, initial encounter for closed fracture
S12.200B	Unspecified displaced fracture of third cervical vertebra, initial encounter for open fracture
S12.201A	Unspecified nondisplaced fracture of third cervical vertebra, initial encounter for closed fracture
S12.201B	Unspecified nondisplaced fracture of third cervical vertebra, initial encounter for open fracture
S12.300A	Unspecified displaced fracture of fourth cervical vertebra, initial encounter for closed fracture
S12.300B	Unspecified displaced fracture of fourth cervical vertebra, initial encounter for open fracture
S12.301A	Unspecified nondisplaced fracture of fourth cervical vertebra, initial encounter for closed fracture
S12.301B	Unspecified nondisplaced fracture of fourth cervical vertebra, initial encounter for open fracture
S12.400A	Unspecified displaced fracture of fifth cervical vertebra, initial encounter for closed fracture
S12.400B	Unspecified displaced fracture of fifth cervical vertebra, initial encounter for open fracture
S12.401A	Unspecified nondisplaced fracture of fifth cervical vertebra, initial encounter for closed fracture
S12.401B	Unspecified nondisplaced fracture of fifth cervical vertebra, initial encounter for open fracture
S12.500A	Unspecified displaced fracture of sixth cervical vertebra, initial encounter for closed fracture
S12.500B	Unspecified displaced fracture of sixth cervical vertebra, initial encounter for open fracture
S12.501A	Unspecified nondisplaced fracture of sixth cervical vertebra, initial encounter for closed fracture
S12.501B	Unspecified nondisplaced fracture of sixth cervical vertebra, initial encounter for open fracture
S12.600A	Unspecified displaced fracture of seventh cervical vertebra, initial encounter for closed fracture
S12.600B	Unspecified displaced fracture of seventh cervical vertebra, initial encounter for open fracture
S12.601A	Unspecified nondisplaced fracture of seventh cervical vertebra, initial encounter for closed fracture
S12.601B	Unspecified nondisplaced fracture of seventh cervical vertebra, initial encounter for open fracture
S12.9XXA	Fracture of neck, unspecified, initial encounter
S14.101A	Unspecified injury at C1 level of cervical spinal cord, initial encounter
S14.102A	Unspecified injury at C2 level of cervical spinal cord, initial encounter
S14.103A	Unspecified injury at C3 level of cervical spinal cord, initial encounter
S14.104A	Unspecified injury at C4 level of cervical spinal cord, initial encounter
S14.105A	Unspecified injury at C5 level of cervical spinal cord, initial encounter
S14.106A	Unspecified injury at C6 level of cervical spinal cord, initial encounter
S14.107A	Unspecified injury at C7 level of cervical spinal cord, initial encounter
S14.109A	Unspecified injury at unspecified level of cervical spinal cord, initial encounter
S14.111A	Complete lesion at C1 level of cervical spinal cord, initial encounter
S14.112A	Complete lesion at C2 level of cervical spinal cord, initial encounter
S14.113A	Complete lesion at C3 level of cervical spinal cord, initial encounter
S14.114A	Complete lesion at C4 level of cervical spinal cord, initial encounter
S14.115A	Complete lesion at C5 level of cervical spinal cord, initial encounter
S14.116A	Complete lesion at C6 level of cervical spinal cord, initial encounter
S14.117A	Complete lesion at C7 level of cervical spinal cord, initial encounter
S14.121A	Central cord syndrome at C1 level of cervical spinal cord, initial encounter
S14.122A	Central cord syndrome at C2 level of cervical spinal cord, initial encounter
S14.123A	Central cord syndrome at C3 level of cervical spinal cord, initial encounter
S14.124A	Central cord syndrome at C4 level of cervical spinal cord, initial encounter
S14.125A	Central cord syndrome at C5 level of cervical spinal cord, initial encounter
S14.126A	Central cord syndrome at C6 level of cervical spinal cord, initial encounter
S14.127A	Central cord syndrome at C7 level of cervical spinal cord, initial encounter
S14.131A	Anterior cord syndrome at C1 level of cervical spinal cord, initial encounter
S14.132A	Anterior cord syndrome at C2 level of cervical spinal cord, initial encounter
S14.133A	Anterior cord syndrome at C3 level of cervical spinal cord, initial encounter
S14.134A	Anterior cord syndrome at C4 level of cervical spinal cord, initial encounter
S14.135A	Anterior cord syndrome at C5 level of cervical spinal cord, initial encounter
S14.136A	Anterior cord syndrome at C6 level of cervical spinal cord, initial encounter
S14.137A	Anterior cord syndrome at C7 level of cervical spinal cord, initial encounter
S14.151A	Other incomplete lesion at C1 level of cervical spinal cord, initial encounter
S14.152A	Other incomplete lesion at C2 level of cervical spinal cord, initial encounter
S14.153A	Other incomplete lesion at C3 level of cervical spinal cord, initial encounter
S14.154A	Other incomplete lesion at C4 level of cervical spinal cord, initial encounter
S14.155A	Other incomplete lesion at C5 level of cervical spinal cord, initial encounter
S14.156A	Other incomplete lesion at C6 level of cervical spinal cord, initial encounter
S14.157A	Other incomplete lesion at C7 level of cervical spinal cord, initial encounter
S22.009A	Unspecified fracture of unspecified thoracic vertebra, initial encounter for closed fracture
S22.009B	Unspecified fracture of unspecified thoracic vertebra, initial encounter for open fracture
S22.019A	Unspecified fracture of first thoracic vertebra, initial encounter for closed fracture
S22.019B	Unspecified fracture of first thoracic vertebra, initial encounter for open fracture
S22.029A	Unspecified fracture of second thoracic vertebra, initial encounter for closed fracture
S22.029B	Unspecified fracture of second thoracic vertebra, initial encounter for open fracture
S22.039A	Unspecified fracture of third thoracic vertebra, initial encounter for closed fracture
S22.039B	Unspecified fracture of third thoracic vertebra, initial encounter for open fracture
S22.049A	Unspecified fracture of fourth thoracic vertebra, initial encounter for closed fracture
S22.049B	Unspecified fracture of fourth thoracic vertebra, initial encounter for open fracture
S22.059A	Unspecified fracture of T5-T6 vertebra, initial encounter for closed fracture
S22.059B	Unspecified fracture of T5-T6 vertebra, initial encounter for open fracture
S22.069A	Unspecified fracture of T7-T8 vertebra, initial encounter for closed fracture
S22.069B	Unspecified fracture of T7-T8 vertebra, initial encounter for open fracture
S22.079A	Unspecified fracture of T9-T10 vertebra, initial encounter for closed fracture
S22.079B	Unspecified fracture of T9-T10 vertebra, initial encounter for open fracture
S22.089A	Unspecified fracture of T11-T12 vertebra, initial encounter for closed fracture
S22.089B	Unspecified fracture of T11-T12 vertebra, initial encounter for open fracture
S24.101A	Unspecified injury at T1 level of thoracic spinal cord, initial encounter
S24.102A	Unspecified injury at T2-T6 level of thoracic spinal cord, initial encounter
S24.103A	Unspecified injury at T7-T10 level of thoracic spinal cord, initial encounter
S24.104A	Unspecified injury at T11-T12 level of thoracic spinal cord, initial encounter
S24.109A	Unspecified injury at unspecified level of thoracic spinal cord, initial encounter
S24.111A	Complete lesion at T1 level of thoracic spinal cord, initial encounter
S24.112A	Complete lesion at T2-T6 level of thoracic spinal cord, initial encounter
S24.113A	Complete lesion at T7-T10 level of thoracic spinal cord, initial encounter
S24.114A	Complete lesion at T11-T12 level of thoracic spinal cord, initial encounter
S24.131A	Anterior cord syndrome at T1 level of thoracic spinal cord, initial encounter
S24.132A	Anterior cord syndrome at T2-T6 level of thoracic spinal cord, initial encounter
S24.133A	Anterior cord syndrome at T7-T10 level of thoracic spinal cord, initial encounter
S24.134A	Anterior cord syndrome at T11-T12 level of thoracic spinal cord, initial encounter
S24.151A	Other incomplete lesion at T1 level of thoracic spinal cord, initial encounter
S24.152A	Other incomplete lesion at T2-T6 level of thoracic spinal cord, initial encounter
S24.153A	Other incomplete lesion at T7-T10 level of thoracic spinal cord, initial encounter
S24.154A	Other incomplete lesion at T11-T12 level of thoracic spinal cord, initial encounter
S32.009A	Unspecified fracture of unspecified lumbar vertebra, initial encounter for closed fracture
S32.009B	Unspecified fracture of unspecified lumbar vertebra, initial encounter for open fracture
S32.10XA	Unspecified fracture of sacrum, initial encounter for closed fracture
S32.10XB	Unspecified fracture of sacrum, initial encounter for open fracture
S32.019A	Unspecified fracture of first lumbar vertebra, initial encounter for closed fracture
S32.019B	Unspecified fracture of first lumbar vertebra, initial encounter for open fracture
S32.029A	Unspecified fracture of second lumbar vertebra, initial encounter for closed fracture
S32.029B	Unspecified fracture of second lumbar vertebra, initial encounter for open fracture
S32.039A	Unspecified fracture of third lumbar vertebra, initial encounter for closed fracture
S32.039B	Unspecified fracture of third lumbar vertebra, initial encounter for open fracture
S32.049A	Unspecified fracture of fourth lumbar vertebra, initial encounter for closed fracture
S32.049B	Unspecified fracture of fourth lumbar vertebra, initial encounter for open fracture
S32.059A	Unspecified fracture of fifth lumbar vertebra, initial encounter for closed fracture
S32.059B	Unspecified fracture of fifth lumbar vertebra, initial encounter for open fracture
S32.2XXA	Fracture of coccyx, initial encounter for closed fracture
S32.2XXB	Fracture of coccyx, initial encounter for open fracture
S34.101A	Unspecified injury to L1 level of lumbar spinal cord, initial encounter
S34.102A	Unspecified injury to L2 level of lumbar spinal cord, initial encounter
S34.103A	Unspecified injury to L3 level of lumbar spinal cord, initial encounter
S34.104A	Unspecified injury to L4 level of lumbar spinal cord, initial encounter
S34.105A	Unspecified injury to L5 level of lumbar spinal cord, initial encounter
S34.109A	Unspecified injury to unspecified level of lumbar spinal cord, initial encounter
S34.111A	Complete lesion of L1 level of lumbar spinal cord, initial encounter
S34.112A	Complete lesion of L2 level of lumbar spinal cord, initial encounter
S34.113A	Complete lesion of L3 level of lumbar spinal cord, initial encounter
S34.114A	Complete lesion of L4 level of lumbar spinal cord, initial encounter
S34.115A	Complete lesion of L5 level of lumbar spinal cord, initial encounter
S34.119A	Complete lesion of unspecified level of lumbar spinal cord, initial encounter
S34.121A	Incomplete lesion of L1 level of lumbar spinal cord, initial encounter
S34.122A	Incomplete lesion of L2 level of lumbar spinal cord, initial encounter
S34.123A	Incomplete lesion of L3 level of lumbar spinal cord, initial encounter
S34.124A	Incomplete lesion of L4 level of lumbar spinal cord, initial encounter
S34.125A	Incomplete lesion of L5 level of lumbar spinal cord, initial encounter
S34.129A	Incomplete lesion of unspecified level of lumbar spinal cord, initial encounter
S34.131A	Complete lesion of sacral spinal cord, initial encounter
S34.132A	Incomplete lesion of sacral spinal cord, initial encounter
S34.139A	Unspecified injury to sacral spinal cord, initial encounter
S34.3XXA	Injury of cauda equina, initial encounter

b. Spinal cord injury.

(1)International Classification of Diseases, 9th Revision, Clinical Modification:

952.00-952.9

Spinal cord injury without evidence of spinal bone injury

(2)International Classification of Diseases, 10th Revision, Clinical Modification:

S14.101A	Unspecified injury at C1 level of cervical spinal cord, initial encounter
S14.102A	Unspecified injury at C2 level of cervical spinal cord, initial encounter
S14.103A	Unspecified injury at C3 level of cervical spinal cord, initial encounter
S14.104A	Unspecified injury at C4 level of cervical spinal cord, initial encounter
S14.105A	Unspecified injury at C5 level of cervical spinal cord, initial encounter
S14.106A	Unspecified injury at C6 level of cervical spinal cord, initial encounter
S14.107A	Unspecified injury at C7 level of cervical spinal cord, initial encounter
S14.108A	Unspecified injury at C8 level of cervical spinal cord, initial encounter
S14.109A	Unspecified injury at unspecified level of cervical spinal cord, initial encounter
S14.111A	Complete lesion at C1 level of cervical spinal cord, initial encounter
S14.112A	Complete lesion at C2 level of cervical spinal cord, initial encounter
S14.113A	Complete lesion at C3 level of cervical spinal cord, initial encounter
S14.114A	Complete lesion at C4 level of cervical spinal cord, initial encounter
S14.115A	Complete lesion at C5 level of cervical spinal cord, initial encounter
S14.116A	Complete lesion at C6 level of cervical spinal cord, initial encounter
S14.117A	Complete lesion at C7 level of cervical spinal cord, initial encounter
S14.118A	Complete lesion at C8 level of cervical spinal cord, initial encounter
S14.121A	Central cord syndrome at C1 level of cervical spinal cord, initial encounter
S14.122A	Central cord syndrome at C2 level of cervical spinal cord, initial encounter
S14.123A	Central cord syndrome at C3 level of cervical spinal cord, initial encounter
S14.124A	Central cord syndrome at C4 level of cervical spinal cord, initial encounter
S14.125A	Central cord syndrome at C5 level of cervical spinal cord, initial encounter
S14.126A	Central cord syndrome at C6 level of cervical spinal cord, initial encounter
S14.127A	Central cord syndrome at C7 level of cervical spinal cord, initial encounter
S14.128A	Central cord syndrome at C8 level of cervical spinal cord, initial encounter
S14.131A	Anterior cord syndrome at C1 level of cervical spinal cord, initial encounter
S14.132A	Anterior cord syndrome at C2 level of cervical spinal cord, initial encounter
S14.133A	Anterior cord syndrome at C3 level of cervical spinal cord, initial encounter
S14.134A	Anterior cord syndrome at C4 level of cervical spinal cord, initial encounter
S14.135A	Anterior cord syndrome at C5 level of cervical spinal cord, initial encounter
S14.136A	Anterior cord syndrome at C6 level of cervical spinal cord, initial encounter
S14.137A	Anterior cord syndrome at C7 level of cervical spinal cord, initial encounter
S14.138A	Anterior cord syndrome at C8 level of cervical spinal cord, initial encounter
S14.151A	Other incomplete lesion at C1 level of cervical spinal cord, initial encounter
S14.152A	Other incomplete lesion at C2 level of cervical spinal cord, initial encounter
S14.153A	Other incomplete lesion at C3 level of cervical spinal cord, initial encounter
S14.154A	Other incomplete lesion at C4 level of cervical spinal cord, initial encounter
S14.155A	Other incomplete lesion at C5 level of cervical spinal cord, initial encounter
S14.156A	Other incomplete lesion at C6 level of cervical spinal cord, initial encounter
S14.157A	Other incomplete lesion at C7 level of cervical spinal cord, initial encounter
S14.158A	Other incomplete lesion at C8 level of cervical spinal cord, initial encounter
S24.101A	Unspecified injury at T1 level of thoracic spinal cord, initial encounter
S24.102A	Unspecified injury at T2-T6 level of thoracic spinal cord, initial encounter
S24.103A	Unspecified injury at T7-T10 level of thoracic spinal cord, initial encounter
S24.104A	Unspecified injury at T11-T12 level of thoracic spinal cord, initial encounter
S24.109A	Unspecified injury at unspecified level of thoracic spinal cord, initial encounter
S24.111A	Complete lesion at T1 level of thoracic spinal cord, initial encounter
S24.112A	Complete lesion at T2-T6 level of thoracic spinal cord, initial encounter
S24.113A	Complete lesion at T7-T10 level of thoracic spinal cord, initial encounter
S24.114A	Complete lesion at T11-T12 level of thoracic spinal cord, initial encounter
S24.131A	Anterior cord syndrome at T1 level of thoracic spinal cord, initial encounter
S24.132A	Anterior cord syndrome at T2-T6 level of thoracic spinal cord, initial encounter
S24.133A	Anterior cord syndrome at T7-T10 level of thoracic spinal cord, initial encounter
S24.134A	Anterior cord syndrome at T11-T12 level of thoracic spinal cord, initial encounter
S24.151A	Other incomplete lesion at T1 level of thoracic spinal cord, initial encounter
S24.152A	Other incomplete lesion at T2-T6 level of thoracic spinal cord, initial encounter
S24.153A	Other incomplete lesion at T7-T10 level of thoracic spinal cord, initial encounter
S24.154A	Other incomplete lesion at T11-T12 level of thoracic spinal cord, initial encounter
S34.109A	Unspecified injury to unspecified level of lumbar spinal cord, initial encounter
S34.139A	Unspecified injury to sacral spinal cord, initial encounter
S34.3XXA	Injury of cauda equina, initial encounter

Item 7. Strike "traumatic" wherever it appears in rule 641—21.4(135), subrule 21.6(1), and paragraph 21.6(2)"g."

Item 8. Rescind rule 641—21.5(135) and adopt the following new rule in lieu thereof:

641—21.5(135) Method and frequency of reporting.

21.5(1) To the extent possible, activities conducted under this chapter shall be coordinated with other health data collection methods. The department shall obtain brain and spinal cord injury data from the Iowa Hospital Association pursuant to 641—Chapter 177, and the association shall serve as the department's intermediary in the collection of brain and spinal cord injury data.

21.5(2) Hospitals shall report to the Iowa Hospital Association the required information for any reportable case of brain injury or spinal cord injury no later than 45 days after the end of the quarter during which the patient was discharged, transferred to another acute care hospital, or pronounced dead in the emergency department.

21.5(3) Reports shall meet the data quality, format, and timeliness standards prescribed by the department and the Iowa Hospital Association.

Item 9. Amend subrule 21.6(2), introductory paragraph, as follows:

21.6(2) A registry report of a traumatic brain or spinal cord injury that which is submitted to the agency that department and which can be associated with a particular individual shall be released as follows solely by the department and only under the following conditions:

Item 10. Rescind paragraph 21.6(2)"e" and adopt the following new paragraph in lieu thereof:

e. To an authorized representative of a study or research project that shall be reviewed and approved by the department's research and ethics review committee and approved by the director of the division of behavioral health. If information identifies individuals with brain or spinal cord injuries, the release of such information for research purposes shall be subject to the terms and conditions set by the department. Such study or research project shall maintain the identifying information as confidential and privileged.

Item 11. Rescind paragraph 21.6(2)"f."

Item 12. Reletter paragraph 21.6(2)"g" as 21.6(2)"f."

Item 13. Amend 641—Chapter 21, implementation sentence, as follows:

These rules are intended to implement Iowa Code section 135.22 as amended by 1994 Iowa Acts, House File 2145.

[Filed 7/14/16, effective 9/7/16]

[Published 8/3/16]

Editor's Note: For replacement pages for IAC, see IAC Supplement 8/3/16.