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Scientific Data Documentation
National Survey of Ambulatory Surgery, 1996 1996 NATIONAL SURVEY OF AMBULATORY SURGERY
PUBLIC USE DATA TAPE DOCUMENTATION

Abstract

This material provides documentation for users of the 1996 NSAS Public Use Data Tape. The NSAS was implemented by the National Center for Health Statistics (NCHS) in 1994. It covers ambulatory surgery procedures performed in hospitals and free-standing ambulatory surgery centers in the United States.

Section I describes the survey and includes information on the history and scope of the NSAS; the survey methodology, data collection and medical coding procedures; population estimates, measurement errors, and sampling errors.

Section II provides technical details of the tape.

Section III provides a detailed description of the contents of each data record.

Appendix A defines certain terms used in this document;
Appendix B contains the ICD-9-CM Addenda;
Appendix C provides population estimates to allow the user to calculate rates; and
Appendix D provides unweighted and weighted frequencies for selected descriptive variables.

I. Description of the National Survey of Ambulatory Surgery

Introduction. This document describes the 1996 National Survey of Ambulatory Surgery (NSAS) and provides information for users of the 1996 NSAS public use data file. This survey, conducted by the National Center for Health Statistics (NCHS) and implemented in 1994, covers ambulatory surgery procedures performed in hospitals and in free-standing ambulatory surgery centers in the United States. A brief description of the survey design and data collection procedures is given below. A more detailed description of the survey design, data collection procedures, and the estimation process has been published (1).

History. The National Survey of Ambulatory Surgery was undertaken to obtain information about the use of ambulatory surgery. Ambulatory, or outpatient, surgery has increased in the United States since the early 1980's. Two major reasons for this increase were advances in medical technology and cost containment initiatives.

On the medical side, many surgeries performed for hospital inpatients have moved to outpatient settings. This is due, in part, to the fact that improvements in anesthesia and better analgesics for relief of pain have made surgery less complex and risky (2). Also, minimally invasive and non-invasive procedures, such as laser surgery, laparoscopy, and endoscopy, have been developed and are being performed with increasing frequency.

On the cost side, concern about rising health care costs led to changes in the Medicare program that encouraged the use of ambulatory surgery (3). In 1982 the Medicare program was expanded to cover care in ambulatory surgery centers. In 1983, a prospective payment system based on diagnosis-related groups (DRG's) was adopted for hospital inpatient care. This system created strong financial incentives for hospitals to perform less complex surgery in an ambulatory setting. In the mid-1980's, the peer review organizations for Medicare established outpatient settings as the norm for certain surgeries and denied Medicare payment for hospital admissions deemed inappropriate or medically unnecessary. Many State Medicaid plans and private insurers followed the lead of the Medicare program and adopted similar policies.

As these changes went into effect, freestanding ambulatory surgery centers increased in number, from 239 centers that performed 380,000 procedures in 1983, to over 1,800 centers performing more than 3.2 million procedures ten years later (4). The number of ambulatory surgery procedures done in hospitals and freestanding settings combined rose from 5.4 million in 1983 to 16.2 million in 1993 (5).

The National Hospital Discharge Survey (NHDS), which has been conducted by the National Center for Health Statistics every year since 1965, includes information on procedures performed on inpatients (6). The NHDS remains a good source of data for surgical procedures, such as open-heart surgery or cesarean sections, that must be done on an inpatient basis. But for surgeries that can be performed on an ambulatory basis, NHDS estimates are incomplete. Thus the National Survey of Ambulatory Surgery was undertaken to provide data on the increasing use of this type of health care.

SURVEY METHODOLOGY

Source of the Data. The NSAS covers ambulatory surgery procedures performed in hospitals and free-standing ambulatory surgery centers (FSASC). The hospital universe includes noninstitutional hospitals exclusive of Federal, military, and Department of Veterans Affairs hospitals, located in the 50 States and the District of Columbia. Only short-stay hospitals (hospitals with an average length of stay for all patients of less than 30 days) or those whose specialty is general (medical or surgical) or children's general are included in the survey. These hospitals must also have six beds or more staffed for patient use. The universe definition is the same as that used for the National Hospital Discharge Survey. The sampling frame for the hospital universe consisted of eligible hospitals listed in the 1993 SMG Hospital Market Database (7).

The universe of freestanding facilities includes FSASCs that are regulated by the States or certified by HCFA, the Health Care Financing Administration, for Medicare participation. The sampling frame consisted of facilities listed in the 1993 Freestanding Outpatient Surgery Center Database (8) and Medicare-certified facilities included in the HCFA Provider-of-Services (POS) file (9). Facilities specializing in dentistry, podiatry, abortion, family planning, or birthing are excluded. However, these procedures are not excluded from in-scope locations.

Sample design and data collection. The NSAS samples facilities using a multi-stage probability design with some facilities selected with certainty and others sampled with varying selection probabilities. Independent samples of hospitals and free-standing ambulatory surgery centers were drawn. The sample includes with certainty facilities which perform a high volume of ambulatory surgeries annually. Non-certainty facilities are selected using a stratified, cluster design, where the clusters are 198 primary sampling units (PSUs) that comprise the sample of PSUs used in the 1985-1996 National Health Interview Survey (NHIS). PSUs are counties or groups of counties, or county equivalents, or towns and townships (the latter in New England and Hawaii).

Noncertainty facilities were stratified by facility type (hospital versus freestanding), ambulatory surgery status of hospitals (i.e. whether or not the hospital performed such surgery), facility specialty, and geographic region. From each stratum containing fewer than six facilities, up to three facilities were selected by means of systematic random sampling, with selection probabilities proportional to size, where size is the number of ambulatory surgeries performed annually. For strata containing six or more facilities, first stage sampling involved selection of 112 PSUs, which are a probability subsample of the 198 PSUs in the 1985-94 NHIS sample. Some of these PSUs were sampled with certainty. Selection of noncertainty PSUs was performed within PSU strata defined within the four geographic regions by the number of people in the 1980 Census of Population and NHIS stratification variables. From each PSU stratum, the PSUs were selected with probability proportional to the projected 1985 population. The hospital sample is clustered within a probability subsample of 112 of those PSUs.

The second stage of the cluster design consisted of selection of noncertainty facilities from the sampled PSUs, using systematic random sampling with probabilities proportional to the annual number of ambulatory surgeries performed. For both hospitals and FSASCs, up to three facilities of each type and specialty were selected from each non-certainty PSU and up to 15 facilities were selected across the combined certainty PSUs in each region. For the stratum of hospitals which, according to the sampling frame data, did not have ambulatory surgery, a national sample of 50 hospitals was selected to permit estimates of surgery in hospitals that either change their status or differ from frame data. Any sampled facility which performed less than 50 ambulatory surgeries in the year prior to the data collection year was considered out-of-scope for the data collection year.

Within sampled facilities, a sample of ambulatory surgery visits was selected using a systematic random sampling procedure. Selection of visits within each facility was performed separately for each location where ambulatory surgery is performed. These locations include: main operating rooms, dedicated ambulatory surgery units, cardiac catherization laboratories, laser procedure rooms, endoscopy and laparoscopy rooms, etc. Locations within facilities that specialize in or are dedicated to inpatients, dentistry, abortion, podiatry, pain block, or small procedures are excluded. However, as mentioned above, these procedures are not excluded from in-scope locations.

Following selection of ambulatory surgery visits, data was abstracted from the medical record for each visit. The Medical Abstract Form used in data collection is shown in Figure 1. It contains items relating to the personal characteristics of the patient, including birth date or age, sex, race, zipcode, but not name and address; administrative information, including the date of the surgery, dispostion of the patient, and medical record number; principal and other additional expected sources of payment; and medical information, including diagnoses and surgical and nonsurgical procedures performed, as well as types of anesthesia administered and by whom. The medical record number, date of birth, and patient zip code, are confidential information and are not available to the public.

Response Rate. The 1996 NSAS sample included 332 ASCs from the 1,732 facilities in the 1993 FSASC sampling frame; and 418 hospitals from the 6,267 listed in the 1993 hospital sampling frame. Of the 750 sampled facilities, 150 were found to be out-of-scope for the NSAS. Nineteen percent of the 600 in-scope facilities were nonresponding in 1996. The number of hospitals responding in 1996 was 298, which was 91 percent of the 329 in-scope hospitals. The number of FSASCs responding in 1996 was 190, which represented 70 percent of the 272 in-scope FSASCs.

Medical Coding and Edit. The medical information abstracted from the sampled medical records was coded centrally by NCHS contract staff. A maximum of seven diagnostic codes and six procedure codes was assigned for each sampled abstract. The system currently used for coding the diagnoses and procedures on the medical abstract forms is the International Classification of Diseases, 9th Revision, Clinical Modification, or ICD-9-CM (10).

Following conversion of the data on the medical abstract to computer tape, a final medical edit was accomplished by computer inspection and by a manual review of rejected records. Priority was given to medical information in the editing decision.

Users of the NSAS diagnostic and/or procedure data must take into account annual ICD-9-CM addenda. The addenda lists new codes, new fourth or fifth digits to existing codes, as well as other modifications. Changes go into effect October 1 of the calendar year. However, in order to preserve consistent coding throughout the data year, the NSAS coding for 1996 data is consistent with the ICD-9-CM and the Addenda through October 1, 1995. Appendix B lists the changes for 1986 through 1995.

Population Estimates. Appendix C shows population estimates provided by the U.S. Bureau of the Census. The estimates are of the U.S. civilian resident population on July l of the data year. These population estimates are consistent with those published in Current Population Reports, Series P-25; however, they are not official population estimates of the Bureau of the Census.

Measurement Errors and Limitations of the Data. As in any survey, results are subject to nonsampling or measurement errors, which include errors due to facility nonresponse, missing abstracts, information incompletely or inaccurately recorded on abstract forms, and processing errors.

In a very small number of records, the age or sex of the patient was missing. For these records, a legitimate value was imputed in such a way as to preserve the original, known distribution of the variable. Fewer than two percent of the records have an imputed age or sex value.

Forty-two percent of the records were missing a value for race of the patient. No attempt was made to impute for these missing values.

Figure 1. Medical abstract for the 1996 National Survey of Ambulatory Surgery

The determination of whether an ambulatory surgery facility is a hospital or a freestanding center is based on the SMG universe from which the facility is selected. In most cases it is apparent whether a facility is a hospital or a freestanding ambulatory surgery center, but some facilities are not easily classified. For example, a "freestanding" facility may be owned by a hospital but located some distance away. If such a facility is separately listed in the 1993 SMG Freestanding Outpatient Surgery Center Database and is selected into the NSAS sample from this universe, it is considered a freestanding facility.

The distinction between ambulatory and inpatient surgery is not always clear. According to the 1996 NSAS, an estimated 1.9 percent of ambulatory surgery visits were for patients subsequently admitted to the hospital as inpatients. Some of these patients had procedures which are currently performed exclusively on inpatients, such as coronary artery bypass graft, in addition to diagnostic procedures such as cardiac catheterization. These visits and their suspected "inpatient" procedures have not been eliminated from the data file because they are operationally part of the survey design. It is left to the prerogative of the researcher whether or not to include these procedures in an analysis. In NCHS publications for the 1994 NSAS, patients discharged to inpatient status were included in estimates of visits and procedures. For the 1995 and 1996 NSAS, these visits were excluded from all tabulations.

Sampling errors. Statistics from the NSAS are derived by a multistage estimation procedure that produces essentially unbiased estimates. The estimation procedure has three basic components: (a) inflation by reciprocals of the probabilities of sample selection, (b) adjustment for nonresponse, and (c) population weighting ratio adjustments.

The standard error of a statistic is primarily a measure of sampling variability that occurs by chance because only a sample rather than the entire universe is surveyed. The relative standard error of the estimate is obtained by dividing the standard error by the estimate itself. The resulting value is multiplied by 100, so the relative standard error (RSE) is expressed as a percent of the estimate. Estimates of sampling variability were calculated with SUDAAN software, which computes standard errors by using a first-order Taylor series approximation of the deviation of estimates from their expected values. A description of the software and the approach it uses has been published (11).

Relative Standard Errors for Aggregate Estimates

Table 1 presents parameter estimates to be used in formulae for deriving the approximate relative standard errors for aggregate estimates. To provide error estimates that would be applicable to a wide variety of statistics, numerous variances were calculated and the best fit formula was derived. The formula is based on an empirically determined relationship between the size of an estimate X and its relative variance. The relative standard error is then derived by taking the square root of the relative variance. The relative standard error of an estimate X [RSE(X)], expressed as a percent, may be calculated from the formula:

with a and b provided in Table 1.

For example, in 1996 the estimated number of ambulatory surgery visits to hospitals and free-standing ambulatory surgery centers by persons aged 65 and over with a first-listed diagnosis of cataracts (ICD-9-CM code 366) was 1,952,000 (excluding those visits admitted to hospitals as inpatients). Using the applicable constants from Table 1 for estimates by age produces:

RSE(1,952,000) = 6.58 %

The relative standard error for the estimate of interest is 6.58 percent. From this the standard error is obtained by multiplying the relative standard error by the estimate:

SE(1,952,000) = 1,952,000 * 6.58 % = 128,442

The standard error can be employed to generate confidence intervals for statistical testing. In this example, the 95% confidence interval for the estimate of the total number visits by persons aged 65 and over with a first-listed diagnosis of cataracts is:

(1,952,000 - 2*128,442)<-> (1,952,000 + 2*128,442)

1,695,116<->2,208,884

Relative Standard Error for Estimates of Percents

Approximate relative standard errors for estimates of percents may be calculated from Table 1 also. The relative standard error for a percent, 100 p (0<p<1), (expressed as a percent), may be calculated using the formula:

where 100p is the percent of interest, X is the base of the percent, and b is the parameter value, b, given in Table 1.

For example, in 1996 the estimated number of ambulatory surgery visits by persons 65 years old and over was 6,998,000 (excluding those admitted to hospitals as inpatients). This is 33.6 percent of the estimated 20,838,000 visits for that year. Using the applicable constants from Table 1 for estimates by age produces:

RSE (.336) = 0.655%

The relative standard error for the estimate of interest is 0.655 percent. From this the standard error is obtained by multiplying the relative standard error by the estimate:

SE(.336) = .336 * 0.655 % = .0022

The standard error can be employed to generate confidence intervals for statistical testing. In this example, the 95% confidence interval for the estimate of the percentage of ambulatory surgery visits by persons in the 65 and over age group is:

(.336 - 2*.0022) <-> (.336 + 2*.0022)

.332 <-> .340

or, equivalently, 33.2% <->34.0%

Table 1. Estimated parameters for relative standard error formulae for National Survey of Ambulatory Surgery aggregate  
              statistics by statistic type: United States, 1996

Characteristic	First-listed diagnoses TOTAL		All-listed procedures TOTAL		First-listed diagnoses Hospital		All-listed procedures Hospital		First-listed diagnoses Freestanding		All-listed procedures Freestanding
	a	b	a	b	a	b	a	b	a	b	a	b
TOTAL	0.00362	515.109	0.00356	644.341	0.00914	695.494	0.00413	659.574	0.04372	130.840	0.02120	103.392
SEX
Male	0.00329	551.613	0.00366	563.173	0.00379	579.559	0.00424	588.725	0.01632	159.005	0.01849	154.071
Female	0.00638	684.723	0.00366	563.173	0.00851	598.747	0.00424	588.725	0.01632	159.005	0.01849	154.071
AGE
Under 15 Years	0.00417	359.202	0.00516	338.199	0.00451	385.025	0.00580	346.482	0.02270	151.749	0.01975	154.088
15-44 years	0.00368	493.767	0.00402	544.278	0.00404	526.481	0.00432	602.045	0.01567	151.412	0.01975	154.088
45-64 years	0.00342	549.183	0.00445	502.229	0.00398	586.678	0.00501	577.548	0.01567	151.412	0.01757	153.988
65 years and over	0.00410	452.924	0.00458	439.690	0.00512	468.762	0.00559	464.666	0.05699	77.782	0.06462	94.912
REGION
Northeast	0.01370	397.969	0.01245	523.405	0.01479	402.828	0.02186	606.764	0.04601	220.357	0.05544	115.495
Midwest	0.00100	1,055.211	0.01851	787.293	0.00199	1,044.057	0.01421	458.817	0.04788	178.682	0.05544	115.495
South	0.01985	507.941	0.01201	384.235	0.01479	402.828	0.01325	391.794	0.04597	149.763	0.03901	78.268
West	0.01267	405.414	0.01601	378.322	0.01479	402.828	0.02117	396.008	0.04601	220.357	0.05176	127.581
EXP SOURCE OF PYMT
WC	0.00866	348.044	0.01342	433.164	0.01494	468.010	0.01606	496.465	0.02812	178.616	0.03380	132.951
Medicare	0.00497	417.136	0.00548	400.935	0.00607	436.564	0.00660	424.813	0.02371	129.197	0.02350	141.168
Medicaid	0.00866	348.044	0.00951	309.740	0.00741	341.659	0.01053	314.720	0.02812	178.616	0.03380	132.951
Othr Govt	0.00866	348.044	0.01342	433.164	0.01494	468.010	0.01606	496.465	0.02812	178.616	0.03380	132.951
Private Insurance	0.00277	850.458	0.00481	567.757	0.00430	619.704	0.00548	617.649	0.03018	202.646	0.01885	160.261
Self-Pay	0.00866	348.044	0.01342	433.164	0.01494	468.010	0.01606	496.465	0.02812	178.616	0.03380	132.951
NC/Other	0.00866	348.044	0.01342	433.164	0.01494	468.010	0.01606	496.465	0.02812	178.616	0.03380	132.951
Not Stated	0.09954	389.357	0.08124	279.306	0.01494	468.010	0.09493	244.499	0.02812	178.616	0.20987	424.040

Presentation of Estimates. Publication of estimates for the NSAS is based on the relative standard error of the estimate and the number of sample records on which the estimate is based (referred to as the sample size). Estimates are not presented in NCHS reports unless a reasonable assumption regarding the probability distribution of the sampling error is possible.

Based on consideration of the complex sample design of the NSAS, the following guidelines are used for presenting the NSAS estimates:

If the sample size is less than 30, the value of the estimate is not reported.

If the sample size is 30-59, the value of the estimate is reported but should not be assumed reliable.

If the sample size is 60 or more and the relative standard error is less than 30 percent, the estimate is reported.

If the sample size is 60 or more but the relative standard error is over 30 percent, the estimate is reported but should not be assumed reliable.

How to Use the Data Tape. The NSAS records are weighted to allow inflation to national or regional estimates. The weight applied to each record is found in tape location 21-25. To produce an estimate of the number of visits, the weights for the desired records must be summed.

Appendix D contains unweighted and weighted frequencies for selected descriptive variables on the data tape. These may be used as a cross-check when processing the data on the user's system.

Questions. Questions concerning data on the tape should be directed to Maria Owings, Ph.D., Hospital Care Statistics Branch, Division of Health Care Statistics, National Center for Health Statistics, Presidential Building, Room 956, 6525 Belcrest Road, Hyattsville, Maryland 20782, (301)-436-7125.


REFERENCES

1. McLemore T and Lawrence L. Plan and Operation of the National Survey of Ambulatory Surgery. Vital and Health
    Statistics, Series 1, No. 37. Hyattsville, MD: National Center for Health Statistics. 1997.

2. New surgical technologies reshape hospital strategies. Hospitals 66(9):30-36, 38, 40-42. 1992.

3. Leader S and Moon M. Medicare trends in ambulatory surgery. Health Affairs Spring: 158-170. 1989.

4. Durant G. Ambulatory surgery centers: surviving, thriving into the 1990's. Medical Group Management Journal 36(2):
    16-18, 20. 1989.

5. SMG Marketing Group, Inc. Outpatient surgery centers exceed 3 million cases. SMG Market Letter 8(5). 1996.

6. Graves EJ and Gillum BS. 1996 summary: National Hospital Discharge Survey. Advance data from Vital and Health
    Statistics; no 278. Hyattsville, Maryland: National Center for Health Statistics. 1996.

7. SMG Marketing Group, Inc. Hospital Market Database. Chicago: Healthcare Information Specialists. April 1993.

8. SMG Marketing Group, Inc. Freestanding Outpatient Surgery Centers Database. Chicago: Healthcare Information
    Specialists. 1993.

9. Health Care Financing Administration. Provider of Services Public Use File. Baltimore: 1993.

10. Public Health Service and Health Care Financing Administration. International Classification of Diseases, 9th Revision,
      Clinical Modification. Washington: Public Health Service. 4th ed. 1991.

11. Shah BV, Barnwell BG, Bieler GS. SUDAAN User's Manual: Software for Analysis of Correlated Data, Release 6.40.
      Research Triangle Park, NC: Research Triangle Institute. 1996.

II. TECHNICAL DESCRIPTION OF TAPE

Data Set Name------------------------------------------------------BG00.NSAS96.PU
Number of REELS or CARTRIDGES--------------------------------------------------1
Number of Recording Tracks, REEL----------------------------------------------------9
Number of Recording Tracks, CARTRIDGE------------------------------------------18
Density for REEL (bpi)-------------------------------------------------------------6,250
Density for CARTRIDGE (bpi)---------------------------------------------------38,000
Language-----------------------------------------------------------------------EBCDIC
Parity-------------------------------------------------------------------------------Odd
Record Length------------------------------------------------------------------------97
Block Size------------------------------------------------------------------------32,689
Number of Records-------------------------------------------------------------125,433

III. RECORD FORMAT: Location and Coding of Data Elements

This section provides detailed information for each sampled record on the tape, with a description of each item included in the record. Data elements are arranged sequentially according to their physical location on the tape record. Data are derived from the abstract form; the SMG Hospital Market Tape is an alternative source of data; some items are computer generated.

Item Number	Tape Location	Number of Positions	Item Description and Codes
1	1-2	2	Survey Year: 96
2	3	1	Facility Type: 1=Hospital 2=Free-Standing Ambulatory Surgery Center
3	4	1	Units for Age: 1 = Years 2 = Months 3 = Days
4	5-6	2	Age in years, months, or days: If Units = Years: 0-99* If Units = Months: 01-11 If Units = Days: 00-31
5	7	1	Age Flag: 1 = Value for Age was Imputed 2 = Value for Age was Not Imputed
6	8	1	Sex: 1 = Male 2 = Female
7	9	1	Sex Flag: 1 = Value for Sex was Imputed 2 = Value for Sex was Not Imputed
8	10	1	Race: 1 = White 2 = Black 3 = American Indian/Eskimo 4 = Asian/Pacific Islander 5 = Other 9 = Race Not Stated
9	11	1	Discharge Status: 1 = Routine discharge to customary residence 2 = Discharge to observation status 3 = Discharge to recovery care center 4 = Admitted to hospital as inpatient 5 = Surgery cancelled or terminated 6 = Other, specified 9 = Discharge Status Not Stated
10	12-13	2	Month of Surgery: 01 = January to 12 = December
11	14	1	Geographic Region 1 = Northeast 2 = Midwest 3 = South 4 = West
12	15-16	2	Principal Expected Source of Payment 00 = No Charge 01 = Worker's Compensation 02 = Medicare 03 = Medicaid 04 = CHAMPUS 05 = Other Government Payments 06 = Blue Cross/Blue Shield 07 = HMO/PPO 08 = Other private or commercial insurance 09 = Self Pay 10 = Other, specified 99 = No expected source of payment
13	17-18	2	Other Additional Source of Payment #1: Same coding as Principal ESOP
14	19-20	2	Other Additional Source of Payment #2: Same coding as Principal ESOP
15	21-25	5	Analysis Weight: Use to Obtain Weighted Estimates
16-25	26-35	10	Type of Anesthesia: 10 types/options 1 = Option Checked 0 = Not Checked/Blank
16	26	1	Type of Anesthesia: Topical/Local
17	27	1	Type of Anesthesia: IV Sedation
18	28	1	Type of Anesthesia: Monitored Anesthesia Care
19	29	1	Type of Anesthesia: Regional, Epidural
20	30	1	Type of Anesthesia: Regional, Spinal
21	31	1	Type of Anesthesia Regional, Retrobulbar block
22	32	1	Type of Anesthesia: Regional, Peribulbar block
23	33	1	Type of Anesthesia: Regional, Block
24	34	1	Type of Anesthesia: General
25	35	1	Type of Anesthesia: Other, specified
26-28	36-38	3	Anesthesia Administrator: 3 givers/options 1 = Option Checked 0 = Not checked/Blank
26	36	1	Anesthesia Administrator: Anesthesiologist
27	37	1	Anesthesia Administrator: Certified Registered Nurse Anesthetist
28	38	1	Anesthesia Administrator: Other Surgeon/Physician
29	39-43	5	Diagnosis ICD9-CM ** Code #1
30	44-48	5	Diagnosis ICD9-CM ** Code #2
31	49-53	5	Diagnosis ICD9-CM ** Code #3
32	54-58	5	Diagnosis ICD9-CM ** Code #4
33	59-63	5	Diagnosis ICD9-CM ** Code #5
34	64-68	5	Diagnosis ICD9-CM ** Code #6
35	69-73	5	Diagnosis ICD9-CM ** Code #7
36	74-77	4	Procedure ICD9-CM ** Code #1
37	78-81	4	Procedure ICD9-CM ** Code #2
38	82-85	4	Procedure ICD9-CM ** Code #3
39	86-89	4	Procedure ICD9-CM ** Code #4
40	90-93	4	Procedure ICD9-CM ** Code #5
41	94-97	4	Procedure ICD9-CM ** Code #6

------------------------------------------------------------------------------------------------------------------

* Ages 100 and over were recoded to 99.

** Codes are in compliance with the International Classification of Diseases, 9th Revision, Clinical Modification, (ICD-9-CM). For diagnosis codes, there is an implied decimal between positions 3 and 4. For V-Codes and E-codes, the implied decimal is between positions 4 and 5. For inapplicable 4th or 5th digits, a dash is inserted. For procedure codes, there is an implied decimal between positions 2 and 3. For inapplicable 3rd or 4th digits, a dash is inserted.

APPENDIX A

Definition of  Terms

Hospitals-Short-stay hospitals or hospitals whose specialty is general (medical or surgical), or children's general. Hospitals must have 6 beds or more staffed for patients use. Federal hospitals and hospital units of institutions are not included.

Free-Standing Ambulatory Surgery Centers-Facilities listed in the 1993 Freestanding Outpatient Surgery Center Database and Medicare-certified facilities included in the HCFA Provider-of-Services (POS) file. Facilities specializing in dentistry, podiatry, abortion, family planning, or birthing are excluded.

Ambulatory Surgery-Scheduled outpatient surgery performed in any of the following locations: general or main operating room, satelitte operating room, cystoscopy room, endoscopy room, cardiac catherterization lab, laser procedures room.

First-listed diagnosis-The coded diagnosis which is listed first on the face sheet of the medical record. The number of first-listed diagnoses is equivalent to the number of ambulatory surgery visits.

Procedures-Surgical or nonsurgical operations, procedures, or special treatments listed by the physician on the medical record. In the NSAS, all terms listed on the face sheet (summary sheet) of the medical record under the caption "operation," "operative procedures," "operations and/or special treatment," and the like are transcribed in the order listed. A maximum of six procedures is coded.

Rate of procedures-The ratio of the number of procedures during a year to the number of persons in the civilian population on July 1 of that year.

Age-The age of the patient on the birthday prior to the date of surgery.

Population-Civilian population is the resident population excluding members of the Armed Forces.

Geographic region-Hospitals are classified by location in one of the four geographic regions of the United States corresponding to those used by the U.S. Bureau of the Census:

U.S. CENSUS REGIONS

NORTHEAST	MIDWEST	SOUTH	WEST
Maine	Michigan	Delaware	Montana
New Hampshire	Ohio	Maryland	Idaho
Vermont	Illinois	District of Columbia	Wyoming
Massachusetts	Indiana	Virginia	Colorado
Connecticut	Wisconsin	West Virginia	New Mexico
Rhode Island	Minnesota	North Carolina	Arizona
New York	Iowa	South Carolina	Utah
New Jersey	Missouri	Georgia	Nevada
Pennsylvania	North Dakota	Florida	Washington
	South Dakota	Kentucky	Oregon
	Nebraska	Tennessee	California
	Kansas	Alabama	Hawaii
		Mississippi	Alaska
		Arkansas
		Louisana
		Oklahoma
		Texas

APPENDIX B

The International Classification of Diseases, 9th Revision, Clinical Modification, which has been used for coding NHDS data since 1979, undergoes annual updating. Assignment of new diagnostic and procedure codes, fourth and fifth digit expansion of codes, as well as code deletions, are contained in addenda developed by the ICD-9-CM Coordination and Maintenance Committee and approved by the Director of NCHS and the Administrator of the Health Care Financing Administration. Addenda to the ICD-9-CM become effective on October 1 of the calendar year and have been released for 1986 through 1996.

As described earlier in this document, all data collected for the 1996 NSAS were coded using the third edition of the ICD-9-CM, which includes the addenda for 1986 through 1995. Although the October 1996 Addendum was available, it was decided not to implement those coding changes, since the other nine months of data were coded to the 1995 Addendum. This was done in order to prevent NSAS data users from mistaking partial year estimates for annual estimates.

In order to assist users in data retrieval and analysis, a conversion table is provided that shows the date of introduction of each new code and the previously assigned code equivalent. The latter had been used for reporting the selected diagnosis or procedure prior to issuance of the new code.

DIAGNOSIS CODES
	Effective
Current code(s) assignment	October 1	Previous code(s) assignment
005.81	1995	005.8
005.89	1995	005.8
008.00-008.09	1992	008.0
008.43-008.47	1992	008.49
008.61-008.69	1992	008.6
041.00-041.09	1992	041.0
041.10-041.19	1992	041.1
041.81-041.89	1992	041.8
041.86	1995	041.84
042	1994	042.0-042.2,042.9,043.0-043.3,
		043.9,044.0,044.9
042.0-042.9	1986	279.19
043.0-043.9	1986	279.19
044.0-044.9	1986	279.19
070.20-070.21	1991	070.2
070.22	1994	070.20
070.23	1994	070.21
070.30-070.31	1991	070.3
070.32	1994	070.30
070.33	1994	070.31
070.41-070.49	1991	070.4
070.44	1994	070.41
070.51-070.59	1991	070.5
070.54	1994	070.51
077.98-077.99	1993	077.9
078.10-078.11,078.19	1993	078.1
078.88	1993	078.89
079.4	1993	079.8
079.50-079.53,079.59	1993	079.8
079.81	1995	079.89
079.88-079.89	1993	079.8
079.98-079.99	1993	079.9
088.81,088.89	1989	088.8
088.82	1993	088.89
099.40-099.49	1992	099.4
099.50-099.59	1992	078.89
112.84-112.85	1992	112.89
114.4-114.5	1993	114.3
176.0-176.9	1991	173.0-173.9
203.00	1991	203.0
203.01	1991	V10.79
203.10	1991	203.1
203.11	1991	V10.79
203.80	1991	203.8
203.81	1991	V10.79
204.00	1991	204.0
204.01	1991	V10.61
204.10	1991	204.1
204.11	1991	V10.61
204.20	1991	204.2
204.21	1991	V10.61
204.80	1991	204.8
204.81	1991	V10.61
204.90	1991	204.9
204.91	1991	V10.61
205.00	1991	205.0
205.01	1991	V10.62
205.10	1991	205.1
205.11	1991	V10.62
205.20	1991	205.2
205.21	1991	V10.62
205.30	1991	205.3
205.31	1991	V10.62
205.80	1991	205.8
205.81	1991	V10.62
205.90	1991	205.9
205.91	1991	V10.62
206.00	1991	206.0
206.01	1991	V10.63
206.10	1991	206.1
206.11	1991	V10.63
206.20	1991	206.2
206.21	1991	V10.63
206.80	1991	206.8
206.81	1991	V10.63
206.90	1991	206.9
206.91	1991	V10.63
207.00	1991	207.0
207.01	1991	V10.69
207.10	1991	207.1
207.11	1991	V10.69
207.20	1991	207.2
207.21	1991	V10.69
207.80	1991	207.8
207.81	1991	V10.69
208.00	1991	208.0
208.01	1991	V10.60
208.10	1991	208.1
208.11	1991	V10.60
208.20	1991	208.2
208.21	1991	V10.60
208.80	1991	208.8
208.81	1991	V10.60
208.90	1991	208.9
208.91	1991	V10.60
237.70-237.72	1990	237.7
250.02	1993	250.90
250.03	1993	250.91
250.12	1993	250.10
250.13	1993	250.11
250.22	1993	250.20
250.23	1993	250.21
250.32	1993	250.30
250.33	1993	250.31
250.42	1993	250.40
250.43	1993	250.41
250.52	1993	250.50
250.53	1993	250.51
250.62	1993	250.60
250.63	1993	250.61
250.72	1993	250.70
250.73	1993	250.71
250.82	1993	250.80
250.83	1993	250.81
250.92	1993	250.90
250.93	1993	250.91
278.00-278.01	1995	278.0
283.10-283.11,283.19	1993	283.1
305.1	1994	305.10,305.11,305.12,
		305.13 (delete code)
312.81-312.82,381.89	1994	312.8
320.81-320.89	1992	320.8
333.92-333.93	1994	333.99
337.20-337.22,337.29	1993	337.9
342.00-342.02	1994	342.0
342.10-342.12	1994	342.1
342.80-342.82	1994	342.9
342.90-342.92	1994	342.9
344.00-344.04,344.09	1994	344.0
344.30-344.32	1994	344.3
344.40-344.42	1994	344.4
344.81,344.89	1993	344.8
345.00-345.01	1989	345.0
345.10-345.11	1989	345.1
345.40-345.41	1989	345.4
345.50-345.51	1989	345.5
345.60-345.61	1989	345.6
345.70-345.71	1989	345.7
345.80-345.81	1989	345.8
345.90-345.91	1989	345.9
346.00-346.01	1992	346.0
346.10-346.11	1992	346.1
346.20-346.21	1992	346.2
346.80-346.81	1992	346.8
346.90-346.91	1992	346.9
355.71	1993	354.4
355.79	1993	355.7
371.82	1992	371.89
374.87	1990	374.89
403.00-403.01	1989	403.0
403.10-403.11	1989	403.1
403.90-403.91	1989	403.9
404.00-404.03	1989	404.0
404.10-404.13	1989	404.1
404.90-404.93	1989	404.9
410.00-410.02	1989	410.0
410.10-410.12	1989	410.1
410.20-410.22	1989	410.2
410.30-410.32	1989	410.3
410.40-410.42	1989	410.4
410.50-410.52	1989	410.5
410.60-410.62	1989	410.6
410.70-410.72	1989	410.7
410.80-410.82	1989	410.8
410.90-410.92	1989	410.9
411.81	1989	410.9
411.89	1989	411.8
414.00-414.01	1994	414.0
414.02-414.03	1994	996.03
415.11	1995	997.3 & 415.1
415.19	1995	415.1
429.71	1989	410.0-410.9
429.79	1989	410.0-410.9
433.00-433.01	1993	433.0
433.10-433.11	1993	433.1
433.20-433.21	1993	433.2
433.30-433.31	1993	433.3
433.80-433.81	1993	433.8
433.90-433.91	1993	433.9
434.00-434.01	1993	434.0
434.10-434.11	1993	434.1
434.90-434.91	1993	434.9
435.3	1995	435.0 & 435.1
437.7	1992	780.9
440.20-440.22	1992	440.2
440.23	1993	440.20 & 707.1 or 707.8 or 707.9
440.24	1993	440.20 & 785.4
440.29	1993	440.20
440.30-440.32	1994	996.1
441.00-441.03	1994	441.0
441.6	1993	441.1 & 441.3
441.7	1993	441.2 & 441.4
446.20-446.21,446.29	1990	446.2
451.82-451.84	1993	451.89
458.2	1995	997.9 & 458.9
482.30-482.39	1992	482.3
482.81-482.89	1992	482.8
483.0	1992	483
483.8	1992	483
491.20-491.21	1991	491.2
493.20	1989	493.90
493.21	1989	493.91
512.1	1994	997.3
518.81	1987	799.1
518.82-518.89	1987	518.8
524.00-524.09	1992	524.0
524.10-524.19	1992	524.1
524.60-524.69	1991	524.6
524.70-524.79	1992	524.8
530.10-530.11, 530.19	1993	530.1
530.81	1993	530.1
530.82-530.84, 530.89	1993	530.8
535.00-535.01	1991	535.0
535.10-535.11	1991	535.1
535.20-535.21	1991	535.2
535.30-535.31	1991	535.3
535.40-535.41	1991	535.4
535.50-535.51	1991	535.5
535.60-535.61	1991	535.6
536.3	1994	536.8
537.82	1990	537.89
537.83	1991	537.82
556.0-556.6	1994	556
556.8-556.9	1994	556
562.02	1991	562.00
562.03	1991	562.01
562.12	1991	562.10
562.13	1991	562.11
569.60-569.61	1995	569.6
569.69	1995	569.6
569.84	1990	557.1
569.85	1991	569.84
593.70-593.73	1994	593.7
596.51-596.53	1992	596.5
596.54	1992	344.61
596.55-596.59	1992	596.5
599.81-599.89	1992	599.8
645.0	1991	645
651.30-651.31,651.33	1989	651.00-651.01,651.03
651.40-651.41,651.43	1989	651.10-651.11,651.13
651.50-651.51,651.53	1989	651.20-651.21,651.23
651.60-651.61,651.63	1989	651.80-651.81,651.83
654.20-654.21,654.23	1990	654.2,654.9
654.90-651.94	1990	654.2,654.9
657.0	1991	657
659.60,659.61,659.63	1992	659.80,659.81,659.83
665.10,665.11	1992	665.10,665.11,665.12,665.14
Note: The title for the subcategory, 665.1 has been changed,
making the fifth-digit subclassification, 665.12 and 665.14
invalid.
670.0	1991	670
672.0	1991	672
677	1994	* No previous code assignments.
690.10	1995	690
690.11	1995	691.8 & 704.8
690.12	1995	691.8
690.18	1995	690
690.8	1995	690
692.72-692.74	1992	692.79
692.82-692.83	1992	692.89
702.0-702.8	1991	702
702.11,702.19	1994	702.1
704.02	1993	704.09
709.00-709.01,709.09	1994	709.0
710.5	1992	288.3,729.1
728.86	1995	729.4
733.10-733.16, 733.19	1993	733.1
738.10-738.19	1992	738.1
747.60-747.64, 747.69	1993	747.6
747.82	1993	747.89
753.10-753.17,753.19	1990	753.1
759.81-759.89	1989	759.8
759.83	1994	759.89
760.75	1991	760.79
760.76	1994	760.79
764.00-764.09	1988	764.0
764.10-764.19	1988	764.1
764.20-764.29	1988	764.2
764.90-764.99	1988	764.9
765.00-765.09	1988	765.0
765.10-765.19	1988	765.1
780.01-780.09	1992	780.0
780.03	1993	780.01
780.57	1992	780.51,780.53
781.8	1994	781.9
787.01-787.03	1994	787.0
787.91	1995	558.9
787.99	1995	787.9
788.20-788.21, 788.29	1993	788.2
788.30-788.39	1992	788.3
788.41-788.43	1993	788.4
788.61-788.62, 788.69	1993	788.6
789.00-789.07, 789.09	1994	789.0
789.30-789.37, 789.39	1994	789.3
789.40-789.47, 789.49	1994	789.4
789.60-789.67, 789.69	1994	789.6
790.91	1993	790.9
790.92	1993	286.9
790.93, 790.99	1993	790.9
795.71	1994	795.8 (delete code)
795.79	1994	795.7
795.8	1986	795.7
864.05	1992	864.09
864.15	1992	864.19
909.5	1994	909.9
925.1-925.2	1993	925
989.81-989.84	1995	989.8
989.89	1995	989.8
995.60-995.69	1993	995.0
996.04	1994	996.09
996.51-996.59	1987	996.5
996.60-996.69	1989	996.6
996.70-996.79	1989	996.7
996.80-996.89	1987	996.8
996.85	1990	999.8
997.00-997.01	1995	997.0
997.02	1995	997.9 & 430-434, 436
997.09	1995	997.0
997.91	1995	997.9
997.99	1995	997.9
998.81-998.82, 998.89	1994	998.8
V03.81-V03.82, V03.89	1994	V03.8
V05.3-V05.4	1993	V05.8
V06.5-V06.6	1994	V06.8
V07.31,V07.39	1994	V07.3
V07.4	1992	V07.8
V08	1994	044.9, 795.8 (delete code)
V09.0-V09.91	1993	* No previous code assignments
V12.00-V12.03, V12.09	1994	V12.0
V12.50-V12.52	1995	V12.5
V12.59	1995	V12.5
V12.70-V12.72, V12.79	1994	V12.7
V13.00-V13.01, V13.09	1994	V13.0
V15.82	1994	305.13 (delete code)
V15.84-V15.86	1995	V15.89
V25.43	1992	V25.49
V25.5	1992	V25.8
V29.0-V29.8	1992	V71.8
V29.9	1992	V71.9
V30.00-V30.01	1989	V30.0
V31.00-V31.01	1989	V31.0
V32.00-V32.01	1989	V32.0
V33.00-V33.01	1989	V33.0
V34.00-V34.01	1989	V34.0
V35.00-V35.01	1989	V35.0
V36.00-V36.01	1989	V36.0
V37.00-V37.01	1989	V37.0
V39.00-V39.0l	1989	V39.0
V43.60-V43.66, V43.69	1994	V43.6
V43.81-V43.82	1995	V43.8
V43.89	1995	V43.8
V45.00	1994	V45.89
V45.01	1994	V45.0
V45.02, V45.09	1994	V45.89
V45.51	1994	V45.5
V45.52, V45.59	1994	V45.89
V45.82	1994	V45.89
V45.83	1995	V45.89
V49.60-V49.67	1994	V49.5
V49.70-V49.77	1994	V49.5
V50.41-V50.42, V50.49	1994	V50.8
V53.31	1994	V53.3
V53.32, V53.39	1994	V53.9
V56.1	1995	V58.89
V57.21-V57.22	1994	V57.2
V58.41, V58.49	1994	V58.4
V58.61	1995	V67.51
V58.69	1995	V67.51
V58.81, V58.89	1994	V58.8
V58.82	1995	V58.89
V59.01-V59.02	1995	V59.0
V59.09	1995	V59.0
V59.6	1995	V59.8
V65.40-V65.45, V65.49	1994	V65.4
V69.0-V69.3	1994	* No previous code assignments.
V69.8-V69.9	1994	* No previous code assignments.
V72.81-V72.85	1993	V72.8
V73.88-V73.89	1993	V73.8
V73.98-V73.99	1993	V73.9
E854.8	1995	E858.8
E869.4	1994	E869.8
E880.1	1995	E884.9
E884.3-E884.4	1995	E884.2
E884.5-E884.6	1995	E884.9
E906.5	1995	E906.3
E908.0-E908.4	1995	E908
E908.8-E908.9	1995	E908
E909.0-E909.4	1995	E909
E909.8-E909.9	1995	E909
E920.5	1995	E920.4
E924.2	1995	E924.0
E968.5	1995	E968.8

PROCEDURE CODES
	Effective
Current code(s) assignment	October 1	Previous code(s) assignment
02.96	1992	89.19
03.90	1987	03.99 (Insertion of Catheter)
05.25	1995	39.7 (delete)
11.75	1989	11.79
11.76	1989	11.62
20.96-20.98	1986	20.95
22.12	1988	22.11
26.12	1988	26.11
29.31	1991	83.02
29.32	1991	29.3
29.33	1991	29.3
29.39	1991	29.3
31.45	1988	31.43-31.44
31.95	1989	31.75
32.01	1989	32.0
32.09	1989	32.0
32.22	1995	32.29, 32.9
32.28	1989	32.29
33.27	1987	33.22 + 33.27
33.28	1987	33.27
33.29	1987	33.28-33.29
33.50	1995	33.5
33.51	1995	33.5
33.52	1995	33.5
33.6	1990	33.5 + 37.5
34.05	1994	34.99
35.84	1988	35.82
35.96	1986	35.03
36.00-36.03	1986	36.0
36.04	1986	39.97
36.05	1987	36.01
36.05	1986	36.01 (Before October 1986 contents of current code 36.05 would have been assigned to 36.0), 36.02
36.06	1995	36.01, 36.02, 36.03, 36.05
36.09	1986	36.0
36.09	1991	36.00 (Code Deleted)
37.26-37.27	1988	37.29
37.34	1988	37.33
37.65	1995	37.62
37.66	1995	37.62
37.70 (Leads only)	1987	37.70 (Leads/Device)
37.71-37.72 (Leads only)	1987	37.74 (Leads/Device)
37.73 (Leads only)	1987	37.73 (Leads/Device)
37.74 (Leads only)	1987	37.76 (Leads/Device)
37.75 (Leads only)	1987	37.89 (Leads/Device)
37.76 (Leads only)	1987	37.81 (Leads/Device)
37.77 (Leads only)	1987	37.83-37.84 (Leads/Device)
37.78	1987	37.71-37.72
37.79	1987	86.09
37.80-37.87	1992	89.49 (Code deleted, this procedure is included in the code for pacemaker insertion/replacement)
37.80 (Device only)	1987	37.73-37.77 (Leads/Device)
37.81 (Device only)	1987	37.73-37.77 (Leads/Device)
37.82 (Device only)	1987	37.73-37.77 (Leads/Device)
37.83 (Device only)	1987	37.73-37.77 (Leads/Device)
37.85-37.87	1987	37.85
37.89	1987	37.86 + 37.89
37.94-37.98	1986	37.99
38.22	1986	38.29
38.44 (Abdominal Aorta only)	1986	38.44 (Entire Aorta)
38.45 (Thoracic Aorta Added)	1986	38.44-38.45
38.95	1989	38.93
39.28	1991	39.29
39.50	1995	39.59
39.65	1988	39.61
39.66	1990	39.65
41.00-41.03	1988	41.0
41.04	1994	99.79
42.25	1988	42.24
42.33	1989	42.32, 42.39
42.33	1990	42.91
43.11	1989	43.1
43.19	1989	43.1, 43.2
43.41	1989	43.41,43.49
44.21	1986	44.2
44.22	1986	44.99
44.29	1986	44.2
44.43	1989	43.49,45.32
44.44	1989	38.86
44.49	1989	43.0
44.93-44.94	1986	44.99
45.16	1988	45.14 (45.15 before 1987)
45.30	1989	45.31,45.32
45.42	1988	45.41
45.43	1989	45.49
45.75 (Hartmann Resection Added)	1988	48.66 (Code Deleted)
45.95	1987	45.93
46.13	1992	46.12 (Code Deleted)
46.32	1989	46.39
46.85	1989	46.99
48.36	1995	45.42
49.31	1989	49.3
49.39	1989	49.3
51.10	1989	51.97
51.11	1989	51.11,51.97
51.14	1989	51.12
51.15	1989	51.97
51.22	1991	51.21 (Code Deleted),51.22
51.23	1991	51.22
51.64	1989	51.69
51.84-51.88	1989	51.97
51.97	1986	52.91,51.99, or 51.82
51.98	1986	51.99
52.13	1989	51.97,52.91
52.14	1989	52.11
52.21	1989	52.2
52.22	1989	52.2
52.93	1989	52.93 + 52.91
52.94	1989	52.09
52.97	1989	52.91
52.98	1989	52.91
52.99	1989	52.93,52.94,52.99
54.24	1987	54.23
54.25	1993	54.98
55.03-55.04	1986	55.02
56.33-56.34	1987	56.33
56.35	1987	45.12
57.17-57.18	1989	57.21
57.22	1989	57.22,57.82
58.31	1990	58.3
58.39	1990	58.3
58.93	1986	57.99
59.72	1995	59.79
59.96	1986	59.95
60.21	1995	60.2
60.29	1995	60.2
60.95	1991	60.99
64.97	1986	64.95
66.01	1992	66.0
66.02	1992	66.73
68.15	1987	68.14
68.16	1987	68.13
68.9	1992	68.4
74.3	1992	69.11 (Code Deleted)
77.56	1989	77.89,78.49,81.18
77.57	1989	77.89,80.48,81.18,83.85
77.58	1989	77.59,81.18
78.10	1991	78.40
78.11	1991	78.41
78.12	1991	78.42
78.13	1991	78.43
78.14	1991	78.44
78.15	1991	78.45
78.16	1991	78.46
78.17	1991	78.47
78.18	1991	78.48
78.19	1991	78.49
78.20	1991	78.10,78.20,78.30
78.21	1991	78.11,78.31
78.22	1991	78.12,78.22,78.32
78.23	1991	78.13,78.23,78.33
78.24	1991	78.14,78.34
78.25	1991	78.15,78.25,78.35
78.27	1991	78.17,78.27,78.37
78.28	1991	78.18,78.38
78.29	1991	78.11,78.16,78.19,78.29,78.39
78.39	1991	78.31
78.90 2/	1987	78.40
78.91 2/	1987	78.41
78.92 2/	1987	78.42
78.93 2/	1987	78.43
78.94 2/	1987	78.44
78.95 2/	1987	78.45
78.96 2/	1987	78.46
78.97 2/	1987	78.47
78.98 2/	1987	78.48
78.99 2/	1987	78.49
80.50-80.59	1986	80.5
81.03	1989	81.02
81.04-81.05	1989	81.03,81.04,81.05
81.06-81.07	1989	81.06,81.07
81.08	1989	81.06,81.07,81.08
81.09	1989	81.08
81.40	1989	81.69
81.51	1989	81.51,81.59
81.52	1989	81.61,81.62,81.63,81.64
81.53	1989	81.51,81.59,81.61,81.62,
		81.63,81.64
81.54-81.55	1989	81.41
81.56	1989	81.48
81.57	1989	81.31,81.39
81.59	1989	81.39
81.72	1989	81.79
81.73-81.74	1989	81.86
81.75	1989	81.87
81.79	1989	81.79,81.87
81.80	1989	81.81
81.97	1992	81.59
85.95	1987	85.99
85.96	1987	85.99
86.06	1987	86.09
86.07	1990	86.09
86.27	1986	86.22-86.23
86.28	1988	86.22
86.93	1987	86.89
88.90	1986	88.39
88.91	1986	89.15
88.92	1986	89.39
88.93	1986	89.15
88.94	1986	89.39
88.95	1986	89.29
88.97	1989	88.99
88.98	1989	88.90
88.99	1986	89.39
89.10	1989	89.15
89.17-89.18	1988	89.15
89.19	1989	89.15
89.50	1991	89.54
92.3	1995	01.59, 04.07, 07.63, 07.68
93.90	1988	93.92
94.61-94.69	1989	94.25
96.6	1986	96.35
96.70	1991	93.92 (Code Deleted)
96.71	1991	93.92 (Code Deleted)
96.72	1991	93.92 (Code Deleted)
97.05	1989	51.97
98.51-98.52	1989	59.96 (Code Deleted)
98.59	1989	59.96 (Code Deleted)
99.00	1995	99.02
99.15	1986	99.29
99.28	1994	99.25
99.71-99.79 3/	1988	99.07
99.85	1987	93.35
99.86	1987	93.39
99.88	1988	99.83
1/ Before October 1986 contents of current code 36.05 would have
been assigned to 36.0.
2/ Codes 78.90-78.99 were retitled as "Insertion of bone growth
stimulator" in October 1987; the previous contents of codes
78.90-78.99 were reassigned to codes 78.40-78.49.
3/ Codes 99.71-99.79 were deleted in October 1987; their contents
were not transferred elsewhere. In the October 1988 revision,
codes 99.71-99.79 were reclassified as "Therapeutic apheresis."

APPENDIX C

Civilian Population* by Sex, Age, Geographic Region and Race

United States, July 1, 1996

[Population estimates consistent with Series P-25,

Current Population Reports, U.S. Bureau of the Census]

Age, geographic
region and race	Both sexes	Male	Female
	Population in thousands
All ages	263,998	128,691	135,306
Northeast	51,520	24,867	26,653
Midwest	61,983	30,212	31,771
South	92,373	44,718	47,655
West	58,122	28,895	29,228
White	218,755	107,170	111,586
Black	33,257	15,707	17,550
All other	11,985	5,815	6,171
Under 15 years	57,708	29,549	28,159
Under 1 year	3,769	1,928	1,841
1-4 years	15,516	7,940	7,577
5-14 years	38,422	19,681	18,741
Northeast	10,606	5,433	5,173
Midwest	13,445	6,888	6,557
South	20,097	10,280	9,817
West	13,561	6,949	6,612
White	45,727	23,461	22,266
Black	8,946	4,539	4,408
All other	3,035	1,549	1,486
15-44 years	118,734	59,292	59,442
15-24 years	35,739	18,206	17,533
25-34 years	39,868	19,754	20,114
35-44 years	43,127	21,332	21,795
Northeast	22,835	11,362	11,473
Midwest	27,798	13,901	13,898
South	41,417	20,460	20,957
West	26,684	13,570	13,114
White	96,782	48,770	48,012
Black	15,981	7,613	8,368
All other	5,971	2,909	3,061
45-64 years	53,694	25,969	27,725
45-54 years	32,334	15,804	16,530
55-64 years	21,360	10,165	11,195
Northeast	10,763	5,150	5,613
Midwest	12,612	6,125	6,488
South	19,036	9,140	9,896
West	11,283	5,554	5,729
White	45,979	22,484	23,495
Black	5,564	2,479	3,085
All other	2,151	1,006	1,145
65 years & over	33,861	13,881	19,980
65-74 years	18,669	8,325	10,345
75-84 years	11,430	4,486	6,944
85 years and over	3,762	1,070	2,692
Northeast	7,316	2,922	4,394
Midwest	8,128	3,299	4,829
South	11,824	4,838	6,985
West	6,594	2,822	3,772
White	30,266	12,454	17,813
Black	2,766	1,077	1,689
All other	829	350	478

*The NHDS used the civilian noninstitutional population to calculate hospital utilization rates from 1965 through 1980. Beginning in 1981, the civilian resident population has been used to calculate rates. If you have purchased NHDS tapes for years before 1981 and calculated rates using the civilian noninstitutionalized population provided in the documentation, these rates will have to be adjusted to be comparable to 1996 rates using the civilian resident population.

Civilian Population of the United States, July 1, 1996. Estimates by Age, Sex, and Region.

Data are consistent with the estimates announced in Census Advisory CB94-43. Methodology is described in

Current Population Report Series P25-1106. Release date 3/15/94

---

United States Northeast Midwest South West

Age Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female

---

Civilian Population in Thousands

ALL	263,998	128,691	135,306	51,520	24,867	26,653	61,983	30,212	31,771	92,373	44,718	47,655	58,122	28,895	29,228
0-4	19,286	9,868	9,418	3,514	1,799	1,715	4,344	2,222	2,121	6,716	3,434	3,282	4,712	2,412	2,300
5-9	19,441	9,954	9,487	3,649	1,871	1,778	4,499	2,305	2,194	6,728	3,440	3,289	4,564	2,339	2,226
10-14	18,981	9,727	9,254	3,443	1,763	1,680	4,602	2,360	2,242	6,653	3,406	3,246	4,284	2,198	2,086
15-19	18,573	9,545	9,028	3,299	1,690	1,609	4,555	2,340	2,215	6,602	3,378	3,224	4,116	2,137	1,979
20-24	17,167	8,662	8,505	3,122	1,574	1,548	4,048	2,041	2,007	6,160	3,056	3,104	3,836	1,989	1,846
25-29	18,733	9,302	9,432	3,691	1,831	1,860	4,266	2,112	2,154	6,510	3,187	3,323	4,267	2,171	2,095
30-34	21,135	10,453	10,682	4,215	2,082	2,133	4,800	2,374	2,426	7,299	3,567	3,732	4,820	2,429	2,392
35-39	22,395	11,096	11,299	4,447	2,200	2,248	5,245	2,612	2,633	7,689	3,763	3,926	5,014	2,521	2,493
40-44	20,732	10,235	10,497	4,061	1,985	2,075	4,883	2,420	2,463	7,157	3,508	3,648	4,632	2,322	2,310
45-49	18,406	9,033	9,373	3,655	1,770	1,885	4,307	2,117	2,190	6,418	3,137	3,280	4,027	2,009	2,017
50-54	13,928	6,771	7,157	2,812	1,351	1,461	3,236	1,576	1,660	4,923	2,379	2,545	2,956	1,465	1,491
55-59	11,361	5,454	5,907	2,276	1,083	1,192	2,695	1,299	1,396	4,063	1,933	2,130	2,328	1,139	1,189
60-64	9,999	4,711	5,288	2,019	945	1,074	2,375	1,133	1,242	3,632	1,691	1,941	1,973	941	1,032
65-69	9,892	4,507	5,384	2,091	939	1,152	2,317	1,061	1,256	3,544	1,605	1,938	1,939	901	1,038
70-74	8,778	3,818	4,960	1,875	799	1,076	2,067	903	1,163	3,094	1,338	1,756	1,742	776	965
75-79	6,873	2,821	4,052	1,508	602	906	1,641	662	980	2,376	973	1,402	1,347	583	763
80-84	4,557	1,666	2,892	1,002	355	647	1,132	406	725	1,553	562	990	872	343	529
85+	3,762	1,070	2,692	839	227	613	970	266	704	1,257	359	898	695	218	477
0-14	57,708	29,549	28,159	10,606	5,433	5,173	13,445	6,888	6,557	20,097	10,280	9,817	13,561	6,949	6,612
15-44	118,734	59,292	59,442	22,835	11,362	11,473	27,798	13,901	13,898	41,417	20,460	20,957	26,684	13,570	13,114
45-64	53,694	25,969	27,725	10,763	5,150	5,613	12,612	6,125	6,488	19,036	9,140	9,896	11,283	5,554	5,729
15+	206,290	99,142	107,147	40,914	19,434	21,479	48,538	23,324	25,214	72,277	34,438	37,839	44,561	21,946	22,615
45+	87,555	39,850	47,705	18,078	8,072	10,006	20,740	9,424	11,316	30,860	13,978	16,882	17,877	8,376	9,501
65+	33,861	13,881	19,980	7,316	2,922	4,394	8,128	3,299	4,829	11,824	4,838	6,985	6,594	2,822	3,772
75+	15,192	5,556	9,635	3,349	1,183	2,166	3,743	1,334	2,409	5,185	1,894	3,291	2,913	1,144	1,769

Civilian Population of the United States, July 1, 1996.

Source: U.S. Bureau of the Census. Population Division Release PPL#57.

---

All races White Black Other races

Age Total Male Female Total Male Female Total Male Female Total Male Female

---

Civilian population in thousands

All	263,998	128,691	135,306	218,755	107,170	111,586	33,257	15,707	17,550	11,985	5,815	6,171
0-4	19,286	9,868	9,418	15,289	7,839	7,450	2,948	1,494	1,454	1,048	534	514
0	3,769	1,928	1,841	3,015	1,546	1,469	546	277	270	208	106	102
1	3,785	1,934	1,850	3,013	1,544	1,469	566	286	280	206	105	101
2	3,828	1,961	1,868	3,028	1,554	1,474	591	300	291	209	107	103
3	3,885	1,990	1,894	3,065	1,574	1,491	609	309	300	210	107	103
4	4,019	2,054	1,964	3,168	1,622	1,546	636	322	314	215	110	105
5-9	19,441	9,954	9,487	15,361	7,879	7,482	3,093	1,569	1,524	988	507	481
5	4,046	2,072	1,974	3,193	1,638	1,555	638	324	315	215	110	105
6	4,020	2,058	1,962	3,186	1,634	1,552	633	322	312	201	103	98
7	3,876	1,984	1,892	3,052	1,565	1,487	630	319	311	194	100	94
8	3,645	1,865	1,780	2,881	1,476	1,404	578	293	285	186	95	91
9	3,853	1,975	1,878	3,050	1,565	1,484	612	311	301	191	98	93
10-14	18,981	9,727	9,254	15,077	7,744	7,334	2,905	1,475	1,430	998	508	490
10	3,862	1,982	1,880	3,070	1,579	1,492	595	302	292	196	101	96
11	3,798	1,946	1,853	3,027	1,554	1,474	578	293	285	193	99	95
12	3,688	1,887	1,800	2,922	1,499	1,423	567	288	280	199	101	98
13	3,803	1,947	1,856	3,020	1,550	1,471	575	292	283	208	105	102
14	3,830	1,965	1,865	3,038	1,562	1,475	591	300	290	202	103	99
15-19	18,573	9,545	9,028	14,768	7,617	7,150	2,888	1,463	1,425	917	465	452
15	3,789	1,948	1,841	3,000	1,546	1,453	588	299	288	202	102	99
16	3,822	1,973	1,849	3,032	1,569	1,463	600	307	293	190	97	93
17	3,727	1,930	1,797	2,959	1,537	1,422	583	298	285	185	94	90
18	3,546	1,819	1,728	2,835	1,461	1,374	546	275	272	165	83	82
19	3,688	1,875	1,813	2,942	1,504	1,438	570	283	287	176	88	88
19-24	17,167	8,662	8,505	13,700	6,961	6,739	2,523	1,227	1,296	944	473	471
20	3,492	1,773	1,719	2,793	1,426	1,367	523	258	265	176	89	87
21	3,458	1,752	1,706	2,761	1,406	1,355	512	252	260	184	93	91
22	3,287	1,659	1,628	2,624	1,333	1,290	479	233	246	184	92	92
23	3,329	1,674	1,655	2,646	1,342	1,305	491	237	255	191	96	96
24	3,601	1,805	1,796	2,876	1,454	1,422	517	247	270	208	103	105
25-29	18,733	9,302	9,432	15,130	7,589	7,542	2,546	1,201	1,345	1,057	512	545
25	3,825	1,905	1,920	3,070	1,542	1,528	534	254	281	221	110	112
26	3,801	1,886	1,915	3,072	1,538	1,534	512	242	270	217	106	111
27	3,720	1,849	1,871	3,018	1,515	1,502	490	231	259	212	102	110
28	3,472	1,720	1,752	2,813	1,409	1,404	468	220	249	191	91	100
29	3,915	1,941	1,974	3,158	1,584	1,574	542	254	288	215	103	112
30-34	21,135	10,453	10,682	17,306	8,657	8,649	2,763	1,282	1,481	1,066	514	552
30	3,934	1,944	1,990	3,185	1,592	1,593	539	251	288	209	100	109
31	4,078	2,014	2,064	3,325	1,662	1,664	542	252	290	211	101	110
32	4,249	2,099	2,149	3,484	1,741	1,743	550	254	295	215	104	111
33	4,312	2,126	2,186	3,552	1,771	1,781	547	252	294	213	103	111
34	4,562	2,269	2,293	3,759	1,891	1,868	585	272	313	218	106	112
35-39	22,395	11,096	11,299	18,559	9,297	9,262	2,796	1,299	1,497	1,040	500	540
35	4,542	2,251	2,292	3,755	1,881	1,874	568	263	304	220	106	113
36	4,478	2,218	2,260	3,711	1,859	1,852	560	259	301	208	100	108
37	4,464	2,208	2,256	3,695	1,848	1,846	562	260	302	208	100	108
38	4,220	2,086	2,135	3,515	1,756	1,759	514	238	276	191	91	100
39	4,690	2,334	2,355	3,883	1,953	1,930	593	278	315	213	103	110
40-44	20,732	10,235	10,497	17,319	8,648	8,671	2,465	1,141	1,324	947	446	501
40	4,379	2,165	2,214	3,633	1,816	1,817	540	250	289	206	98	108
41	4,244	2,096	2,148	3,534	1,766	1,768	512	236	276	198	94	104
42	4,119	2,031	2,088	3,448	1,719	1,729	486	225	261	185	88	98
43	3,963	1,946	2,017	3,311	1,646	1,666	460	212	249	191	89	102
44	4,028	1,997	2,030	3,394	1,702	1,692	467	218	250	166	78	89
45-49	18,406	9,033	9,373	15,618	7,753	7,865	1,993	909	1,084	795	371	424
45	3,770	1,856	1,914	3,161	1,575	1,585	438	201	237	171	80	91
46	3,634	1,786	1,848	3,060	1,523	1,537	412	188	224	162	75	87
47	3,594	1,757	1,836	3,022	1,496	1,526	407	185	222	165	77	88
48	3,408	1,665	1,743	2,920	1,443	1,478	345	156	189	142	66	76
49	4,001	1,969	2,032	3,455	1,717	1,738	391	179	212	155	73	82
50-54	13,928	6,771	7,157	11,947	5,868	6,079	1,413	633	780	568	270	298
50	2,828	1,379	1,449	2,404	1,185	1,219	293	132	161	131	63	69
51	2,787	1,358	1,429	2,380	1,172	1,208	288	130	159	119	56	63
52	2,769	1,345	1,424	2,383	1,170	1,213	276	124	153	109	52	58
53	2,936	1,426	1,510	2,552	1,252	1,300	279	125	154	105	50	55
54	2,607	1,262	1,345	2,228	1,090	1,138	276	123	153	103	49	54
55-59	11,361	5,454	5,907	9,762	4,738	5,025	1,163	510	653	436	207	229
55	2,407	1,159	1,248	2,052	998	1,054	256	114	142	98	47	51
56	2,346	1,127	1,218	2,012	979	1,033	244	106	138	89	42	47
57	2,327	1,116	1,210	1,998	969	1,029	241	106	135	88	42	46
58	2,135	1,022	1,112	1,849	895	954	208	91	117	77	36	41
59	2,148	1,029	1,119	1,850	896	954	214	94	121	83	39	44
60-64	9,999	4,711	5,288	8,652	4,125	4,526	995	427	568	352	158	194
60	2,078	980	1,098	1,792	854	937	209	90	119	77	36	41
61	2,061	978	1,083	1,792	861	930	198	85	114	71	33	39
62	1,921	907	1,014	1,656	791	865	195	84	110	70	32	39
63	1,942	916	1,025	1,684	804	879	191	82	109	67	30	37
64	1,997	929	1,068	1,729	815	914	202	86	116	67	29	38
65-69	9,892	4,507	5,384	8,667	3,985	4,683	929	398	532	295	125	170
65	2,044	944	1,100	1,771	828	944	207	88	119	66	28	37
66	2,017	933	1,084	1,761	822	940	194	85	109	61	26	35
67	1,978	905	1,073	1,732	801	931	188	79	108	58	24	34
68	1,944	879	1,066	1,715	781	934	173	74	99	56	23	32
69	1,909	847	1,062	1,687	753	934	167	71	96	54	23	32
70-74	8,778	3,818	4,960	7,844	3,434	4,410	704	285	419	229	99	131
70	1,839	811	1,028	1,624	722	902	163	67	96	52	22	30
71	1,827	800	1,027	1,633	720	913	147	60	87	48	21	27
72	1,780	780	1,000	1,597	705	892	135	54	81	48	21	27
73	1,664	715	949	1,491	644	847	130	52	78	43	18	25
74	1,668	711	956	1,499	643	856	129	51	78	39	17	22
75-79	6,873	2,821	4,052	6,198	2,556	3,642	526	202	324	149	62	86
75	1,603	679	924	1,442	615	827	124	49	75	37	15	21
76	1,442	603	839	1,300	546	754	110	44	66	32	13	19
77	1,347	552	795	1,215	501	715	102	39	63	29	12	17
78	1,282	512	770	1,161	467	694	96	35	61	26	11	15
79	1,198	474	724	1,079	428	652	94	35	59	25	11	14
80-84	4,557	1,666	2,892	4,150	1,520	2,631	320	109	211	87	37	50
80	1,081	415	665	984	380	604	75	26	49	21	9	12
81	1,003	376	627	914	344	571	70	24	46	19	8	11
82	904	329	575	824	301	524	63	21	42	17	7	10
83	838	295	544	763	268	494	60	20	40	16	7	9
84	731	251	481	664	227	438	53	18	35	14	6	8
85-89	2,394	739	1,655	2,182	669	1,513	170	52	118	42	17	25
85	617	202	415	563	184	379	43	14	29	11	5	7
86	544	173	371	495	156	339	39	12	27	10	4	6
87	475	146	329	434	132	302	33	10	23	8	3	5
88	413	121	292	376	109	267	30	9	21	7	3	4
89	346	97	248	314	88	226	26	7	18	6	2	4
90-94	1,024	261	763	923	231	692	82	22	60	19	7	12
90	291	78	213	264	70	193	22	6	16	5	2	3
91	253	65	187	227	58	169	21	6	15	5	2	3
92	202	50	151	182	45	137	16	4	12	4	1	2
93	159	38	121	143	34	109	13	4	10	3	1	2
94	119	28	91	107	25	83	9	2	7	2	1	2
95-99	286	60	226	254	51	202	27	7	20	6	2	4
95	102	23	79	90	19	70	10	3	8	2	1	1
96	72	15	56	63	13	50	7	2	5	2	1	1
97	50	10	40	45	9	36	4	1	3	1	0	1
98	36	7	29	32	6	26	3	1	2	1	0	1
99	27	5	22	24	4	19	2	1	2	1	0	0
100+	57	10	47	47	8	40	8	2	6	2	1	1
0-14	57,708	29,549	28,159	45,727	23,461	22,266	8,946	4,539	4,408	3,035	1,549	1,486
15-44	118,734	59,292	59,442	96,782	48,770	48,012	15,981	7,613	8,368	5,971	2,909	3,061
45-64	53,694	25,969	27,725	45,979	22,484	23,495	5,564	2,479	3,085	2,151	1,006	1,145
15+	206,290	99,142	107,147	173,028	83,708	89,320	24,311	11,168	13,143	8,951	4,266	4,685
45+	87,555	39,850	47,705	76,246	34,938	41,308	8,330	3,556	4,774	2,980	1,357	1,623
65+	33,861	13,881	19,980	30,266	12,454	17,813	2,766	1,077	1,689	829	350	478
75+	15,192	5,556	9,635	13,755	5,035	8,720	1,132	394	738	305	127	178
85+	3,762	1,070	2,692	3,406	959	2,447	286	83	203	69	27	42

APPENDIX D

UNWEIGHTED AND WEIGHTED ESTIMATES FOR SELECTED NSAS VARIABLES

UNWEIGHTED N WEIGHTED ESTIMATE

SURVEY YEAR
96	125,433	21,236,913
FACILITY TYPE
1 = HOSPITAL	76,950	17,916,916
2 = FREESTANDING	48,483	3,319,997
UNITS FOR AGE
1 = YEARS	123,764	21,054,628
2 = MONTHS	1,616	171,456
3 = DAYS	53	10,829
AGE GROUPS
UNDER 15	14,915	1,774,324
15-44	35,117	6,440,689
45-64	31,646	5,882,069
65 & OVER	43,755	7,139,831
AGE FLAG
1 = IMPUTED VALUE	614	126,787
2 = NO IMPUTATION	124,819	21,110,126
SEX
1 = MALE	54,389	9,304,189
2 = FEMALE	71,044	11,932,724
SEX FLAG
1 = IMPUTED VALUE	933	121,327
2 = NO IMPUTATION	124,500	21,115,586
RACE
1 = WHITE	63,688	13,003,559
2 = BLACK	6,501	1,223,369
3 = AMIND/ESK/ALT	272	44,435
4 = ASIAN/PACISL	1,632	192,794
5 = OTHER	1,136	210,091
9 = NOT STATED	52,204	6,562,665
STATUS AT DISPOSITION
1 = ROUTINE	115,019	19,090,255
2 = OBSERVATION STATUS	3,108	757,730
3 = RECOVERY CARE CTR	1,340	185,491
4 = INPATIENT ADMISSION	1,595	399,277
5 = SURGERY CANC/TERM	144	32,551
6 = OTHER	562	145,839
9 = NOT STATED	3,665	625,770
MONTH OF SURGERY
01 = JANUARY	10,212	1,730,415
02 = FEBRUARY	10,142	1,745,564
03 = MARCH	10,514	1,821,931
04 = APRIL	11,119	1,904,785
05 = MAY	11,200	1,923,352
06 = JUNE	10,266	1,758,782
07 = JULY	10,758	1,830,425
08 = AUGUST	10,647	1,750,547
09 = SEPTEMBER	9,941	1,680,831
10 = OCTOBER	11,017	1,816,678
11 = NOVEMBER	9,939	1,640,753
12 = DECEMBER	9,678	1,632,850
REGION
1 = NORTHEAST	26,405	4,612,713
2 = MIDWEST	28,058	5,377,620
3 = SOUTH	45,844	7,021,243
4 = WEST	25,126	4,225,337
PRINCIPAL EXPECTED SOURCE OF PAYMENT
00 = NO CHARGE	692	91,473
01 = WORKERS COMP	2,865	485,710
02 = MEDICARE	39,826	6,572,537
03 = MEDICAID	8,530	1,320,669
04 = CHAMPUS	528	95,207
05 = OTHER GOVT	1,029	183,961
06 = BLUE CROSS	14,095	2,554,866
07 = HMO/PPO	19,836	3,645,498
08 = OTHER PRIVATE	25,728	4,213,419
09 = SELF PAY	3,635	528,601
10 = OTHER	1,909	333,594
99 = NOT STATED	6,760	1,211,378
FIRST-LISTED DIAGNOSIS
VCODES	8,398	1,456,986
CHAPTER 1	574	100,639
CHAPTER 2	10,462	1,929,480
CHAPTER 3	1,081	151,166
CHAPTER 4	496	119,526
CHAPTER 5	142	23,995
CHAPTER 6	32,602	4,052,289
CHAPTER 7	3,910	1,015,821
CHAPTER 8	5,086	917,383
CHAPTER 9	18,383	3,512,901
CHAPTER 10	13,133	2,306,248
CHAPTER 11	1,399	229,990
CHAPTER 12	2,870	465,430
CHAPTER 13	11,337	2,062,377
CHAPTER 14	1,691	189,815
CHAPTER 15	13	2,399
CHAPTER 16	6,947	1,379,229
CHAPTER 17	6,909	1,321,239
ALL-LISTED PROCEDURES		32,266,752
CHAPTER 1		1,249,575
CHAPTER 2		37,294
CHAPTER 3		5,319,085
CHAPTER 4		847,949
CHAPTER 5		2,127,174
CHAPTER 6		440,275
CHAPTER 7		1,059,585
CHAPTER 8		167,445
CHAPTER 9		7,033,405
CHAPTER 10		1,473,423
CHAPTER 11		555,110
CHAPTER 12		2,037,569
CHAPTER 13		16,677
CHAPTER 14		4,320,869
CHAPTER 15		2,416,204
CHAPTER 16		3,165,113

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