# Agency Information Collection Activities: Submission to OMB for Review and Approval; Public Comment Request; National Practitioner Data Bank: Modification of the National Practitioner Data Bank Code Lists
**AGENCY:**
Health Resources and Services Administration (HRSA), Department of Health and Human Services.
**ACTION:**
Request for public comment on the National Practitioner Data Bank's (NPDB) Basis for action code lists for licensure and certification actions.
**SUMMARY:**
HRSA, a sub-agency of the Department of Health and Human Services, is announcing a change in the NPDB Basis for Action Code Lists for Federal Licensure, and State Licensure or Certification Actions to individuals and entities authorized to report and request information from the NPDB. These changes will contain updated codes and code use guidance applicable to organizations submitting Federal Licensure, or State Licensure or Certification Actions. The code modifications and guidance are intended to provide improved report accuracy and promote a better understanding of the use and application of the basis of action codes available for report submission. The modifications are based in part upon recommendations made through a collaborative effort with NPDB industry partners: the Federation of State Boards of Physical Therapy, the National Council of State Boards of Nursing, the Federation of State Medical Boards, the Association of State and Provincial Psychology Boards, the National Board for Certification in Occupational Therapy, the Association of Social Work Boards, and the National Association of Boards of Pharmacy. Basis for Action codes help to accurately describe the basis for licensure actions reported. Basis for Action codes have no impact on the licensure action reported or the applicability of NPDB reporting criteria. New, modified, and retired codes have no impact on historical reporting. The coding of previously submitted reports will remain unchanged.
**DATES:**
Submit comments no later than February 2, 2022.
**ADDRESSES:**
Written and/or electronic comments should be submitted to *[email protected]* by February 2, 2022.
**FOR FURTHER INFORMATION CONTACT:**
David Loewenstein, Director, Division of Practitioner Data Bank, Bureau of Health Workforce, HRSA, (301) 443-2300, *[email protected].*
**SUPPLEMENTARY INFORMATION:**
The current published NPDB Code Lists are available on the NPDB website: *https://www.npdb.hrsa.gov/hcorg/codes.jsp.*
The NPDB is authorized by the Health Care Quality Improvement Act of 1986 (the Act), Title IV of Public Law 99-660, as amended (42 U.S.C. 11101 *et seq.* ). Further, two additional statutes expanded the scope of the NPDB—Section 1921 of the Social Security Act, as amended (42 U.S.C. 1396r-2) and Section 1128E of the Social Security Act, as amended (42 U.S.C. 1320a-7e). Information collected under the Section 1128E authority was consolidated within the NPDB pursuant to Section 6403 of the Affordable Care Act, Public Law 111-148; this consolidation became effective on May 6, 2013.
| Table | Code | Status | Current code | New/modified code description | Guideline or explanation of status change | Code use examples and explanations |
| --- | --- | --- | --- | --- | --- | --- |
| | | | | | | |
| 48 | 44 | U | Default on Health Education Loan or Scholarship Obligations | | Fails to meet health education loan or scholarship obligations | Explanation: Use only if your state has this requirement. |
| 48 | 35 | U | Drug Screening Violation | | Fails a drug screening test | Examples: |
| 48 | A2 | U | Failure to Comply With Continuing Education or Competency Requirements | | Fails to meet the continuing education or competency requirements for renewal or reinstatement | Examples: |
| 48 | 31 | M | Failure to Comply With Health and Safety Requirements | Failure to comply with health and safety requirements or state health code | Fails to comply with federal, state, local, or institutional safety requirements or state health codes | Examples: |
| 48 | 23 | U | Failure to Cooperate With Board Investigation | | Interferes with an investigation or disciplinary proceeding by withholding information, deliberate misrepresentation of facts or attempts to suppress evidence | Examples: |
| 48 | 50 | M | Failure to Maintain Adequate or Accurate Records | Failure to Maintain or Provide Adequate or Accurate Medical Records, Financial Records or Other Required Information | Fails to meet documentation requirements for maintaining patient care, financial or other records | Example: |
| 48 | 45 | R | Failure to Maintain Records or Provide Medical, Financial or Other Required Information | | Redundant code, use code 50 | |
| 48 | A3 | R | Failure to Meet Licensing Board Reporting Requirements | | Use code A1 | |
| 48 | A1 | M | Failure to Meet the Initial Requirements of a License | Failure to Meet Licensure Requirements/Licensing Board Reporting Requirements | Fails to meet board specified licensing requirements or provide requested/required information. NOTE: Do not report or include threshold criteria: the accepted minimum licensure requirements that are universally applied without decision or exception. Examples include academic degrees, criminality, certifications, or training hours or requirements | Examples: |
| 48 | 37 | M | Failure to Pay Child Support/Delinquent Child Support | Failure to Pay or Delinquent with Child Support | Fails to meet child support responsibilities | Explanation: Use only if your state has this requirement. |
| 48 | 39 | M | License Revocation, Suspension or Other Disciplinary Action Taken by a Federal, State or Local Licensing Authority | Disciplinary Action Taken by another Federal, State or Local Licensing Authority | Grounds for action are based on action(s) taken by another state licensing, federal, or other authority | Examples: |
| 48 | 29 | U | Practicing Beyond the Scope of Practice | | Provides care not permitted under the terms of a license or within the licensee's level of education, training, knowledge, skills, experience, or demonstrated competency | Examples: |
| 48 | 24 | U | Practicing With an Expired License | | Fails to renew license and continues to practice | Example: |
| 48 | 25 | R | Practicing Without a License | | Redundant code, use code A4 | |
| 48 | A4 | U | Practicing Without a Valid License | | Practices without obtaining the proper authorization | Examples: |
| 48 | A6 | U | Violation of Federal or State Statutes, Regulations or Rules | | Violation of federal or state statutes, regulations or rules not associated with the practice act | Examples: |
| 48 | 36 | U | Violation of Federal or State Tax Code | | Fails to meet federal or state tax code responsibilities | Example: |
| 48 | 84 | R | Violation of State Health Code | | Redundant code, use code 31 | |
| 48 | A5 | U | Violation of or Failure to Comply With Licensing Board Order | | Fails to comply with a specific board order | Example: |
| | | | | | | |
| 49 | 19 | U | Criminal Conviction | | Convicted of a felony or misdemeanor crime | Example: |
| 49 | 18 | U | Deferred Adjudication | | Plea that avoids criminal conviction by meeting certain probationary requirements | Explanation: |
| 49 | B1 | U | Nolo Contendere Plea | | Plea of no contest, same consequence as a guilty plea | |
| 49 | I1 | U | Diverted Conviction | | Pre-trial sentencing that avoids criminal conviction by completing a court ordered intervention program | Explanation: |
| | | | | | | |
| 50 | C3 | U | Breach of Confidentiality | | Releases or obtains patient information without appropriate authorization | Example: |
| 50 | C2 | U | Failure to Comply With Patient Consultation Requirements | | Fails to meet requirements for consultation with other health care providers or refer when appropriate | Examples: |
| 50 | C1 | U | Failure to Obtain Informed Consent | | Fails to meet informed consent requirements | Examples: |
| | | | | | | |
| 51 | D4 | U | Abusive Conduct Toward Staff | | Engages in the maltreatment of a colleague or employee which can include mental, physical and/or verbal abuse | Example: |
| 51 | D7 | M | Conduct Evidencing Ethical Unfitness | Conduct Evidencing Ethical or Moral Unfitness | Engages in conduct that is unethical or violates the ethical code of conduct | Examples: |
| 51 | D6 | R | Conduct Evidencing Moral Unfitness | | Use Code D7 | |
| 51 | 71 | U | Conflict of Interest | | Fails to disclose information that presents a conflict of interest | Examples: |
| 51 | D5 | U | Disruptive Conduct | | Engages in conduct which interferes with or disrupts normal operations in the patient care setting or workplace | Example: |
| 51 | D3 | U | Exploiting a Patient for Financial Gain | | Exploits a professional relationship with a patient to benefit financially beyond that which is reasonable for the provision of treatment | Examples: |
| 51 | 16 | U | Misappropriation of Patient Property or Other Property | | Uses a patient's or coworker's property or the property of a facility without approval or permission | Example: |
| 51 | D2 | M | Non-Sexual Dual Relationship or Boundary Violation | Non-Sexual Boundary Violation | Engages in a non-sexual relationship, behavior or boundary violation that involves exploitation or coercion of a patient or former patient and contains harmful or potentially harmful elements | Examples: |
| 51 | 14 | U | Patient Abuse | | Engages in the maltreatment of a patient which can include mental, physical and/or verbal abuse | Example: |
| 51 | D1 | U | Sexual Misconduct | | Engages in behavior that exploits the practitioner-patient relationship in a sexual way, or engages in workplace sexual harassment such as unwelcome sexual advances or conduct of a sexual nature which interferes with the performance of another person's job or creates an intimidating, hostile, or offensive work environment | Examples: |
| 51 | D8 | R | Other Unprofessional Conduct, Specify | | Redundant code, covered by other categories, or use code 99 | |
| | | | | | | |
| 52 | E6 | U | Failure to Disclose | | Fails to disclose information that is required by the board | Examples: |
| 52 | E3 | U | Filing False Reports or Falsifying Records | | Fabricates patient, medical, health, employee, or other records | Examples: |
| 52 | 5 | R | Fraud—Unspecified | | Redundant code, covered by other fraud codes | |
| 52 | E4 | U | Fraud, Deceit or Material Omission in Obtaining License or Credentials | | Provides false, altered or omitting documents and information when applying for licensure | Examples: |
| 52 | 55 | M | Improper or Abusive Billing Practices | Improper Billing Practices | Knowingly or intentionally bills improperly | Examples: |
| 52 | E1 | U | Insurance Fraud (Medicare, Medicaid or Other Insurance) | | Convicted of Medicare, Medicaid or other insurance fraud | Examples: |
| 52 | E5 | U | Misleading, False or Deceptive Advertising or Marketing | | Uses misleading, false or deceptive advertising or marketing related to services, treatment, procedures or care | Example: |
| 52 | 81 | U | Misrepresentation of Credentials | | Fails to properly identify oneself with regards to education, training, knowledge, experience, or skills | Example: |
| 52 | E2 | U | Providing or Ordering Unnecessary Tests or Services | | Orders or provides unnecessary tests, procedures, treatment or services | Examples: |
| 52 | 56 | U | Submitting False Claims | | Requests reimbursement for services that did not occur or does not reflect the actual treatment provided | Example: |
| | | | | | | |
| 53 | F8 | U | Failure to Consult or Delay in Seeking Consultation With Supervisor/Proctor | | Fails to provide or delaying proper consultation with supervisor or proctor | Example: |
| 53 | 53 | R | Failure to Provide Medically Reasonable and/or Necessary Items or Services | | Redundant code, use code 13 | |
| 53 | F1 | M | Immediate Threat to Health or Safety | Immediate Threat to Public | Presents an immediate risk to health or safety; Board uses emergency measures to remove a practitioner from practice | Examples: |
| 53 | 17 | U | Inadequate or Improper Infection Control Practices | | Fails to conform to recognized standards or orders for infection control | Example: |
| 53 | FA | U | Inappropriate Refusal to Treat | | Refuses to treat a patient due to religious, moral or other reasons | Example: |
| 53 | 11 | R | Incompetence | | Redundant code, use F1 or F6 | |
| 53 | 12 | R | Malpractice | | Redundant code, use specific reason associated with malpractice | |
| 53 | 13 | U | Negligence | | Fails to exercise the skill, care and learning expected of a reasonably prudent health care provider | Example: |
| 53 | F9 | U | Patient Abandonment | | Terminates care without adequate notice of the professional relationship between a health care provider and a patient/client at a time when the patient needs further care | Example: |
| 53 | 15 | R | Patient Neglect | | Redundant code, use 13 | |
| 53 | F6 | M | Substandard or Inadequate Care | Substandard Care or Inadequate Skill Level | Fails to meet clinical standards of practice, unable to practice competently or practicing with insufficient skill | Example: |
| 53 | F7 | R | Substandard or Inadequate Skill Level | | Redundant code, use code F6 | |
| 53 | F5 | R | Unable to Practice Safely | | Redundant code, use code F2, F3, or F4 | |
| 53 | F2 | M | Unable to Practice Safely by Reason of Alcohol or Other Substance Abuse | Unable to Practice Safely by Reason of Substance Use | Unable to practice safely by reason of substance use | Example: |
| 53 | F4 | M | Unable to Practice Safely by Reason of Physical Illness or Impairment | Unable to Practice Safely by Reason of Physical Impairment | Unable to practice safely by reason of physical impairment | Example: |
| 53 | F3 | M | Unable to Practice Safely by Reason of Psychological Impairment or Mental Disorder | Unable to Practice Safely by Reason of Psychological Impairment | Unable to practice safely by reason of psychological impairment | Example: |
| 53 | To be determined | N | N/A | Incorrect Site Procedure | Procedure performed on the wrong side or site of the body, wrong surgical procedure performed | Example: |
| 53 | To be determined | N | N/A | Foreign Body Retained Inappropriately in a Patient | Leaves an item(s) inside a patient after a procedure that should not be there | Example: |
| 53 | To be determined | N | N/A | Wrong Patient | Procedure or treatment performed on the wrong patient | Example: |
| | | | | | | |
| 54 | G2 | U | Allowing or Aiding Unlicensed Practice | | Allows or assists someone practice without a license | Example: |
| 54 | G1 | U | Improper or Inadequate Supervision or Delegation | | Fails to supervise adequately or properly those assigned to you | Example: |
| | | | | | | |
| 55 | H6 | U | Inappropriate Acquisition or Diversion of Controlled Substance | | Diverts prescription medication from a patient or a healthcare facility with intent to sell, distribute or consume for personal misuse | Example: |
| 55 | H5 | U | Error in Prescribing, Dispensing or Administering Medication or Sedation | | Makes an error when prescribing, dispensing, or administering medications | Examples: |
| 55 | H1 | M | Narcotics Drug Violation or Other Violation of Drug Statutes | Drug Violation or Other Violation of Drug Statutes | Controlled substance violation regardless of conviction | Examples: |
| 55 | H4 | U | Inappropriate or Unauthorized Administration of Medication or Sedation | | Administers medications improperly or without the appropriate prescription or medication order | Example: |
| 55 | H3 | U | Inappropriate or Unauthorized Dispensing of Medication | | Dispenses medication improperly or without the appropriate authorization | Example: |
| 55 | H2 | U | Inappropriate or Unauthorized Prescribing of Medication | | Improper prescribing or attempting to prescribe without authority or altering medication order | Examples: |
| | | | | | | |
| 56 | 99 | U | Other—Not Classified, Specify | | Use only if no other code is applicable | |
Diana Espinosa,
Acting Administrator.