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BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association. This document has been classified as public Information.
Stopping to Simplify: Driver Tables
Presented at IBM FAMS Users Meeting
Diane Ward RN MHSA CCS-P, ManagerSpecial Investigations Unit - Analytics
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HIPAA Clinical Code Sets: Codes within the Driver Tables
• Provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II) require that all entities utilize only recognized, standard coding schematics (e.g. CPT®, ICD-9, HCPCS)
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HIPAA Clinical Code Sets: Codes within the Driver Tables
Administrative simplification was the key component
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HIPAA Clinical Code Sets: Codes within the Driver Tables
Key foundation of claim, driver tables with related features is the code
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Stop the Confusion of Driver Tables: Standardization
Saves on creation and lookup of code time
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Stop the Confusion of Driver Tables: Standardization
Saves on creation and lookup of code time
Takes some of the guess work out of what
code should be included
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Stop the Confusion of Driver Tables: Standardization
Saves on creation and lookup of code time
Takes some of the guess work out of what
code should be included
Simplifies Organization of codes listed in tables
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Stop the Confusion of Driver Tables: Standardization
Saves on creation and lookup of code time
Takes some of the guess work out of what
code should be included
Simplifies Organization of codes listed in tables
Portability of data information and ability to compare
data
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Yield to Empty Age Tables: Age Control Tables
References to extremely young versus extremely old
differ from specialty to specialty.
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Yield to Empty Age Tables: Age Control Tables
References to extremely young versus extremely olddiffer from specialty to specialty.
What is the basis of determining the four (4) Age categories: extremely young, young, old,extremely old?
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Yield to Empty Age Tables: Age Control Tables
References to extremely young versus extremely olddiffer from specialty to specialty.
What is the basis of determining the four (4) Age categories: extremely young, young, old,extremely old?
Should specialty to specialty age references beconsistent throughout FAMS users?
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Yield to Empty Age Tables: Age Control Tables
References to extremely young versus extremely olddiffer from specialty to specialty.
What is the basis of determining the four (4) Age categories: extremely young, young, old,extremely old?
Should specialty to specialty age references beconsistent throughout FAMS users?
If data becomes portable in that we begin sharing oraggregating, reference variables must be consistent.
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Go Ahead…Think of the Possibilities
What driver tables could be standardized based uponthe feature question? High level E/M
FBG081 - % of High Level Eval & Mgmt Pxs.Consultation codes
FBG126 - % of High Level Consultation Pxs.Physical therapy codes
FBP012 - # of Visits w/PT Pxs/MonthPlace of Service codes
FBG481 - # of Procs w/Short Procedure Units POSPreventive visit codes
FBG188 - % Preventive Medicine visitsVenipuncture/Blood draw codes
FBG174 - % Venipunctr Vsts w/Blood test
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Coding Examples
Consultation codes: “High level”Office/Other Outpatient - New or Established Patient (99241-99245)
Top 2 are considered high level per descriptor indicating three component requirement as all other consultation codes plus typical 60 minutes or 80 minutes face-to-face physician time respectively
Initial Inpatient – New or Established Patient (99251-99255)
Top 2 are considered high level per descriptor indicating three component requirement as all other consultation codes plus typical 80 minutes or 110 minutes with physician at bedside and on the patient’s hospital floor or unit
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Merge Some Other Thoughts For Clarification
Remember that CPT®, HCPCS and ICD-9 Codes are standard code sets used nationally and even internationally
Code descriptions are standardizedPlace of service codes are defined by CPT
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Merge Some Other Thoughts For Clarification
Remember that CPT®, HCPCS and ICD-9 Codes are standard code sets used nationally and even internationallyCode descriptions are standardizedPlace of service codes are defined by CPT
Portability of data will be enhanced by standardization of codes utilized in modeling
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Merge Some Other Thoughts For Clarification
Remember that CPT®, HCPCS and ICD-9 Codes are standard code sets used nationally and even internationallyCode descriptions are standardized
Place of service codes are defined by CPT
Portability of data will be enhanced by standardization of codes utilized in modeling
It is imperative that someone in your organization understand the ins and outs of the industry standard code sets…preferably a certified professional coder!
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Collaboration and Discussion: Possibilities for Standardization of Driver Tables
Deriving age categories from claims data
Determining correct codes from code descriptors
Deriving correct codes from FAMS user agreement
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Discussion & Questions
How can this be done?
Why would we want to do this?
When is it appropriate to do this?
Will this make the process more difficult?