Stream: Da Vinci PDex
Topic: Encounter Classification CodeSet
Vishak OS (Jun 16 2021 at 16:20):
Hi All,
I'm looking out for some guidance to populate the Encounter Classification code (https://terminology.hl7.org/1.0.0//ValueSet-v3-ActEncounterCode.html) from the Medicaid Claims data.
I could find that, the category of Service field in the Claims data could be used to map the Inpatient and Home Health (HH) directly and Emergency setting could be identified as well from the claim data. But am having trouble with other set of services.
In the PDEX Profile, I could see an example with ExplanationOfBenefit.type used to map the ActCode (http://build.fhir.org/ig/HL7/davinci-epdx/USCoreEncounter.html)
Encounter Type | ACT Code
institutional -> IMP
oral -> AMB
pharmacy -> AMB
professional -> AMB
vision -> AMB
Questions:
-
I could see the usage of Encounter Type Code could be very broad,
- For Example, Vision services - a Medicaid claim could be generated from an inpatient, Emergency, Office/Outpatient facility, Home Care setting.
So providing this as an “AMB” classification may not be the right choice. Any thoughts on this?
- For Example, Vision services - a Medicaid claim could be generated from an inpatient, Emergency, Office/Outpatient facility, Home Care setting.
-
What other fields from the Medicaid Claims data could be used in combination with the Category of Service to crosswalk the ActEncounterCode?
Thank you!
Tag: @Lloyd McKenzie @Mark Scrimshire @Paul Church
Lloyd McKenzie (Jun 23 2021 at 19:50):
I agree that the type of service doesn't necessarily guarantee a specific encounter type. All disciplines could be inpatient or outpatient. (Some might even be phone/virtual). To clarify, is the issue that you don't have enough source information to be able to determine what the encounter type is?
Vishak OS (Jun 28 2021 at 14:13):
Thanks @Lloyd McKenzie for the update.
So, the issue is that - Initially I wasn't sure what source information from the Medicaid Claims could be used judiciously to cross walk the encounter classification mentioned in the ActEncounterCode valueset. I was wondering if anyone have taken the same road, that could be of help.
btw, I was able to make progress on the crosswalk.
- HH - Home Health:- Use of Invoice Type field (Value:- 24, 25)
- IMP - Inpatient:- Use of Invoice Type field (Value:- 11,12)
- ACUTE - Acute Inpatient:- Invoice Type field (11,12) & CPT Codes from the HEDIS 2020 valueset directory with value set name like 'Acute'
- NONAC - Non-Acute Inpatient:- Invoice Type field (11,12) & CPT Codes from the HEDIS 2020 valueset directory with value set name like 'Nonacute'
- AMB - Ambulatory:- Use of Detail category of service - that indicates - Ambulatory Services
- EMER - Emergency:- Use of Service Setting value 'ER or Emergency'
- OBSENC - Observation Encounter:- Use of CPT Codes ('99234', '99236', '99235', '99217', '99218', '99219', '99220')
Pending Items: I haven't found what information could be used to identify the below from the Medicaid Claims data.
- FLD - Field Classification
- PRENEC - Pre-Admission Classification
- SS - Short Stay
Any pointers on the above would be helpful, Thank you!
Lloyd McKenzie (Jun 28 2021 at 17:15):
@Paul Knapp
Vishak OS (Jul 06 2021 at 12:08):
Hi All,
I'm having some trouble to map the encounter class mentioned in https://terminology.hl7.org/1.0.0//ValueSet-v3-ActEncounterCode.html for the "Residential Treatment Facility, Child Foster Care" services.
Does it come under the Ambulatory Encounter class, or should I extend this valueset to include the custom classification? Thank you!!
Last updated: Apr 12 2022 at 19:14 UTC
