1. Click to edit Master title style 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, Manager Special Investigations Unit - Analytics

2. 2 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)

3. 3 HIPAA Clinical Code Sets: Codes within the Driver Tables Administrative simplification was the key component

4. 4 HIPAA Clinical Code Sets: Codes within the Driver Tables Key foundation of claim, driver tables with related features is the code

5. 5 Stop the Confusion of Driver Tables: Standardization Saves on creation and lookup of code time

6. 6 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

7. 7 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

8. 8 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

9. 9 Yield to Empty Age Tables: Age Control Tables References to extremely young versus extremely old differ from specialty to specialty.

10. 10 Yield to Empty Age Tables: Age Control Tables References to extremely young versus extremely old differ from specialty to specialty. What is the basis of determining the four (4) Age categories: extremely young, young, old, extremely old?

11. 11 Yield to Empty Age Tables: Age Control Tables References to extremely young versus extremely old differ 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 be consistent throughout FAMS users?

12. 12 Yield to Empty Age Tables: Age Control Tables References to extremely young versus extremely old differ 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 be consistent throughout FAMS users? If data becomes portable in that we begin sharing or aggregating, reference variables must be consistent.

13. 13 Go Ahead…Think of the Possibilities What driver tables could be standardized based upon the 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/Month Place of Service codes FBG481 - # of Procs w/Short Procedure Units POS Preventive visit codes FBG188 - % Preventive Medicine visits Venipuncture/Blood draw codes FBG174 - % Venipunctr Vsts w/Blood test

14. 14 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 patients hospital floor or unit

15. 15 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 standardized Place of service codes are defined by CPT

16. 16 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 standardized Place of service codes are defined by CPT Portability of data will be enhanced by standardization of codes utilized in modeling

17. 17 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 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!

18. 18 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

19. 19 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?