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HCPCS domains

Vocabulary Users
#1

Friends:
A few questions about HCPCS domains assignment have been flying around recently. I’m suggesting starting a new thread for all the related question.
Here’s current assignment for starters:

The main domain is ‘Procedure’, but we also introduce others:
Devices:
B codes between B4000-B9999 coding ‘Enteral and Parenteral Therapy’ (example ‘HCPCS Code |B4081| Nasogastric tubing with stylet’)
E codes between E0100-E9999 coding ‘Durable Medical Equipment’ (example ‘HCPCS Code |E0607| Home blood glucose monitor ‘)
K codes between K0000-K9999 coding ‘Durable medical equipment (DME) Medicare administrative contractors (MACs) (example ‘HCPCS Code |K0007|Extra heavy duty wheelchair‘)
L codes between L0000-L9999 coding ‘Orthotic Procedures and services’ and ‘Prosthetic Procedures’ (example ‘HCPCS Code |L3208| Surgical boot, each, infant‘)
Additionally, we define as Devices radiopharmaceuticals, supplies, blood products etc.

Measurements:
Lab tests, diagnostic studies (example HCPCS Code |S3630|Eosinophil count, blood, direct).If code represents a panel/set of tests where the result can’t be stored as a single answer, we assign them domain ‘Observation’.

Drugs:
J codes between J0100-J9999 coding ‘Drugs Administered Other than Oral Method’ and ‘Chemotherapy Drugs’ (example ‘HCPCS Code |J0133| Injection, acyclovir, 5 mg‘).
We also consider every HCPCS, that contain drug substances as ‘Drug’ and map them to RxNorm where possible.

Observations:
If name consist definition of time period we define this code as domain ‘Observation’( example ‘HCPCS Code |G0378| Hospital observation service, per hour’).
We also define as Observation entities that represent visits, episodes of care, training and educational/screening services, home management, home infusions and home therapy without exact drugs, per diem etc.
Example ‘M0064|Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disorders ’.

tagging @Gowtham_Rao, @jenniferduryea for any questions about storing quantities for those HCPCS codes that are observations.

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#2

HCPCS codes that are standard codes, but with domain-id that is not procedure is always confusing.
http://athena.ohdsi.org/search-terms/terms/2617452
http://athena.ohdsi.org/search-terms/terms/2720490
it makes missing these codes in a query more likely. we just have to be cognizant.

@jenniferduryea could you share an example of how the US claims system source data represents quantities for the HCPCS codes?

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#3

Hm. I’d say the opposite: Why is “Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disorders” a procedure? And why would making it an Observation go missing?

This one btw will go back to valid, till we fixed the Procedure Hierarchy problem.

#4

@Gowtham_Rao, no problem. Thanks for the tag.

Units associated with HCPCS are different, depending on the definition of the HCPCS code. For example:

  • 1 unit for J1040 “Injection, methylprednisolone acetate, 80 mg” = 80mg
  • 1 unit for J0717 “Injection, certolizumab pegol, 1 mg” = 1mg
  • 1 unit for 97110 “Therapeutic exercises to develop strength and endurance, range of motion, and flexibility” = 15 mins
  • 1 unit for 96415 “Under Injection and Intravenous Infusion Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration” = 1 hour

Units for hcpcs codes need to be associated with the billed hcpcs code to properly describe the service rendered. When hcpcs codes are moved to different domains, there is confusion as to how to store the units associated with that hcpcs code. So that is one reason why @Gowtham_Rao and I like to keep hcpcs codes in the procedure_occurrence table - there is a built-in units field.

#5

@jenniferduryea:

Oh boy. I have to breathe. This train really left the station several times already.

Look:

  • The quantity of drugs is preserved
  • The quantity of procedures is preserved (even though we need to tighten the way this is expressed through THEMIS)
  • The quantity of devices is preserved
  • I have no idea what use we’d get from the “quantities” in 97110 and 96415. The former only exists in a 15 minute version, so a structured record of that quantity is hardly any useful. Furthermore, it actually says in the description “Therapeutic procedure, 1 or more areas…”. Now what? Same is true for the second one. The one hour is utterly irrelevant for what is done - some infusion. Whether it took one hour or an hour and a half is only important for billing the amount of time spent by the medical staff at the provider institution.

So, let’s not kick that dead horse anymore. The fact that the vocabularies have the term “procedure” in its name doesn’t make them all procedures. They are a mechanism to justify payment, a negotiated price list of things. Less than half of them actually reflect true procedures carried out on the patient.

#6

Maybe we should refocus on @aostropolets primary question of how to represent quantities.The domain assignment discussion is not important - sorry i brought that up.

This makes sense. We just have to remember it.

so have we answered the question in this thread? is the question trying to hint breaking one code into multiple codes?

#7

I actually thought of any observations where quantities make sense and are important for you/other researchers.
If you experience troubles storing them, we can try to come up with a nice solution.

#8

@jenniferduryea
are there examples of codes where one code = more than one unit?

How do providers bill for many units? Repeat the same code or use a code with more units built into it’s meaning.

#9

@Gowtham_Rao Yes.

In my first example, you bill (and the claims data will reflect) J1040 with units = 1, which means 80mg of methylprednisolone acetate. For laymen who don’t know the entire definition of J1040, the user may think that only 1mg of methylprednisolone acetate was given to the patient. But actually, 80mg was given to the patient.

Another example of “one code = more than one unit” is dialysis code 90960, defined as “End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 4 or more face-to-face visits by a physician or other qualified health care professional per month”. You would bill (and the claims data will reflect) 90960 with units = 1. Again, to the layman, it would look like there was only one face-to-face meeting between the physician and patient in the month. But there were actually “4 or more” visits with the patient. There are no other dates provided in the claims data when billing that code, except for the month that this code applies.

#10

Great

Follow up question. So there is no explicit quantified value for units as a separate field in the source data correct. I.e. the source does not have fields similar to quantity, days supply, days of service like we have in drug claims.

Everything is implcit and buried in the HCPCS codes. Correct?

#11

@Gowtham_Rao correct.

#12

@aostropolets this sounds like a drug_strength scenario?

#13

Ooops, I lost the track…
So yes, drugs are covered by drug_exposure where you can put quantities (it will be a size of a pack in a bill, I suppose, rather than a tablet). And as a drug_concept_id you’ll have RxNorm id reflecting methylprednisolone 80 MG Oral Tablet (and 80 MG will be stored in drug_strength, correct), as HCPCS codes under domain Drug are mapped to RxNorm.

In the second example you actually have ‘4 or more…visits’ in the name, so it’s hard to define the quantity regardless of the way we choose. Can be 4 or 5 or 6…

#14

@aostropolets:

Actually: We should change the HCPCS script to create RxNorm Extension records like a Clinical Drug Component “Methylprednisolone 80 mg”. Because right now HCPCS can’t “create” RxNorm Extensions, and there is no 80 mg Methylprednisolone right now, because there isn’t such a component. Instead, it is mapped to the Clinical Drug Form 35606532 “Methylprednisolone Injection”.

#15

Does the current version of concepts nest category 1,2,3 into the HCPCS vocabulary? Are there historic CPT codes that may be represented soley buy a CPT “vocabulary” and not by HCPCS?

Thanks
@Christian_Reich @cukarthik

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#16

@dblatt could you please elaborate on this?
CPT4 vocabulary is a separate vocabulary and you can find CPT concepts there.
We will start to gather all missing ones, so you’re welcome to share those that you need.

Which categories?

#17

Hi!
Apologies - \categories\levels. CPT is now essentially HCPCS level 1 yes?

#18

Yes.

t