In talking about CDM v5 for drugs today with the Medicare ETL group, I realized I was not clear on how procedures for drug administration should be recorded. By way of background, a J-code (a specific HCPCS code) generally indicates an infused drug. This is typically accompanied (on a different record) with an administration code (generally injection or infusion). Sometimes an administration code covers more than one drug depending on the payer policy (e.g., an infusion of two drugs at the same time).
This is from the wiki for CDM v5 procedure occurrences (my emphasis on “simultaneously”):
Procedures could involve the application of a drug, in which case the procedural component is recorded in the procedure table and simultaneously the administered drug in the drug exposure table when both the procedural component and drug are identifiable.
I just want to be clear what records are generated.
- Does the J-code result in a record in the drug exposure table? Sounds like “yes” and that make sense.
- Does the administration code result in a record in the procedure occurrence table? Sounds like an obvious “yes”.
- Does the ETL process generate a record in the procedure occurrence table for the J-code? This seems like it should be a “no”.
If the answer to the third bullet is “yes”, I worry a little about double-counting if the J-code shows up in two places. Also this has implications for attributing costs in the cost table.
Any clarification, or other thoughts?