Proposal for a Unified Cost Table

@Christian_Reich! Leave my revenue codes alone! :joy: @Gowtham_Rao revenue codes are retained because they do provide some clinical information about the patient’s visit that submitted ICD-9/ICD-10 codes on facility claims do not provide. Inpatient facility claims are notorious for not providing much detail about the patient’s visit (mostly because they do not submit HCPCS/CPT codes, and ICD-9/ICD-10 procedure coding is minimal/scarce at best). But, based on the revenue codes submitted on the inpatient facility claim, the analyst will be able to see if the patient received dialysis (revenue code 0304 or 080x), received EPO (revenue code 0634 or 0635), or went to the emergency room (revenue code 045x).

Should revenue codes should be stored somewhere else in the CDM? Maybe. They provide clinical information which does not seem to align with the purpose of a ā€œcostā€ table. But, as I’m sure @Gowtham_Rao is aware, revenue codes are assigned to the cost of the claim and sometimes the procedure code as well (for outpatient facility claims and some inpatient facility claims using revenue codes requiring a procedure code). And it is important to retain the linkage between the procedure code and revenue code (if there is one). So right now, revenue codes stay in the Cost Table because that is how the source data represents revenue codes. But I’m open to suggestions on relocating them if they meet use-case requirements.

Here is a use case for revenue codes (I’m just putting this here in case I have to reference this again): a study wants to determine the cost of emergency room services in the U.S. The analyst will need to look at the amount charged for all physician claims billed with a place of service of ā€œemergency roomā€ (or CMS value 23) and all of the charged amounts with revenue codes 045x. The revenue codes will pick up charges from all patients who visited an ER, regardless of whether they were admitted as an inpatient or not. Basically the revenue codes will look at specific ER charges from inpatient and outpatient facility claims.

Hope that helps @Gowtham_Rao!