一个医学编码的服务

一个医学编码的服务

网友问俺一个Coding的质量的处理，俺推荐了这个服务。

TruCode Partner Portal

TruCode Partner Portalhttps://partner.trucode.com/这个网站提供的API 主要有以下几类

以APC_ASC / Calculate 为例

This web method groups and prices outpatient visits. Only one APC and one ASC grouping and reimbursement amount are calculated for each call.

这里有使用场景 和 各种例子

请求

请求的格式可以是xml的，也可以是json的，下面就是请求的例子。

{
  "outpatient_source": {
    "encounter": {
      "patient": {
        "admit_date": "2023-06-01",
        "discharge_date": "2023-06-01",
        "age_in_years": "55",
        "patient_status": "01",
        "sex": "1",
        "bill_type": "131",
        "coding_system": "ICD10"
        },
      "diagnoses": {
      "diagnosis": [      {
        "code": "J18.9"
        }      ]
      },
      "procedures": {
      "procedure": [      {
        "code": "22899",
        "procedure_date": "2023-06-01",
        "modifier1": "50",
        "revenue_code": "0001"
        }      ]
      }
      },
    "grouping_sources": {
    "grouping_source": [    {
      "medicare_provider_number": "010001",
      "grouper_source": {
        "grouper_type": "OCEAPC"
        },
      "pricer_source": {
        "pricer_type": "CmsApc",
        "exclude_all_fee_schedule_pricing": "false",
        "calculate_apc_for_all_claim_dispositions": "false",
        "use_sequestration_reduction": "false"
        }
      }    ]
    },
    "edit_options": {
      "apply_mue_edits": "true",
      "apply_trucode_edits": "true"
      }
    }}

这里包含了 病人的信息、诊断、处治 等内容。

回应

回应里包含了edits, edit 分不同的level

例如 Warning：Modifiers are used to indicate that a performed service or procedure identified by a specific CPT code has been altered by some circumstance but not changed in its definition.  It is not appropriate to append modifiers to unlisted procedure codes because the unlisted procedure codes in the CPT codebook do not describe specific procedures.  Instead, when reporting an unlisted code to describe a procedure or service, supporting documentation (eg, procedure report) should be submitted to provide an adequate description of the nature, extent, need for the procedure, time, effort, and equipment necessary to provide the service.

{
    "outpatient_calculation_results": {
        "apc_calculation_result": {
            "apc_grouping_result": {
                "cost_to_charge_ratio": "0.149",
                "grouper_version": "24.1.2",
                "location_cbsa": "20020",
                "service_provider": "",
                "apc_grouping_procedures_results": {
                    "apc_grouping_procedure_result": [
                        {
                            "code": "22899",
                            "apc": "0",
                            "apc_description": ""
                        }
                    ]
                }
            },
            "apc_pricing_result": {
                "total_outlier_amt": "0.00",
                "wage_index": "0",
                "total_medicare_amount": "0.00",
                "total_adjusted_coin": "0.00",
                "total_reimbursement": "0.00",
                "service_provider": "",
                "apc_pricing_procedures_results": {
                    "apc_pricing_procedure_result": [
                        {
                            "code": "22899",
                            "outlier_amt": "0.00",
                            "payment": "0.00",
                            "weight": "0",
                            "percentage": "0",
                            "adjusted_coin": "0.00",
                            "medicare_amount": "0.00"
                        }
                    ]
                }
            },
            "edits": {
                "edit": [
                    {
                        "id": "0092",
                        "type": "OCE",
                        "level": "Warning",
                        "content_type": "procedures",
                        "source_field": "code",
                        "position": "0",
                        "sources": {
                            "source": [
                                {
                                    "content_type": "procedures",
                                    "source_field": "code",
                                    "position": "0"
                                }
                            ]
                        },
                        "description": "Device-intensive procedure reported without device code. <abbr title=\"Return to Provider\">(RTP)</abbr>",
                        "details": ""
                    }
                ]
            }
        },
        "diagnoses": [
            {
                "value": "J18.9",
                "code_type": "ICD10CM_DX",
                "hccs": []
            }
        ],
        "edits": {
            "edit": [
                {
                    "id": "AM5904.1",
                    "type": "TruCode",
                    "level": "Warning",
                    "content_type": "procedures",
                    "source_field": "code",
                    "position": "0",
                    "sources": {
                        "source": [
                            {
                                "content_type": "procedures",
                                "source_field": "code",
                                "position": "0"
                            },
                            {
                                "content_type": "procedures",
                                "source_field": "modifiers",
                                "position": "0"
                            }
                        ]
                    },
                    "description": "Modifier <a href=\"javascript:void(0)\" data-code-type=\"CPT4\" data-content-type=\"procedures\" data-field=\"modifiers\" data-position=\"0\">50</a> is inappropriate with Code <a href=\"javascript:void(0)\" data-code-type=\"CPT4\" data-content-type=\"procedures\" data-field=\"code\" data-position=\"0\">22899</a>",
                    "details": "Modifiers are used to indicate that a performed service or procedure identified by a specific CPT code has been altered by some circumstance but not changed in its definition.  It is not appropriate to append modifiers to unlisted procedure codes because the unlisted procedure codes in the CPT codebook do not describe specific procedures.  Instead, when reporting an unlisted code to describe a procedure or service, supporting documentation (eg, procedure report) should be submitted to provide an adequate description of the nature, extent, need for the procedure, time, effort, and equipment necessary to provide the service.",
                    "source_data": "Coding Clinic for HCPCS, 2018, 1Q, 1"
                },
                {
                    "id": "ADD137312",
                    "type": "TruCode",
                    "level": "Warning",
                    "content_type": "diagnoses",
                    "source_field": "code",
                    "position": "0",
                    "sources": {
                        "source": [
                            {
                                "content_type": "diagnoses",
                                "source_field": "code",
                                "position": "0"
                            }
                        ]
                    },
                    "description": "Code <a href=\"javascript:void(0)\" data-code-type=\"ICD10CM_DX\" data-content-type=\"diagnoses\" data-field=\"code\" data-position=\"0\">J18.9</a> assigned. Use additional code, if applicable, to identify resistance to antimicrobial drugs (<a href=\"javascript:void(0)\" data-code-type=\"ICD10CM_DX\" data-content-type=\"partial_code\">Z16</a><span class=\"code-text\">.-</span>)",
                    "source_data": "ICD-10-CM Code Book, J09-J18"
                },
                {
                    "id": "FRST140407",
                    "type": "TruCode",
                    "level": "Warning",
                    "content_type": "diagnoses",
                    "source_field": "code",
                    "position": "0",
                    "sources": {
                        "source": [
                            {
                                "content_type": "diagnoses",
                                "source_field": "code",
                                "position": "0"
                            }
                        ]
                    },
                    "description": "Code <a href=\"javascript:void(0)\" data-code-type=\"ICD10CM_DX\" data-content-type=\"diagnoses\" data-field=\"code\" data-position=\"0\">J18.9</a> assigned. Code first associated influenza, if applicable (<a href=\"javascript:void(0)\" data-code-type=\"ICD10CM_DX\" data-content-type=\"code\">J09.X1</a>, <a href=\"javascript:void(0)\" data-code-type=\"ICD10CM_DX\" data-content-type=\"partial_code\">J10.0</a><span class=\"code-text\">-</span>, <a href=\"javascript:void(0)\" data-code-type=\"ICD10CM_DX\" data-content-type=\"partial_code\">J11.0</a><span class=\"code-text\">-</span>)",
                    "source_data": "ICD-10-CM Code Book, J18"
                }
            ]
        }
    }
}

回应里还有参考的金额。

另

这个网站有很多种类的Coding的计算，每类又有很多例子。