Introduction to Ranking Models - Text Mining Techniques for Healthcare Provider Quality Determination - page 5

81.1 Arthrodesis and arthroereisis of foot and ankle
81.2 arthrodesis of other joint
81.3 Refusion of spine
81.4 Other repair of joint of lower extremity
81.5 Joint replacement of lower extremity
81.6 Other procedures on spine
81.7 Arthroplasty and repair of hand, fingers, and wrist
81.8 Arthroplasty and repair of shoulder and elbow
81.9 Other operations on joint structures
Each one of the above codes can be further refined by the remaining digit. For example, 81.5 has
the following refinements:
81.51 Total hip replacement
81.52 Partial hip replacement
81.53 Revision of hip replacement, not otherwise speciied
81.54 Total knee replacement
81.55 Revision of knee replacement,not otherwise speciied
81.56 Total ankle replacement
81.57 Replacement of joint of foot and toe
81.59 Revision of joint replacement of lower extremity, not elsewhere classiied
CPT codes were developed by the American Medical Association for procedures.(Smith, 2008) These
codes are 5 digits and numeric in format. They have considerable detail in the coding system, more so
than that available using ICD9 codes. Some examples are given in Table 1.
HCPCS codes include all CPT codes, which are 5 digit numbers. In addition, other HCPCS codes
are available to describe more precise procedures. They have an added alphabetic code.
There are many thousands of these codes, and we must organize them in some manner in order
to be able to use them for defining a risk adjustment measure. For the most part, the risk adjustment
measures choose a group of procedures and/or diagnoses, and base their results on the mortality (or
complications) score. For example, healthgrades.com uses the codes shown in Table 2 (Anonymous-
healthgrades, 2008).
ICD9 codes (or CPT equivalents) are used to identify the specific diagnoses/procedures on the list.
Once identified, they are given weights, with more severe conditions given higher weights.
The ability of a model to predict patient outcomes will depend almost entirely on how well it can
handle all of the patient diagnosis and procedure codes. While risk adjustment can be performed for
each and every procedure, there are still thousands of possible patient diagnoses and co-morbidities that
must be considered. In this text, we will demonstrate a technique that can be used to accommodate all
potential diagnoses in a risk adjustment model.
The Department of Health and Human Services (HHS) just announced a timeline to transition from
ICD9 codes to ICD10 codes, which will require transitioning the severity index formulas. Implementa-
tion is to take place as of October 1, 2011. Another proposal will require the adoption of a standard (X12
standard, Version 5010) for all electronic transactions, including healthcare claims. HHS claims that
adoption of ICD10 codes absolutely requires the adoption of this X12 standard. The present ICD9 coding