Has anyone in their department been involved in analysis of exam code(s) against the income it generates? We seem to work in isolation: radiology updates the NICIP exam code set, distributes the changes to the booking team and department leads. Separate somewhere at the other end, the finance department has a black box, with a big lever on the side, which they pull each month and after an imaginary sound effect, coins roll out. The relation between booking and reward is unknown.
Our activity is pulled by the information department (CRIS scheduler) and imported into their data ware house and an extract is passed on to Finance. There, some combination of SNOMED, OPCS and HRG4 tables is used, where a single row of unique NICP codes is mapped against multiple Y, Z and O codes. As there is no 1:1 translation, additional input is coming from some unknown source.
I was hoping, before we sit down with Information and Finance, l to find out if anyone has gone through this exercise and is actually able to access the impact of exam code upgrades or exam code end dating.
Ah that is good news. I was slightly worried that I would 227 responses saying “Of course. We did this back in 2007 when CRIS arrived. You didn’t?”.
Happy to share the outcome.
I’ve not been involved with doing this formally in our department but have had to spend time attempting to clear up some of the consequences of using extensive non-NICIP-standard Z- examination codes following previous attempts to relate exam codes to payments.
I wondered if it is better to use more granular vetting information and/or DICOM metadata for this purpose?
The vetting data is a join within the Cris DB (and perhaps other RIS DBs).
The DICOM data could be obtained via query-retrieve or perhaps in your data warehouse if you’ve managed to spec this up with your PACS procurement. It has the benefit of reflecting what has actually been carried out rather than what was planned.
The NICIP codes are mapped to the OPCS4 codes within the TRUD table. Your finance department should have access to that table. This is to try and ensure that we map the codes consistently as far as possible. The OPCS4 codes are the billing codes. There can be variable interpretation, for example, the Y modifier signifies if an examination takes more than 20 minutes. For many ultrasound examinations and depending on how your booking, you can interpret that differently. We therefore mapped the codes centrally so that finance departments, following the guidance, should just do that direct mapping and submit the codes. I did suggest that we should just submit the NICIP codes, but that would obviously be too simple!
The OPCS 4 codes for each episode (attendance) are fed in to the HRG grouper, which converts them into HRG codes. Outpatient radiology examinations are unbundled, apart from plain radiography. These unbundled exams each Generate an income based on the HRG bands. For CT and MR scans, these are mainly based on the number of body parts and whether contrast was administered. Impatient examinations are bundled in as part of the admission tariff so do not accrue extra payment.
The payments used to be based on reference costs. This changed when the budget was capped number of years ago, and the tariff was set lower than the reference cost. If the reference costs are correct, this usually means that the radiology loses money for the examinations it does. Hey ho.
Interventional Radiology has a different cost centre within the HRG codes, and the OPCS are mapped differently. I’m not going into that!
Thanks Rhydian, that is useful. I think our finance uses the system you describe but you include already a number of variables that will lead to variation of income at the end of the mapping process. I would expect this process is documented somewhere, ideally in a flow chart.
Looking at OPCS in detail, to do a proper mapping you need to be really clued up on what exactly each procedure booked on CRIS entails, with reference to body part, time slot length, interventional Y/N, how many steps are involved. I doubt if that can be pulled accurately from the information we record in CRIS alone.
I now start to see why Mark Thurston suggests to pull info out of PACS.
We, in radiology do not appear to be involved in that mapping process. So my initial conclusion is that the chances that the filling of the gold chest at the end of the month is reflecting our actual work, are slim. But I can’t be sure until I’ve understood the full process.
For some reason I have a picture of the peaceful Shire in my head just before setting off on a long journey through the mines of Moria.
