Date:         Wed, 9 Feb 2011 12:38:32 -0500
Reply-To:     michael@bassettconsulting.com
Sender:       "SAS(r) Discussion" <SAS-L@LISTSERV.UGA.EDU>
From:         Michael Davis <michael@BASSETTCONSULTING.COM>
Subject:      Re: Healthcare - Outpatient Visits
In-Reply-To:  <AANLkTiny6SCbBpCTDnyT23kOvTRU_ODXqS_s8O2TSJ0o@mail.gmail.com>
Content-Type: text/plain; charset="iso-8859-1"

Hello Joe and other SAS-L Friends,

Okay, I see where you are
taking this but there may be a problem with the example you furnished.

If both physicians are in the same practice, they may bill on the
same form (UB04 or CMS 1500) and those two services, with separate CPT
codes and performing providers [NPIs], are on the same claim ;-)  No
issue there.

On the other hand, if the provider for the office
visit and a clinical lab provide separate bills, there may be separate
claims and a desire to join the claims to construct a single visit or
episode.  You might combine claims for the same patient that occurred
on a single date of service.

However, there are
potential gotchas.  What if a patient visits one doctor for a heart
condition and then while they are in the Medical Arts Building, they visit
their dermatologist?  Or what do you do if the patient visits a
doctor on a given day and subsequently gets an x-ray or a cardiogram from
a specialist on the following day?  You need to look at the diagnoses
codes to join those claims into a episode of care, if that is what you
want to do.

Medical informatics companies spend a lot of
effort to resolve these issues and would be happy to license
"grouper" software to you.  Fortunately for my benevolent
employer, our business model is based upon counts of claims, procedures,
and diagnoses instead of visits.

Best wishes,

Michael

On Wed, February 9, 2011 11:32 am, "Joe
Matise" <snoopy369@GMAIL.COM> wrote:
> Well, just using
a personal example, when I went to see a doctor in an
> outpatient
setting recently and had a blood draw at the office, that
>
generated two claims - for the doctor that I visited and for the
internist
> who took the blood.  I don't know whether the OP wants
to consider them
> separately or not, but I certainly would
consider those to be a single
> visit
> logically
speaking...
>
> -Joe
>
> On Wed, Feb 9,
2011 at 10:13 AM, Michael Davis <
>
michael@bassettconsulting.com> wrote:
>
>> Hello
George [and other SAS-L Friends],
>>
>> Can you make
up an
>> example so we can see the problem you are attempting
to solve?  In
>> general, I think of each outpatient claim as a
separate visit.
>>
>> Best wishes,
>>
>> Michael
>>
>> On Wed, February 9, 2011
>> 10:12 am, "George Mendoza"
<george.mendoza@CIGNA.COM>
>> wrote:
>> >
Hi All,
>> >
>> > I am looking for sample
SAS
>> code / methodology for identifying unique
>>
> outpatient visits from
>> healthcare claims data. I am
able to accurately
>> > identify
>> outpatient
claims but I am not sure what is the best method to
>> >
>> identify unique outpatient visits. Any help would be greatly
>> appreciated.
>> > Thanks.
>> >
>> > Regards,
>> >
>> George.
>> >
>>
>>
>> --
>>
Michael L. Davis
>> Ambler
>> PA
>>
E-Mail:  michael.davis@alumni.duke.edu
>>
>


--
Michael L. Davis
Ambler  PA
E-Mail:
michael.davis@alumni.duke.edu