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Description
This phenotype is used to determine the main Anesthesia CPT code(s) for a given case. Main Anesthesia CPT codes are used for inclusion and exclusion criteria for ASPIRE measures as well as for the procedure type collations. This phenotype uses the prescribed logic to determine which actual or predicted CPT codes should be considered for the case. For predicted CPT codes, this phenotype further refines which ones are assigned to the case. This phenotype may return multiple values.
Limitation
For cases with actual CPT codes, accuracy is dependent upon the reliability of the actual CPT codes. This phenotype is not guaranteed to return a single CPT code. In some scenarios, multiple anesthesia codes will be returned, particularly if the prediction model was used. As such it is not appropriate for specifically finding the "primary" code. Some cases do not have any CPT codes returned. This is often due to billing documentation being unavailable combined with the prediction model failing to generate any likely codes.
Data quality is limited to individual site documentation accuracy, completeness, and variable mapping, which is performed by each site, independently.
MPOG, as the coordinating center, reviews data quality at each data upload and monthly via Data Diagnostics and Case Validation tools. This review,
while thorough, may not contain all data elements relevant to this phenotype and thus should be carefully reviewed by the user.
Enumeration
| Value |
Value Code |
Definition |
Logic
Anesthesia CPT for Measures is determined using either actual CPT codes or predicted CPT codes according to the following logic:
Step 1: If billing data is available, use actual CPT code
- Primary anesthesia code is determined by the Primary Anesthesia CPT Phenotype. This code is returned as the value for this phenotype.
Step 2: If billing data is unavailable, use CPT prediction tool
- The CPT prediction tool predicts the likely CPT codes for a case by using procedure text and a weighted scoring method. The top three CPTs predicted by the model are returned by this phenotype with the following exceptions:
- If the top CPTs include both codes for C-Section and labor epidural, return only those for c-section.
- If the top scoring code is weighted 1.6 times the next highest scoring code, return only the first code.
- If the top scoring code is weighted 1.6 times the third highest scoring code, return only the first two codes.
- If the predicted codes are for OB cases and the patient’s age makes that prediction unlikely (age less than 10 or greater than 55), those codes are not returned.