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.