Start with all cases.
First, compile list of all neuraxial types that a case may qualify for using steps 1-6.
Step 1: Determine if case has 'Epidural' flags
- Evaluate if case has any of the notes
- 50051 Obstetrics- Labor epidural end
- 50614 Neuraxial technique- combined spinal/epidural technique note
- 50050 Obstetrics- labor epidural start
- 50154 Epidural anesthesia catheter placement note
- 50643 Neuraxial - Epidural placed for postoperative pain control
- If any of the above notes present, evaluate if that note has text 'Epidural' AND that note does not have text 'Combined Spinal'
- If yes, add 'Epidural' to list of neuraxial types that case qualifies for and move to step 2.
- OR if case has meds with 2005 (epidural) route concept OR if case has 10513 (other-epidural medication) medication concept
- If yes, add 'Epidural' to list of neuraxial types that case qualifies for and move to step 2.
- If no flags present, move to step 2
Step 2. Determine if case has 'Spinal' flags
- Evaluate if case has any of the following notes
- 90320 High spinal
- 50614 Neuraxial technique - Combined Spinal / Epidural technique note
- If any of the above notes present, evaluate if that note has text 'Spinal' or 'SAB' AND note does not contain 'Combined Spinal'
- If yes, add 'Spinal' to list of neuraxial types that case qualifies for and move to Step 3
- OR Evaluate if case has note concept 50680 and does not contain 'Combined Spinal'
- If yes, add 'Spinal' to list of neuraxial types that case qualifies for and move to Step 3
- OR case has a spinal access type concept 100313 (Spinal)
- If yes, add 'Spinal' to list of neuraxial types that case qualifies for and move to Step 3
- If no flags present, move to Step 3
Step 3. Determine if case has 'Combined Spinal Epidural (CSE)' flags
- Evaluate if case has one of the note concepts
- 50614 Neuraxial technique - Combined Spinal / Epidural technique note
- 50154 Epidural anesthesia catheter placement note
- If any of the above notes present, evaluate if the note has text 'CSE' or 'Combined Spinal'
- If yes, add 'Combined Spinal Epidural (CSE)' to list of neuraxial types that case qualifies for and move to Step 4
- If no flags present, move to Step 4
Step 4. Deternine if case has 'Caudal' flags
- Evaluate if case has note 50635 (Regional - Caudal block performed)
- If yes, add 'Caudal' to list of neuraxial types that case qualifies for and move to final check.
- If no, move to Step 5
Step 5. Determine if the case has broad neuraxial notes
- Evaluate if case has the following note concepts
- 50677 Regional - Block location
- 50665 Procedures - Other unlisted procedure
- 50691 Categorized note - Neuraxial anesthesia
- 50356 Regional - Block performed
- 50229 Induction procedure
- 50507 Procedures - Epidural Blood Patch
- 50764 Misc - Primary Anesthesia Technique Used
- 50165 Epidural dermatomal level achieved
- 50156 Epidural needle approach
- 90100 Actual procedure performed
- If any of the above notes have text 'CSE' or 'Combined Spinal' OR has text 'Epidural' AND 'Spinal' in same note, then add 'Combined Spinal Epidural (CSE)' to list of neuraxial types that case qualifies for and move to Step 6.
- If any of the above notes have text 'Epidural' but does not have text 'Spinal', 'Combined Spinal', or 'CSE', then add 'Epidural' to list of neuraxial types that case qualifies for and move to to Step 6.
- If any of the above notes have text 'Spinal' but do not contain 'Epidural' or 'Combined Spinal' or 'CSE', then add 'Spinal' to list of neuraxial types that case qualifies for and move to Step 6.
- If any of the above notes have text 'Caudal' but do not have text 'Combined Spinal' or 'CSE', then add 'Caudal' to list of neuraxial types that case qualifies for and move to Step 6.
- If none of the above, move to Step 6.
Step 6. Then, check for additional neuraxial note concepts:
- Evaluate if case has any of the following note concepts
- 50687 Neuraxial - comment
- 50679 Neuraxial - complications
- 50340 Neuraxial / Regional- Assessment of Neuraxial or regional technique
- 50341 Neuraxial / Regional - Assessment of neuraxial or regional technique - detail
- 50020 Neuraxial Approach
- 50338 Neuraxial insertion aspiration of blood or CSF- detail
- 50337Neuraxial insertion aspiration of blood or CSF - note
- 50335 Neuraxial insertion paresthesia assessment- note
- 50336 Neuraxial insertion paresthesia yes / no detail
- 50165 Epidural dermatomal level achieved
- 50154 Epidural anesthesia catheter placement note
- 50371 Neuraxial technique - Bilateral Sensory Level Detail
- 50370 Neuraxial technique - Bilateral Sensory Level Tested Note
- 50372 Neuraxial technique - Bilateral Sensory Level Testing Device Detail
- 50364 Neuraxial technique - Sensory Level Left Detail
- 50365 Neuraxial technique - Sensory Level Left Testing Device Detail
- 50367 Neuraxial technique - Sensory Level Right Level Detail
- 50368 Neuraxial technique - Sensory Level Right Testing Device Detail
- 50363 Neuraxial technique - Sensory Level Tested Left Note
- 50366 Neuraxial technique - Sensory Level Tested Right Note
- 50146 Neuraxial technique patient position
- 50329 Neuraxial technique sterile prep and drape note
- 50330 Neuraxial technique sterile prep type detail
- 50333 Neuraxial technique subcutaneous skin infiltrated with local anesthetic
- 50344 Epidural catheter secured
- 50163 Epidural catheter type or brand
- 50164 Epidural catheter withdrawn to depth (cm)
- 50339 Epidural catheter withdrawn to depth (cm) - detail
- 50161 Epidural loss of resistance (saline or air)
- 50162 Epidural loss of resistance depth (cm)
- 50347 Epidural meniscus fall assessment - note
- 50348 Epidural meniscus fall yes / no - detail
- 50159 Epidural needle length (cm)
- 50166 Epidural parasthesias during placement
- 50349 Epidural test dose administered - note
- 50350 Epidural test dose administered - number of ML detail
- 50155 Epidural vertebral interspace final
- 50153 Neuraxial- Spinal dermatomal level achieved
- 50148 Neuraxial- Spinal needle approach
- 50150 Neuraxial- Spinal needle diameter (gauge)
- 50151 Neuraxial- Spinal needle length (cm)
- 50353 Neuraxial - Spinal placement Blood observed in spinal needle note
- 50354 Neuraxial - Spinal placement Blood observed yes / no detail
- 50351 Neuraxial - Spinal placement CSF observed note
- 50352 Neuraxial - Spinal placement CSF observed yes / no detail
- 50147 Neuraxial- Spinal vertebral interspace final
- 50034 Neuraxial – Vertebral interspace final (unspecified)
- 50691 Categorized note - Neuraxial anesthesia
- If case has any of the above note concepts, add 'Neuraxial - Unknown Type' to list of neuraxial types that case qualifies for. Do not consider any terms in note text. Proceed to Final Check.
Final Check: Compile complete list of Neuraxial Types that a case qualifies for based on above logic. One case can have zero assignments or many assignments. Consider complete list of Neuraxial Types assigned in the steps above:
- If list has 'Combined Spinal Epidural (CSE)', then assign final result 'Combined Spinal Epidural (CSE)'
- If case does not have 'Combined Spinal Epidural (CSE)' assignment, then check for 'Caudal', 'Epidural' and 'Spinal' independently
- If case has 'Caudal' and no other neuraxial types on list OR has 'Caudal' and 'Epidural', then assign final result 'Caudal'
- If case has 'Epidural' and no other neuraxial types on list, then assign final result 'Epidural'
- If case has 'Spinal' and no other neuraxial types in list, then assign final result 'Spinal'
- If case has 'Caudal' and 'Spinal', then assign final result 'Neuraxial- Mixed Types Listed'
- If case has 'Epidural' and 'Spinal', then assign final result 'Neuraxial- Mixed Types Listed'
- If case does not have 'Epidural', 'Spinal', 'Caudal' or 'Combined Spinal Epidural (CSE)' and has 'Neuraxial- Unkown Type Assignment', then assign final result 'Neuraxial- Unkown Type'
- If case has no neuraxial types assigned to it, then assign final result 'None'