LOINC for Claims Attachments

Transcription

1 LOINC for Claims Attachments Swapna Abhyankar, MD Associate Director for Content Development 1 Outline Overview of LOINC Content How to access, and staying current LOINC for claims attachments How to find valid attachment codes RELMA HIPAA Attachments tab RELMA or online search LOINC table Q & A 2 1

2 Overview of LOINC 3 What is LOINC? Logical Observation Identifiers Names and Codes LOINC rhymes with Oink Each term represents a unique concept That explains the pig mascot! When information is exchanged, if both the sender and receiver are using the same code, the meaning of the information is preserved Was developed primarily for the lab domain in the 1990s Now covers clinical observations, procedures, documents, and surveys Adopted both in the U.S. and internationally 4 2

3 Three ways to access LOINC 1. Regenstrief LOINC Mapping Assistant (RELMA ) LOINC table in a variety of formats Primary LOINC content is exactly the same no matter which format you use as long as you get the updates twice a year, with each new LOINC release (usually June and December) 5 Tool #1: RELMA REgenstrief LOINC Mapping Assistant (RELMA ) Free Windows-based mapping utility developed by the LOINC software team Use to search the LOINC database and help map local codes to LOINC Have to update twice a year with the LOINC release in order to get new LOINC content Need admin rights to install Available from: 6 3

4 Tool #2: Free online search tool Great for looking up a few codes at a time Fast, easy to use Content updated twice a year with each LOINC release Requires a free LOINC account 7 Tool #3: LOINC download file LOINC table available in.csv and.mdb formats Updated twice a year Convenient if working offline Available from: 8 4

5 Summary of LOINC tools Free Can use offline Requires user action to get the latest content twice a year* Automatically includes new content twice a year* Contains all of the information necessary to find valid attachment request/response codes *If you do not download the latest release of RELMA or the LOINC table after each release, the content you see will be different from what you can find online (i.e., Some new codes are missing from RELMA ) 9 Default settings In both RELMA and the online search, the default setting is to NOT include terms with a status of DEPRECATED If you want to include DEPRECATED codes in your search results, you will have to change you settings If you are getting inconsistent results between the online search, RELMA, and/or the download file, make sure #1, you have the latest release of RELMA and/or the download file #2, the search settings match 10 5

6 LOINC for Claims Attachments 11 LOINC for claims attachments A claims attachment includes the clinical and administrative information that is often needed to adjudicate insurance claims, e.g., for specific procedures or rehabilitation services Regenstrief has worked closely with the HL7 Attachments Work Group for several years to support the use of LOINC document codes in the electronic exchange of attachments between payers and providers 12 6

7 LOINC for attachments 3 main uses To identify the specific kind of information being communicated in both a payer s request and provider s response to that request (e.g., a discharge summary or diagnostic imaging report). To specify certain optional modifier variables for fulfilling the request for information (e.g. variables that indicate a modification to the default time period). In structured attachment responses using HL7 CDA, LOINC codes identify the attachment (document) type, sections, and sometimes the individual entries (tests or observations). 13 LOINC + attachments: key concept #1 Valid HL7 Attachment Request = LOINC terms that payers can use to request claims attachments Valid HL7 Attachment Response = LOINC terms that providers may use to send information in response to a payer request Includes all of the valid request terms, plus a set of more specific terms that can be used for specific services and settings Example: Payer needs more information regarding ophthalmology services provided during a patient s hospital stay Request code: Consult note Response codes: either , or Ophthalmology Consult note, or Ophthalmology Hospital Consult note 14 7

8 LOINC + attachments: key concept #2 Documents with implementation guides ( with HL7 IG ) = documents that have an associated clinically-relevant HL7 CDA implementation guide (IG) that uses the U.S. Realm header Documents without implementation guides ( without HL7 IG ) = documents that don t (yet) have a clinically-relevant HL7 CDA IG that uses the U.S. Realm header Selected by the HL7 Attachments Working Group 15 How key concepts #1 and #2 relate Documents with HL7 IG Documents without HL7 IG Valid HL7 Attachment Request Valid HL7 Attachment Response LOINC document codes with associated HL7 CDA IGs that payers can use to request more information about a claim LOINC document codes with associated HL7 CDA IGs that providers can use to respond to a request for more information LOINC document codes without an associated HL7 CDA IG that have been specified as valid request/response codes by the Attachments WG 16 8

9 How to Find LOINC Claims Attachment Terms 17 Using the RELMA HIPAA Attachments tab 18 9

10 Claims attachment requests Includes all LOINC terms that can be used by payers to request claims attachments Divided into those that have HL7 CDA IGs and those that don t 19 Claims attachment request modifiers Modifier codes to send with the attachment request To constrain responses By time By CDA template 20 10

11 Claims attachment responses without IG Document codes that do not have associated HL7 CDA IGs but are approved as attachment response codes Exactly the same list as the Documents without implementation guide set on the Valid attachment requests tab NOTE: This list contains a small subset of LOINC document codes without associated CDA IGs i.e., not all LOINC document codes are valid attachment responses 21 Claims attachment responses with IG: Overview of Documents with Implementation Guide tab #1: Dropdown menu of HL7 CDA implementation guides with the U.S. Realm header #2: Expandable list of document types associated with the IG selected in #1 #3: List of recommended Section and Entry codes associated with the IG (#1) and document type (#2) #1 #2 #

12 Claims attachment responses with IG, step 1 Choose the appropriate HL7 IG using the dropdown (C-CDA R2.1 is the default) The list of document types will change depending on the selection 23 Claims attachment responses with IG, step 2 Click on the + next to the appropriate document type to see all of the LOINC codes for that type of document All of the codes that are shown are valid response codes The top-level code, indicated by a, is a valid attachment request code All of the starred codes together comprise the Documents with implementation guide list on the Valid attachment requests tab 24 12

13 Claims attachment responses with IG, step 3 Use the right pane to see the Section and Entry codes that are contained in the selected IG (#1) and document type (#2) 25 Finding request/response codes without using RELMA HIPAA tab If you are not using the HIPAA Attachments tab in RELMA, you can get all of the same information using the RELMA search, online search, or LOINC table Key fields: ValidHL7AttachmentRequest: Use this field to identify valid request terms HL7AttachmentStructure: Use this field to differentiate between terms for which an HL7 CDA IG exists and those for which no HL7 CDA IG exists 26 13

14 Searching for request codes ValidHL7AttachmentRequest:TRUE Combine with HL7AttachmentStructure field to find valid request terms that do or do not have HL7 CDA IGs HL7AttachmentStructure:IGexists HL7AttachmentStructure:NoIGexists 27 Searching for response codes HL7AttachmentStructure:IGexists All LOINC codes that are valid response codes and have HL7 CDA IGs HL7AttachmentStructure:NoIGexist s All LOINC codes that are valid response codes and do not have HL7 CDA IGs (remember, the list of request and response codes that do not have associated IGs is exactly the same) BONUS: HL7AttachmentStructure:TRUE Identifies all LOINC codes that are valid response codes 28 14

15 CDA IG, section, and entry-level information using RELMA or online search The details page for each term includes a variety of information, including associated HL7 CDA IGs and Section/Entry codes Open the details page by Double-clicking on the row in the RELMA search screen Clicking on the LOINC code in the online search 29 Using the LOINC table to find request and response codes Use the same two fields as for searching ValidHL7AttachmentRequest HL7AttachmentStructure column header is HL7_Attachment_Structure Filter on the relevant column to find all of the LOINC terms 30 15

16 Request codes: VALIDHL7ATTACHMENTREQUEST = Y 31 Response codes with IG: HL7_ATTACHMENT_STRUCTURE = IG exists 32 16

17 Response codes without IG: HL7_ATTACHMENT_STRUCTURE = No IG exists 33 In case you didn t get all that

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