The goal of this project is to provide a medical coder with suggested procedure codes related to the diagnosis(es) and/or procedure codes already present in a medical claim. The system will be loosely based on ICD-9 procedure codes. The system will have a knowledge base which it queries and updates based on the claims submitted to it. Once a claim has been submitted, the system will determine what other codes (if any) are commonly associated with the codes already submitted in the claim, and suggest that the coder double check with the physician to determine if those procedures or drugs were indeed administered but not recorded on the claim.
The project will not conform to government regulations, as doing so would be an intensive project into itself. Instead, the claims and codes used will be similar in form to real codes, but be completely exclusive to the project itself. The company I work for has a similar system in place, but determines suggestions by hand.
The system will take claims as input, most likely in the form of a comma-delimmitted file. It will read the claim, update its knowledge base to reflect the codes in use (thus becoming more accurate in future claims), then report any further codes that could potentially have been used based on some threshold value (such as occurring with another code in 30% or more of claims and appearing in at least 10 claims). The user will then be able to select any or all of the suggested codes, adding them to the claim.
At present, I plan to use LISP for the actual code, but will consider a different language if it is suggested as a better alternative for this kind of project.
Sample Claim:
Primary Diagnosis: 4235 - Forearm Lesion
Procedures:
6721 - Stitching
Suggested Procedures:
8936 - Topical Anesthetic - 45% of claims, 37 total claims