Healthcare Codeset Management as a Service

Healthcare industry relies on many medical code sets, such as CPT, ICD-10, NDC. There are multiple other code sets that are used for provider specialties, error codes and so on. A typical healthcare claim can use five or six different code sets defining diagnosis, services and supplemental information.

Governance of medical code sets is de-centralized. ICD code sets are managed by CMS, but everything else is controlled by various government and non-government entities, such as FDA, X12, AMA, ADA, National Uniform Billing Committee (NUBC).

This presents several challenges:

  • Most code sets are distributed in text files, each in its own format. Some are fixed width, some are delimited. One of the flavors of ICD-10 code sets relies on XML.
  • Code sets are released on different schedules with different frequency. E.g., ICD codes are updated annually, whereas NDC (drug) codes are updated on a weekly basis.
  • Each code set contains information about new and de-activated codes, however, this information is encoded in a different way. For example, for provider taxonomy code set, it is embedded in the “notes” column. For ICD codes, CMS releases separate file called “addenda” where are the changes are tracked.

Our healthcare code set management service aims to address these challenges:

  • We consolidate all relevant code sets in a single data repository
  • We use the same [schema] for all code sets. The schema includes fields such as code, description, effective date, de-activation date and so on.
  • CSV export and JSON API also use the same schema, meaning that a CSV file’s format does not depend on the type of the code set
  • All code sets in our database are updated as soon as a code set owner releases a new version. Updates can be queried and exported or “pushed” to a subscriber, once again, using a consistent code set-independent schema.
  • Our powerful code search comes with many sophisticated features. For example, you can search by a code prefix, a category, edit type (for procedure and diagnosis). You can also search by any term in code’s description.

As an example, here is a simple search API call. We’re looking for all procedures related to a “knee”:

/clinsight/api/code/search?query=knee&type=PROCEDURE

Here is a fragment of the response:

 {
"type": "PROCEDURE",
"subType": "CPT",
"code": "0350T",
"desc": "Radiologic examination, radiostereometric analysis (RSA); lower extremity(ies), (includes hip, proximal femur, knee, and ankle, when performed)",
"fullDesc": "Radiologic examination, radiostereometric analysis (RSA); lower extremity(ies), (includes hip, proximal femur, knee, and ankle, when performed)",
"shortDesc": "RSA LOWER EXTR EXAM",
"startDate": "2014-07-01"
},
{
"type": "PROCEDURE",
"subType": "CPT",
"code": "0396T",
"desc": "Intra-operative use of kinetic balance sensor for implant stability during knee replacement arthroplasty (List separately in addition to code for primary procedure)",
"fullDesc": "Intra-operative use of kinetic balance sensor for implant stability during knee replacement arthroplasty (List separately in addition to code for primary procedure)",
"shortDesc": "INTRAOP KINETIC BALNCE SENSR",
"startDate": "2016-01-01",
"endDate": "2020-12-31"
},
{
"type": "PROCEDURE",
"subType": "ICD_10_PCS",
"code": "0L5Q0ZZ",
"desc": "Destruction of Right Knee Tendon, Open Approach"
},
{
"type": "PROCEDURE",
"subType": "ICD_10_PCS",
"code": "0L5Q3ZZ",
"desc": "Destruction of Right Knee Tendon, Percutaneous Approach"
},

This simple example shows that our service pulls codes from CPT and ICD-10-PCS code sets.

You can try our code lookup UI and our code search API for free, without creating an account.

Please keep in mind that our free version imposes limits on the size of the CSV export and on the number of items in JSON response. If you’re interested in our commercial version, please fill out this form .

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