Find Billable ICD Codes from CMS GEMs

This function tries to find all the billable ICD codes that can be translated by CMS GEMs for each of the input diagnosis codes representing a major category.

Usage

find_billable(dx, version = 10, year = 2018,
              match_all = TRUE, decimal = FALSE,
              output = c("character", "list", "tidy-data"), ...)

Arguments

dx

A character vector representing diagnosis codes. Each element of the vector can either represent individual diagnosis code or a set of diagnosis codes that are concartenated by commas in between.

version

A numeric value specifying the version of the diagnosis codes that should be either 9 for ICD-9 codes or 10 for ICD-10 codes.

year

A numeric value specifying the year of the CMS GEMs. The currently available options are 2017 and 2018. By default, 2018 CMS GEMs is used.

match_all

A logical value specifying the strategy for finding billable codes based on the input diagnosis category. If TRUE (the default), the function will add the regular expression "[[[[:alnum:]]{1,4}]]" to the tail of diagnosis category so that all the billable diagnosis codes under the given category will be matched. If FALSE, the function will add the regular experssion "[[:alnum:]]" repeatedly at most four times until any set of billable codes are matched.

decimal

A logical value. If TRUE, the diagnosis codes would be returned with decimal points. The default is FALSE.

output

A character value specifying the format of the output. The avaiable options are "character", "list", and "tidy-data". By default, option "character" is used and results in a character vector that consists of element-wise concatenatation by commas of all the translated diagnosis codes from the original codes. If "list" is specified, all the translated codes will not be concartenated and a list of character vectors will be returned by the function. Similarly, if "tidy-data" is specified, a data frame in a tidy format will be returned. The first column of the data frame consists of the original diagnosis codes; the second column consists of the translated diagnosis codes.

...

Other arguments for future usage. A warning will be thrown out if any argument goes into ... accidentally.

Value

A character vector of the same length with the input vector will be returned by default or if output = "charactor". A list of character vectors will be returned if output = "list"; A data frame in tidy-format will be returned if output = "tidy-data". See argument output for details.

Details

It is designed to be used with the function icd_map for translating the diagnosis codes that are not billable but representing major categories. Notice that only the character vector output can be directly passed to the function icd_map for translation.

See also

icd_map

Author

Wenjie Wang <[email protected]>

Examples

library(touch)

### for ICD-9 codes
icd9_major <- c("001", "316", "808", NA, "not_a_dx")

## find all billable codes under the major category
find_billable(icd9_major, version = 9)
#> [1] "0010,0011,0019"                                                                           
#> [2] "316"                                                                                      
#> [3] "8080,8081,8082,8083,80841,80842,80843,80844,80849,80851,80852,80853,80854,80859,8088,8089"
#> [4] NA                                                                                         
#> [5] NA                                                                                         

## find the billable codes right under the major category
(icd9_billable <- find_billable(icd9_major, version = 9,
                                match_all = FALSE))
#> [1] "0010,0011,0019"                "316"                          
#> [3] "8080,8081,8082,8083,8088,8089" NA                             
#> [5] NA                             

## compare the translation results
icd_map(icd9_major, nomatch = NA)
#> [1] NA    "F54" NA    NA    NA   
icd_map(icd9_billable, nomatch = NA)
#> [1] "A000,A001,A009"                                                                 
#> [2] "F54"                                                                            
#> [3] "S32409A,S32409B,S32501A,S32501B,S32502A,S32502B,S32509A,S32509B,S329XXA,S329XXB"
#> [4] NA                                                                               
#> [5] NA                                                                               

### for ICD-10 codes
icd10_major <- c("T36.0X2", "T36.3X2", "T38.6X2")

## find all billable codes and output in different formats
find_billable(icd10_major, version = 10)
#> [1] "T360X2A,T360X2D,T360X2S" "T363X2A,T363X2D,T363X2S"
#> [3] "T386X2A,T386X2D,T386X2S"
find_billable(icd10_major, version = 10, output = "list")
#> [[1]]
#> [1] "T360X2A" "T360X2D" "T360X2S"
#> 
#> [[2]]
#> [1] "T363X2A" "T363X2D" "T363X2S"
#> 
#> [[3]]
#> [1] "T386X2A" "T386X2D" "T386X2S"
#> 
find_billable(icd10_major, version = 10, output = "tidy-data")
#>   ICD-10 Billable_ICD-10
#> 1 T360X2         T360X2A
#> 2 T360X2         T360X2D
#> 3 T360X2         T360X2S
#> 4 T363X2         T363X2A
#> 5 T363X2         T363X2D
#> 6 T363X2         T363X2S
#> 7 T386X2         T386X2A
#> 8 T386X2         T386X2D
#> 9 T386X2         T386X2S

## add decimal if wanted
(icd10_billable <- find_billable(icd10_major, version = 10, decimal = TRUE))
#> [1] "T36.0X2A,T36.0X2D,T36.0X2S" "T36.3X2A,T36.3X2D,T36.3X2S"
#> [3] "T38.6X2A,T38.6X2D,T38.6X2S"

## compare the translation results
icd_map(icd10_major, from = 10, to = 9, nomatch = NA)
#> [1] NA NA NA
icd_map(icd10_billable, from = 10, to = 9)
#> [1] "9090+E959,9600+E9504,V5889" "9090+E959,9603+E9504,V5889"
#> [3] "9090+E959,9621+E9504,V5889"