Question
What is the logic behind the WebMD Ignite Service Lines contextual definition?
Answer
The logic goes through a series of steps to ensure proper visit attribution.
- First, Oncology Diagnosis. This stance was chosen since when cancer has been diagnosed, nothing else matters, because a lot of services will be in support of oncology treatment. While it's true that some of them may not be and they would have occurred anyway, that difference isn’t always obvious or clear If any cancer diagnosis is found, the visit is assigned to the appropriate oncology sub service line based on that cancer code.
- Second, MS-DRG code. If found , and it seems like a good fit based on WebMD Ignite’s proprietary business logic, then it is attributed to the appropriate service line based on that MS-DRG code.
- Third, Procedure codes. The first procedure code is evaluated to define the attribution to the service line. If the procedure codes do not share enough information about why the procedure was done, then the logic moves to the next step.
- Fourth, Diagnosis Codes. The first diagnosis code is evaluated to define the attribution to the service line. The diagnosis can further offer context to the visit allowing for appropriate service line attribution.
