Question
Why do you assess procedures before diagnosis codes in the logic?
Answer
If a procedure is specific enough, that procedure will be categorized to the appropriate service line.
- Example: heart valve surgeries only happen to hearts and are always assigned to Cardiology.
Non-specific procedure codes will be skipped to understand the “why” of the visit by looking at the diagnosis codes.
- Example: The “biopsy of a solid organ” procedure is not specific, so the diagnosis codes would be referenced and if it finds “non-cancerous stomach tumor”, the system would classify the encounter as Digestive Health.
