Purpose

Two of the strategic goals for the Collaboration for Health IT are:

  1. Easy access to data, and
  2. Contain costs

In order to support the accurate and efficient billing and reporting of financial information about a patient, a practitioner and a clinic, accurate information is required about patient care is required.

Background

  • ICE uses ontologies to represent facts that are agreed upon, e.g., SNO-DDS codes and CDT codes. ICE also represents logical assertions, usually represented via IF-THEN rules. (assertional knowledge)
  • For every CDT procedure code, there are charting rules that are expected. The rules are not necessarily clear, and receiving feedback for users on a code-by-code basis is difficult.
  • The ICE team requires guidance from dental professionals in the Collaboration to define when a surface may be required, optional, or unnecessary. The same can be said for materials, and teeth/areas.
  • If we do not clarify these rules and the existing rules are inappropriate, this can lead to negative experiences within the system. There are also many places where rules have not been put into place.

Charge

  1. Develop a process by which a group of subject matter experts can efficiently identify or verify code rules for CDT codes. This process will be used to verify the code rules for the 2018 CDT codes and beyond.
  2. Apply this process to the 2017 code set to ensure that clinical, billing and insurance requirements are met.

Chair

TBD

Composition

One to two experts in the area of billing and patient care from 2 to 3 institutions.

Consultants

Additional persons may attend meetings for advice as required.

Meetings

TBD by the working Group.

Timeframe

The final report is requested by April 1, 2017.

Reports

The Working Group should give quarterly updates to the Advisory Board. The Working Group is requested to submit to the Advisory Board a recommended process for validating current and future CDT codes that a majority of the members agree upon for adoption. They should also validate the 2017 CDT code set. The final report should include the process and 2071 CDT recommendations as well as recommendations for next steps.

Acceptance

The Advisory Board for the Collaboration for Health IT approved this charge on