CONVENIENT

A method and device for reducing a complexity of procedure

[0002] The invention is in the technical ?eld of surgery charge capture and billing softWare, processes, and devices.
In particular, the invention is in the technical ?eld of the generation of visual components on a computer graphical user interface in a manner that reduces the complexity of surgery charge capture.
[0003] When a medical service is provided by a physician, to compose a bill the diagnosis and service must be described ("coded") With accepted diagnosis and services codes.A common system of diagnosis codes in current use is the International Classi?cation of Disease, version 9 (ICD-9), provided by the World Health Organization.A common sys tem of service codes is Common Procedural Terminology (CPT), provided by the American Medical Association.
[0004] For charge capture and coding purposes, medical services may be categoriZed into Evaluation and Manage ment (E & M) and Procedure Services.The Procedure Ser vices include Surgical Services, Wherein there is an invasive component.The E & M services generally include a face-to face encounter betWeen a physician and a patient that may include discussion, ordering of further diagnostic testing, or a prescription for a medicine.There are approximately 30 E & M CPT codes.This is feW enough for the codes to be placed on one or several screens by an E & M softWare program for charge capture, Where they may be combined With ICD-9 codes to complete the coding for a medical service bill.There are a number of commercial and noncommercial softWare programs that offer this functionality.
[0005] A Procedure Service, such as a surgery, commonly requires a combination of multiple CPT codes and multiple ICD-9 codes to describe it completely and accurately.There are in excess of 7,500 CPT codes for Procedure and Surgical Services and there are in excess of 5,000 ICD-9 codes.Thus, the combinatorial number of ICD-9 and CPT code combina tions is thus very large, and has overWhelmed in its magnitude and complexity attempts to construct a graphical user inter face that covers the procedure coding possibilities.
[0006] Accordingly, there is a need for reducing the com plexity of graphical user interfaces for charge capture in Sur gical Services.

SUMMARY OF THE INVENTION
[0007] The invention is a process and device for generating graphical user interface screens for charge capture in Surgical Services by using statistical methods draWn from the area of cluster analysis to reduce the complexity of Surgical Service Coding.
[0008] In one aspect of the invention, a method of reducing a complexity of procedure based medical charge capture and Oct. 31,2013 coding utiliZing a computer system includes searching for previously generated coding scenarios associated With the provider, using existing coding scenarios or adding coding scenarios to a library, generating and ?ltering codes associ ated With at least one of the steps of searching, using, and adding, formatting a graphical user interface speci?cation to use the codes from the generating and ?ltering step, and storing the graphical user interface for presentation.
[0009] Another aspect of the invention is a tangible non transitory computer readable medium comprising instruc tions for reducing a complexity of procedure based medical charge capture and coding utiliZing implemented on a com puter system includes instructions for searching for previ ously generated coding scenarios associated With the pro vider, instructions for using existing coding scenarios or adding coding scenarios to a library, instructions for generat ing and ?ltering codes associated With at least one of the steps of searching, using, and adding, instructions for formatting a graphical user interface speci?cation to use the codes from the generating and ?ltering step, and instructions for storing the graphical user interface for presentation.
[0010] In yet another aspect of the invention a device for reducing a complexity of procedure based medical charge capture and coding utiliZing implemented includes means for searching for previously generated coding scenarios associ ated With the provider, means for using existing coding sce narios or adding coding scenarios to a library, means for generating and ?ltering codes associated With at least one of the steps of searching, using, and adding, means for format ting a graphical user interface speci?cation to use the codes from the generating and ?ltering step, and means for storing the graphical user interface for presentation.
[0011] The invention includes a number of phases as described beloW.There is an enrollment phase Where the medical claim history containing the ICD-9 and CPT codes may be gathered in an electronic ?le.The claim history may be obtained from the Provider in order to generate a simpli?edgraphical user interface using the methods described herein.

The claim history contains codings for many procedures
Where the coding Was performed by hand Without the bene?t of this invention.The claim history is taken to represent a procedure pattern for the Provider likely to continue into the future.
[0012] A cluster analysis is performed on the codes in the claim history.This identi?esWhich ICD-9 and CPT codes commonly co-occur or cluster in claims.These clusters are recorded for subsequent use in the translation phase as described beloW.A cluster may be given a convenient name for selection in a graphical user interface.This constitutes training of this charge capture softWare system for that Pro vider.In this patent application, the term "Provider" refers to an individual medical or surgical provider or group of pro viders (such as from the same surgical specialty) for Whom the range of Surgical Services is suitably represented by the claim history used for cluster analysis.
[0013] There is a translation phase Where the set of codes in a cluster derived from this analysis are translated into com puter instructions for rendering a graphical user interface, and for capturing user input and merging this information into other information in this and other softWare programs for medical Work?oW, charge capture, and billing.The collection of graphical user interface Widgets for a cluster is termed in this system a Scenario.A Scenario may be computed auto matically, for example using rules to attach a checkbox Wid US 2013/0290026 A1 get to a given ICD-9 code which, when checked, indicates that that ICD-9 code is to be included in the claim to be forwarded to the payor.Or a Scenario may undergo editing a rearrange ment by a human analyst to enhance its esthetic or usability value.The Scenarios are stored in the software system, and may be offered as forms to a Provider or designee when a medical or surgical service is being coded.
[0014] In the deployment phase, a Provider logs into the charge capture software using this system after performing a medical or surgical procedure.Having been trained by a ?le of claims that represent the Provider's practice pattern, the graphical user interface of this system can offer the Provider a convenient list of Coding Scenarios, each resulting from a statistical analysis in the enrollment phase, that cover to a statistical criterion, the practice pattern of the Provider.The Provider selects the Coding Scenario, and selects within the ICD-9 and CPT codes that best match the medical or surgical service provided.These codes populate an electronic claim, which, after possible review by other administrative special ists, may be forwarded to the payor.
[0015] The use of cluster analysis of historical claims to produce visual Coding Scenarios that reduce the complexity of a coding graphical user interface is a novel, non-obvious, and useful advance in the ?eld.
[0016] Additional features, advantages, and embodiments of the disclosure may be set forth or apparent from consider ation of the following detailed description, drawings, and claims.Moreover, it is to be understood that both the forego ing summary of the disclosure and the following detailed description are exemplary and intended to provide further explanation without limiting the scope of the disclosure as claimed.

BRIEF DESCRIPTION OF THE DRAWINGS
[0017] The accompanying drawings, which are included to provide a further understanding of the disclosure, are incor porated in and constitute a part of this speci?cation,illustrate embodiments of the disclosure and together with the detailed description serve to explain the principles of the disclosure.
No attempt is made to show structural details of the disclosure in more detail than may be necessary for a fundamental understanding of the disclosure and the various ways in which it may be practiced.In the drawings:  [0025] If the library of existing Coding Scenarios does not suitably match the Provider to be enrolled, then a represen tative list of historical claims for that Provider going back six or twelve months is selected for analysis.While in this docu ment the singular noun Provider is employed, the same tech niques work for a group of Providers with similar practice pattern, such as a group of orthopedic trauma specialists who share a call schedule.
[0026] FIG. 3 contains the ?rst 10 lines of an example ?le of training codes for a particular surgeon (who happens to be a neurosurgeon) according to the invention.Referring now to the invention in more detail, in FIG. 3  [0028] In this invention the Mathematica (Wolfram Research, Urbana Ill.) computer programming language may be used to perform the cluster analysis.Those skilled in the art of cluster analysis will recogniZe that there are other pro gramming languages and libraries well suited to this task, such as the R programming language (http://www.r-project. org/) or the like.In addition, there are many mathematical and statistical techniques for cluster analysis.In the course of [0029] In particular, the cluster analysis ?nds associated combinations of codes.Thereafter, the associated combina tions of codes may be mapped to a graphical user interface.
The cluster analysis or clustering groups a set of codes in such a Way that codes in the same group are similar to each other than to those in other groups.In this approach, the cluster analysis ?nds a more convenient combination of codes for the provider to utiliZe.
[0030] Each cluster generated by this program contains a list of ICD-9 and CPT codes, each With a measure of their strength of association With the cluster.Those codes strongly associated With a cluster are preserved for later rendering in in Coding Scenario for the graphical user interface.Typically, a cluster contains several codes that are Weakly associated With the cluster.These codes may be excluded from the rendered Coding Scenario in order to keep it simple and therefore conveniently usable.
[0031] When a cluster of codes is generated and ?ltered to retain its more strongly associated codes 106, it is then for matted into computer instructions according to a graphical user interface speci?cation 108, in this embodiment HTML.
The HTML instructions may be inserted into a graphical user screen as a Coding Scenario as is, or it may be revieWed and modi?ed by rules implemented in a computer, or by a human according to taste.An example of a computer-based rule modi?cation is that if there are some codes knoWn to be mutually exclusive, they may be rendered With a visual Wid get that enforces this such as a radio box, rather than as a list of checkboxes.
[0032] FIG. 5 is the rendered Coding Scenario on a graphi cal user interface according to an aspect of the invention.
More speci?cally,FIG. 5  [0033] As shoWn in FIG. 1, the HTML instructions for a Coding Scenario are then stored in a computer database and may be presented in the graphical user interface to the pro vider or other appropriate personnel at the appropriate time 110.The captured coding information may then be fused by Oct. 31,2013 this or a separate computer program With other information such as the patient's demographic and payor data, and then conveyed for payment.
[0034] FIG. 2 is a ?owchart of another aspect of the inven tion.Having been trained by a ?le of claims that represent the Provider' s practice pattern, the graphical user interface of this system can offer the Provider a convenient list of Coding Scenarios 202, each resulting from a statistical analysis in the enrollment phase, that cover to a statistical criterion, the practice pattern of the Provider.The Provider selects the Coding Scenario, and selects Within the ICD-9 and CPT codes that best match the medical or surgical service provided 204.These codes populate an electronic claim 206, Which, after possible revieW by other administrative specialists, may be forWarded to the payor.
[0035] The advantages of the invention include, Without limitation, the reduction of complexity in charge capture for procedure based medical services such as surgery, coupled With the custom generation for a Provider of a graphical user interface that is trained from that Provider's historical prac tice pattern.
[0036] This invention has been reduced to practice at Mas sachusetts General Hospital, Where it is currently the foun dation for the charge capture softWare for most surgical and other procedure based medical services.As of the ?ling of, there are approximately 998 Coding Scenarios generated for Providers in about 22 different medical and surgical special ties.The invention has been found to increase the adoption of computer methods for medical procedure Work?oW and charge capture by reducing the complexity of the graphical user interface.This has resulted in increased speed and accu racy of surgical Work?oW and charge capture.
[0037] The invention is a method for reducing the complex ity of a graphical user interface designed for charge capture in procedure-based medicine.The method is to perform a sta tistical cluster analysis of that individual's history and trans form the result into computer instructions for rendering a graphical user interface.
[0038] The steps involved in a medical service include "coding" it, meaning selecting the proper diagnosis and pro cedure codes, Which are then placed on an invoice.Currently, in the United States the commonly used diagnostic coding system is ICD-9 and the procedure coding system is CPT.For consultation services (known and Evaluation and Manage ment) there are approximately 30 CPT codes.This is tractable for placement on a computer graphical user interface.HoW ever, for procedure-based services such as surgery there are more than about 7,500 CPT codes.When combinatorially mixed With the more than 5,000 ICD-9 codes, the graphical user interface may be too complex for e?icient and accurate use.
[0039] This invention stems from the recognition that these codes commonly occur in clusters.For example, the coding and claim history of an orthopedic trauma specialist may include a cluster of codes that cover the diagnosis and treat ment of an arm fracture.Thus, this invention includes for a Provider an enrollment phase Where a claim history is statis tically analyZed for clusters.Then there is a translation phase Where those clusters are translated into computer instructions for generating a graphical user interface.Each graphical user interface translated from a code cluster is termed here a Cod ing Scenario.The coding scenarios are stored in durable computer memory such as a database.There is a deployment phase Where the appropriate Coding Scenarios are retrieved from the database and rendered on a computer screen for convenient interaction With a human user.
[0040] The description above of the invention enables one skill in the arts of computer statistical analysis and graphical user interface creation to make and use What is considered presently to be the best mode thereof.Those of skill in these arts Will understand and appreciate the existence of varia tions, combinations, and equivalents of the speci?c embodi ment, method, and examples herein.The invention should therefore not be limited by the above described embodiment, method, and examples, but by all embodiments and methods Within the scope and spirit of the invention.
[0041] The invention may include communication chan Communications (GSM), CDMA (Code-Division Multiple Access), W-CDMA (Wideband Code-Division Multiple Access), Wireless Fidelity (Wi-Fi), Bluetooth, and/or the like, and/ or a combination of tWo or more thereof.
[0042] The invention may be implemented in any type of computing devices, such as, e.g., a desktop computer, per sonal computer, a laptop/mobile computer, a personal data assistant (PDA), a mobile phone, a tablet computer, cloud computing device, and the like, With Wired/Wireless commu nications capabilities via the communication channels.
[0043] In an embodiment, the invention may be Web-based.
For example, a server may operate a Web application to alloW the invention to operate in conjunction With a database.The Web application may be hosted in a broWser-controlled envi ronment (e.g., a Java applet and/or the like), coded in a broWser-suppor'ted language (e. g., JavaScript combined With a broWser-rendered markup language (e.g., Hyper Text Markup Language (HTML) and/or the like)) and/or the like such that any computer running a common Web broWser (e. g., Internet ExplorerTM, FirefoxTM, ChromeTM or the like) may render the application executable.A Web-based service may be more bene?cialdue to the ubiquity of Web broWsers and the convenience of using a Web broWser as a client (i.e., thin client).Further, With inherent support for cross-platform compatibility, the Web application may be maintained and updated Without distributing and installing softWare on each.
[0044] In an embodiment, the invention may be imple mented in any type of mobile smartphones that are operated by any type of advanced mobile data processing and commu nication operating system, such as, e.g., an AppleTM iOSTM operating system, a GoogleTM AndroidTM operating system, a RIMTM BlackberryTM operating system, a NokiaTM Sym bianTM operating system, a MicrosoftTM WindoWs MobileTM operating system, a MicrosoftTM WindoWs PhoneTM operat ing system, a LinuxTM operating system or the like.
[0045] Further in accordance With various embodiments of the invention, the methods described herein are intended for 1.A method of reducing a complexity of procedure based medical charge capture and coding utiliZing a computer sys tem comprising: searching for previously generated coding scenarios asso ciated With the provider; using existing coding scenarios or adding coding scenarios to a library; generating and ?ltering codes associated With at least one of the steps of searching, using, and adding; formatting a graphical user interface speci?cation to use the codes from the generating and ?ltering step; and storing the graphical user interface for presentation.
2. The method according to claim 1 Wherein the step of formatting comprising formatting the graphical user interface of at least one of a server, a smart phone, a tablet computer, and a netbook.
3. The method according to claim 1 Wherein the step of storing the graphical user interface comprises storing the graphical user interface in a memory of at least one of a server, a smart phone, a tablet computer, and a netbook.
4. The method according to claim 1 Wherein the step gen erating and ?ltering comprises using a statistical cluster analysis of selected historical claims.
5. The method according to claim 1 further comprising receiving a selection of the coding scenario from a provider.
6.The method according to claim 1 further comprising receiving a selection of codes that best match a medical or surgical service provided from a provider.7. A tangible non-transitory computer readable medium comprising instructions for reducing a complexity of proce dure based medical charge capture and coding utiliZing implemented on a computer system comprising: instructions for searching for previously generated coding scenarios associated With the provider; instructions for using existing coding scenarios or adding coding scenarios to a library; instructions for generating and ?ltering codes associated With at least one of the steps of searching, using, and adding; US 2013/0290026 A1 instructions for formatting a graphical user interface speci ?cation to use the codes from the generating and ?ltering step; and instructions for storing the graphical user interface for presentation.
8. The computer readable according to claim 5 Wherein the instructions for formatting comprising instructions for for matting the graphical user interface of at least one of a server, a smart phone, a tablet computer, and a netbook.9.The computer readable according to claim 5 Wherein the instructions for storing the graphical user interface comprises instructions for storing the graphical user interface in a memory of at least one of a server, a smart phone, a tablet computer, and a netbook.10.The computer readable according to claim 5 Wherein the instructions for generating and ?ltering comprises instructions for using a statistical cluster analysis of selected historical claims.
11.The computer readable according to claim 5 further comprising instructions for receiving a selection of the coding scenario from a provider.
12. The computer readable according to claim 5 further comprising instructions for receiving a selection of codes that best match a medical or surgical service provided from a provider.15.The device according to claim 13 Wherein the means for storing the graphical user interface comprises means for stor ing the graphical user interface in a memory of at least one of a server, a smart phone, a tablet computer, and a netbook.
16.The device according to claim 5 Wherein the means for generating and ?ltering comprises instructions for using a statistical cluster analysis of selected historical claims.17.The computer readable according to claim 5 further comprising instructions for receiving a selection of the coding scenario from a provider.
18.The computer readable according to claim 5 further comprising instructions for receiving a selection of codes that best match a medical or surgical service provided from a provider.

[ 0018 ]
FIG. 1 is a ?owchart of an aspect of the invention; [0019] FIG. 2 is a ?owchart of another aspect of the inven tion; [0020] FIG. 3 contains the ?rst 10 lines of an example ?le of training codes for a particular surgeon (who happens to be a neurosurgeon) according to an aspect the invention; [0021] FIG. 4 depicts the clusters from the analysis of the training set of FIG. 3 according to an aspect the invention; and [0022] FIG. 5 is the rendered Coding Scenario on a graphi cal user interface according to an aspect of the invention.DETAILED DESCRIPTION OF THE INVENTION [0023] The aspects of the disclosure and the various fea tures and advantageous details thereof are explained more fully with reference to the non-limiting embodiments and examples that are described and/or illustrated in the accom panying drawings and detailed in the following description.It should be noted that the features illustrated in the drawings 13.A device for reducing a complexity of procedure based medical charge capture and coding utiliZing implemented comprising: means for searching for previously generated coding sce narios associated With the provider; Oct. 31,2013 means forusing existing coding scenarios or adding coding scenarios to a library; means for generating and ?ltering codes associated With at least one of the steps of searching, using, and adding; means for formatting a graphical user interface speci?ca tion to use the codes from the generating and ?ltering step; and means for storing the graphical user interface for presen tation.14.The device according to claim 13 Wherein the means for formatting comprising means for formatting the graphical user interface of at least one of a server, a smart phone, a tablet computer, and a netbook.
skilled artisan would recogniZe, even if not explicitly stated herein.Descriptions of well-known components and processing techniques may be omitted so as to not unneces sarily obscure the embodiments of the disclosure.The examples used herein are intended merely to facilitate an understanding of ways in which the disclosure may be prac ticed and to further enable those of skill in the art to practice the embodiments of the disclosure.Accordingly, the examples and embodiments herein should not be construed as limiting the scope of the disclosure, which is de?ned solely by the appended claims and applicable law.Moreover, it is noted that like reference numerals represent similar parts through out the several views of the drawings.[0024]FIG.1is a ?owchart of an aspect of the invention.As shown in FIG.1, when a Provider elects to use this system the enrollment phase starts with a search of library of previously generated Coding Scenarios 102 to see if existing ones match closely the practice pattern of the Provider to be enrolled.For are not necessarily drawn to scale, and features of one embodiment may be employed with other embodiments asOct.31,2013theexample, if an orthopedic trauma specialist elects to use this system and there are already orthopedic trauma specialists using it, their set of Coding Scenarios may closely match the practice of the initiating provider such that no new custom Coding Scenarios need to be generated.Conversely, all new Coding Scenarios are added to a library for potential use by Provider other than those for whom the Coding Scenarios were generated 104.
the list of training claims is placed in a ?le such that each line represents one claim, and on each line the ICD-9 and CPT codes are comma delimited.For clarity, the ICD-9 codes are prepended with "I" and the CPT codes with "C."[0027] ICD-9 and CPT and the most commonly used code systems in the United States today.There are other coding systems such as ICD-10 (scheduled to replace ICD-9 in the United States in October 2013), and Diagnosis Related Group (DRG).Moreover, there is a subset of ICD-9 and ICD-10 not in common use in 2010 that describes procedures.This sub set, if adopted, would substitute for CPT.Those skilled in the States of America.
performing the research that led to the invention, We have employed several programming languages and cluster library functions, and have assessed their pros and cons.For illustra tive simplicity, We present in this application usage of the While the disclosure has been described in terms of exemplary embodiments, those skilled in the art Will recog niZe that the disclosure can be practiced With modi?cations in the spirit and scope of the appended claims.These examples given above are merely illustrative and are not meant to be an exhaustive list of all possible designs, embodiments, applica operation With dedicated hardWare implementations includ ing, but not limited to, PCs, PDAs, net book computers, tablet computers, iPad, semiconductors, application speci?c inte tions or modi?cations of the disclosure.