COMPUTERIZED MEDICAL RECORD CODING SYSTEM AND METHOD USING CODE MODELS

摘要

A computerized system and method that allows healthcare providers to update the medical codes in health benefits provider member records using medical code models. Each medical code model has an identifier and associated medical codes. Each member record has a code model identifier that indicates which set of medical codes are appropriate for the member's medical conditions. In an example embodiment, the code model identifiers include a medical hierarchical condition code model, and an end-stage renal disease code model. When medical conditions are affirmed or added to a member's database medical record, the member's code model identifier is used to select the set of medical codes from which a computer user can choose. The use of the medical code model identifier limits a user's selection of medical codes and as a result, reduces the likelihood of medical record coding errors.

主权项

1. A computerized method for coding medical records comprising one or more computers executing instructions to:
(a) store in at least one database a plurality of medical code model identifiers and in association with each medical code model identifier, a plurality of health condition codes; (b) generate for display at a user computer a display comprising a medical record for a member of a health benefits plan, said medical record comprising:
(1) identifying data for said member;(2) a medical code model identifier; and(3) data for at least one suspect medical condition comprising:
(i) identifying data for at least one health condition; and(ii) an open condition status indicator; (c) receive from a computer user a request to confirm said at least one medical condition with said open condition status indicator; (d) receive from said computer user a diagnosis code corresponding to said medical condition for which a request to confirm was received; (e) locate in said plurality of health condition codes for said medical code model identifier at least one health condition code correlated with said diagnosis code; (f) generate for display at said user computer a first display comprising:
(i) said at least one health condition code; and(ii) a confirm option; (g) receive from said computer user a selection of said confirm option to confirm said diagnosis code and said health condition code; and (h) update said first display to indicate said at least one suspect medical condition is affirmed; (i) receive from said computer user a request to add a new health condition to said medical record; (j) receive from said computer user a second diagnosis code; (k) locate in said plurality of health condition codes for said medical code model identifier at least one health condition code correlated with said second diagnosis code; and (l) update said first screen to indicate said at least one health condition code has been added to said medical record.