Dialysis Encounter

Definition

Inpatient, outpatient, or home-based encounters during which dialysis was performed, identified via qualifying CPT/HCPCS or revenue center codes. Setting, dialysis modality, and vascular access type of the performed dialysis are identified, when possible, using CPT/HCPCS, place of service, revenue center, and type of bill codes. Instances of dialysis performed in the context of a hospital inpatient admission encounter, ED visit parent encounter, or observation stay parent encounter are also flagged.

Purpose

Used in the URSA-CKD module to construct episodes of ongoing dialysis, which are used to identify ESRD patients.

Related objects

• Document Aggregator for URSA-CKD Concepts
  
• Dialysis Encounter Document Aggregator
  • Dialysis Encounter Document Aggregator, Precursor 1 (Qualifying Non-Inpatient Documents)
  • Dialysis Encounter Document Aggregator, Precursor 2 (All Master Documents)
• Dialysis Encounters

Detailed narrative of logic

1. At a high level, this logic begins in Dialysis Encounter Document Aggregator, Precursor 1 (Qualifying Non-Inpatient Documents), which identifies “qualifying” documents representing direct evidence that dialysis has been performed (i.e., via a procedure code for the actual performance of dialysis, not for ancillary dialysis services, training, equipment, etc.). It then progresses to Dialysis Encounter Document Aggregator, Precursor 2 (All Master Documents) and Dialysis Encounter Document Aggregator, which identify the broader set of documents associated with an encounter during which a qualifying procedure was performed. Finally, Dialysis Encounters collapses the grain down to one record per encounter, synthesizing the many documents associated with the encounter to generate some useful encounter-level properties (e.g., setting, modality, and vascular access of the performed dialysis).
2. As implemented in Dialysis Encounter Document Aggregator, Precursor 1 (Qualifying Non-Inpatient Documents), documents associated with performed dialysis are obtained from Document Aggregator for URSA-CKD Concepts using a restriction on Is Performed Dialysis Code = 1. Next, all such qualifying documents that are also associated with a Hospital Inpatient Admission Encounters, Emergency Visit Parent Encounters, and Hospital Observation Stay Parent Encounters are excluded (though they will be added back later); the remaining documents represent evidence of a dialysis procedure performed outside of the context of a hospital stay; those documents are grouped based on patient and calendar date of service (via the object’s Master Data Management Record Matching capabilities), with matched documents receiving the same encounter ID. 
3. Next, in Dialysis Encounter Document Aggregator, Precursor 2 (All Master Documents), non-qualifying professional claim and bill service line items are matched to the records returned by Dialysis Encounter Document Aggregator, Precursor 1 (Qualifying Non-Inpatient Documents) based on patient and service date. 
4. In Dialysis Encounter Document Aggregator, all children and grandchildren (e.g., professional claim or bill diagnosis codes) of the documents returned by Dialysis Encounter Document Aggregator, Precursor 2 (All Master Documents) are added as well, along with all documents associated with Hospital Inpatient Admission Encounters, Emergency Visit Parent Encounters, and Hospital Observation Stay Parent Encounters if they contain at least one document with a qualifying dialysis procedure.
5. Finally, Dialysis Encounters collapsed the grain from one row per document to one row per encounter. During this step, encounter-level characteristics of the encounter are synthesized from the multiple documents for each encounter obtained from Dialysis Encounter Document Aggregator, using different prioritizations to resolve incompatible values (e.g., if a single encounter contains some documents that indicate a home setting and other documents that indicate a dialysis facility setting, the logic will prioritize the home setting).