Computerized system and method for coding medical records

Patent metadata

Field	Value
Publication number	US-2016358284-A1
Application number	US-201113276741-A
Country	US
Kind code	A1
Filing date	Oct 19, 2011
Priority date	Oct 19, 2011
Publication date	Dec 8, 2016
Grant date	—

Abstract

A computerized system and method for medical record coding is disclosed. The computerized system and method facilitates pre-screening of medical records and analyzes medical record data to identify potential coding errors. When potential coding errors are identified in a record, the suspect record is forwarded to a certified medical coder to confirm the presence or absence of the error. In an example embodiment, synonyms likely to be found in medical records are associated with standardized medical terms and codes and stored in a database. The computerized system and method searches electronic records using the synonyms. If a synonym is present in a record, the system identifies an appropriate code for the associated medical condition confirms that the appropriate medical code is associated with the record. If the code is not found, appropriate action is taken to correct the coding error. Multiple levels of review may be applied to each record.

First claim

1 . A computerized method to identify medical record coding errors comprising:
(a) storing in a database:
(1) a plurality of medical phrases identifying medical conditions; and
(2) in association with each medical phrase, a medical code;
(b) storing in said database in association with each medical phrase a plurality of synonyms; (c) receiving at a server text data for an electronic medical record; (d) searching at said server said text data for a first one of said synonyms; (e) in response to locating said first synonym in said text data:
(1) adding to an extraction for said electronic medical record supporting language for said first synonym;
(2) locating from said database at least one medical code associated with said first synonym; and
(3) searching at said server said text data for presence of said medical code;
(f) in response to confirming said medical code is not present in said electronic medical record,
(1) flagging said electronic medical record with a suspect code indicator; and
(2) transferring said electronic medical record to a queue accessible to a medical record coder to:
(i) review said extraction and said electronic medical record; and (ii) confirm said medical code should be added to said electronic medical record or flag said electronic medical record with a no action indicator; (g) in response to said medical record coder flagging said electronic medical record with a no action indicator:
(1) searching at said server said text data for at least one phrase comprising said first one of said synonyms;
(2) in response to locating said at least one phrase comprising said first synonym in said text data, updating said no action indicator to said suspect code indicator;
(h) transferring said electronic medical record to said queue accessible to said medical record coder to confirm said medical code should be added to said electronic medical record; and (i) adding said medical code to said electronic medical record.

2 . (canceled)

3 . (canceled)

4 . The computerized method of claim 1 wherein said medical code is selected from the group consisting of:
hierarchical clustering codes and International Statistical Classification of Diseases codes.

5 . The computerized method of claim 1 further comprising:
(j) searching said text data of said electronic medical record using a plurality of nearness patterns for said medical code.

6 . The computerized method of claim 5 wherein said nearness patterns comprise negative nearness patterns to confirm a medical condition is not relevant to said patient.

7 . (canceled)

8 . The computerized method of claim 1 wherein said phrase comprises words relevant to a plurality of synonyms.

9 . (canceled)

10 . A computerized system to identify medical record coding errors comprising:
(a) a database storing:
(1) a plurality of medical phrases identifying medical conditions;
(2) in association with each medical phrase, a medical code; and
(3) in association with each medical phrase a plurality of synonyms;
(b) a server executing programming instructions to:
(1) receive text data for an electronic medical record;
(2) search for a first synonym in said text data of said electronic medical record;
(3) in response to locating said first synonym in said text data of said electronic medical record:
(i) adding to an extraction for said electronic medical record supporting language for said first synonym;
(ii) locate from said database at least one medical code associated with said first synonym; and
(iii) search said text data using a nearness pattern for presence of said medical code;

(4) in response to confirming said medical code is not present in said electronic medical record,
(i) flag said electronic medical record with a suspect code indicator; and
(ii) transfer said electronic medical record to a queue accessible to a medical record coder to:
(A) review said extraction and said electronic medical record; and
(B) confirm said medical code should be added to said electronic medical record or flag said electronic medical record with a no action indicator;

(5) in response to said medical record coder flagging said electronic medical record with a no action indicator:
(i) searching at said server said text data for at least one phrase comprising said first one of said synonyms; and
(ii) in response to locating said at least one phrase comprising said first synonym in said text data, updating said no action indicator to said suspect code indicator;

(6) transfer said electronic medical record to said queue accessible to said medical record coder to confirm said medical code should be added to said electronic medical record; and
(7) add said medical code to said electronic medical record.

11 . (canceled)

12 . (canceled)

13 . The computerized system of claim 10 wherein said medical code is selected from the group consisting of: hierarchical clustering codes and International Statistical Classification of Diseases codes.

14 . (canceled)

15 . The computerized system of claim 10 wherein said nearness pattern is a negative nearness pattern applied to said medical code to confirm said patient does not have a related medical condition.

16 . (canceled)

17 . The computerized system of claim 10 wherein said phrase comprises words relevant to a plurality of synonyms.

18 . (canceled)

19 . A computerized method to identify electronic medical records with medical coding errors comprising:
(a) storing in a database:
(1) a plurality of medical phrases identifying medical conditions; and
(2) in association with each medical phrase, a medical code;
(b) storing in said database in association with each medical phrase a plurality of synonyms; (c) receiving at a server text data for at least a first electronic medical record and a second electronic medical record; (d) searching at said server said text data for presence of at least one of said plurality of synonyms in said first electronic medical record and said second electronic medical record; (e) in response to locating at least one of said plurality of synonyms in text data for said first electronic medical record, locating from said database said medical code associated with said synonym and tokenizing said text data according to said medical code said medical code;
(1) in response to confirming said medical code is not present in said first said electronic medical record:
(i) adding to an extraction for said first electronic medical record supporting language according to said synonym;
(ii) flagging at said server said first electronic medical record with a suspect code indicator; and
(iii) transferring at said server said first electronic medical record to a queue accessible to a medical record coder; and

(2) in response to confirming said medical code is present in said second electronic medical record:
(i) leaving said electronic medical record in a no action state;
(ii) searching at said server said text data for at least one phrase comprising said one of said plurality of synonyms;
(iii) in response to locating said at least one phrase in said text data, updating said no action indicator to said suspect code indicator; and
(iv) transferring said electronic medical record to said queue accessible to said medical record coder to confirm said medical code should be added to said electronic medical record.

20 . (canceled)

Assignees

• Bagley Scott
• Humana Inc

Inventors

• Bagley Scott

Classifications

• G06Q50/22 Primary

  Social work or social welfare, e.g. community support activities or counselling services · CPC title

• G16H10/60 Primary

  for patient-specific data, e.g. for electronic patient records · CPC title