northstar

Tidy Healthcare Revenue Integrity

📦 Installation

You can install northstar from GitHub with:

# install.packages("pak")
pak::pak("andrewallenbruce/northstar")

🔰 Usage

library(northstar)

Describe HCPCS

describe_hcpcs(hcpcs = c("33924", "43116"))

> # A tibble: 11 × 8
>    hcpcs description  desc_type level category section rbcs_category rbcs_family
>    <chr> <chr>        <chr>     <chr> <chr>    <chr>   <chr>         <chr>      
>  1 33924 Remove pulm… Short     I     I        Surgery Major Proced… Cardiovasc…
>  2 33924 Ligation an… Long      I     I        Surgery Major Proced… Cardiovasc…
>  3 33924 LIG&TKDN SY… Medical   I     I        Surgery Major Proced… Cardiovasc…
>  4 33924 Disconnecti… Consumer  I     I        Surgery Major Proced… Cardiovasc…
>  5 33924 Ligation an… Clinician I     I        Surgery Major Proced… Cardiovasc…
>  6 33924 Ligation an… Clinician I     I        Surgery Major Proced… Cardiovasc…
>  7 43116 Partial rem… Short     I     I        Surgery Major Proced… Digestive/…
>  8 43116 Partial eso… Long      I     I        Surgery Major Proced… Digestive/…
>  9 43116 PRTL ESOPHA… Medical   I     I        Surgery Major Proced… Digestive/…
> 10 43116 Partial rem… Consumer  I     I        Surgery Major Proced… Digestive/…
> 11 43116 Partial cer… Clinician I     I        Surgery Major Proced… Digestive/…

NCCI Edits

Add-On Codes

get_addon_edits(hcpcs = c("33924", "33935"))

> # A tibble: 6 × 6
>   hcpcs aoc_type aoc_complements   aoc_edit_type aoc_edit_description           
>   <chr> <chr>    <list>                    <int> <chr>                          
> 1 33924 addon    <tibble [39 × 1]>             1 Only Paid if Primary is Paid. …
> 2 33924 addon    <tibble [10 × 1]>             1 Only Paid if Primary is Paid. …
> 3 33924 addon    <tibble [1 × 1]>              1 Only Paid if Primary is Paid. …
> 4 33924 addon    <tibble [3 × 1]>              1 Only Paid if Primary is Paid. …
> 5 33935 primary  <tibble [1 × 1]>              1 Only Paid if Primary is Paid. …
> 6 33935 primary  <tibble [3 × 1]>              1 Only Paid if Primary is Paid. …
> # ℹ 1 more variable: aoc_edit_effective <int>

Retrieve MUEs

get_mue_edits(hcpcs = c("33924", "33935"))

> # A tibble: 4 × 6
>   hcpcs mue_uos mue_mai mue_mai_desc              mue_service_type mue_rationale
>   <chr>   <int>   <int> <chr>                     <chr>            <chr>        
> 1 33924       1       2 Date of Service Edit: Po… Practitioner     Code Descrip…
> 2 33935       1       2 Date of Service Edit: Po… Practitioner     Anatomic Con…
> 3 33924       1       2 Date of Service Edit: Po… Outpatient Hosp… Code Descrip…
> 4 33935       1       2 Date of Service Edit: Po… Outpatient Hosp… Anatomic Con…

Procedure-to-Procedure Edits

get_ptp_edits(hcpcs = c("33924", "33935"))

> # A tibble: 21 × 6
>    hcpcs ptp_type      ptp_complements   ptp_edit_mod ptp_edit_mod_desc
>    <chr> <chr>         <list>                   <int> <chr>            
>  1 33924 comprehensive <tibble [1 × 1]>             0 Not Allowed      
>  2 33924 comprehensive <tibble [4 × 1]>             0 Not Allowed      
>  3 33924 comprehensive <tibble [1 × 1]>             1 Allowed          
>  4 33924 comprehensive <tibble [4 × 1]>             1 Allowed          
>  5 33924 comprehensive <tibble [6 × 1]>             0 Not Allowed      
>  6 33924 comprehensive <tibble [2 × 1]>             1 Allowed          
>  7 33924 comprehensive <tibble [2 × 1]>             1 Allowed          
>  8 33924 comprehensive <tibble [2 × 1]>             1 Allowed          
>  9 33924 comprehensive <tibble [1 × 1]>             0 Not Allowed      
> 10 33924 component     <tibble [1 × 1]>             0 Not Allowed      
> 11 33935 comprehensive <tibble [27 × 1]>            0 Not Allowed      
> 12 33935 comprehensive <tibble [50 × 1]>            1 Allowed          
> 13 33935 comprehensive <tibble [63 × 1]>            1 Allowed          
> 14 33935 comprehensive <tibble [67 × 1]>            1 Allowed          
> 15 33935 comprehensive <tibble [13 × 1]>            0 Not Allowed      
> 16 33935 comprehensive <tibble [1 × 1]>             1 Allowed          
> 17 33935 comprehensive <tibble [2 × 1]>             0 Not Allowed      
> 18 33935 comprehensive <tibble [2 × 1]>             0 Not Allowed      
> 19 33935 comprehensive <tibble [11 × 1]>            0 Not Allowed      
> 20 33935 comprehensive <tibble [24 × 1]>            0 Not Allowed      
> # ℹ 1 more row
> # ℹ 1 more variable: ptp_edit_rationale <chr>

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⚖️ Code of Conduct

Please note that the northstar project is released with a Contributor Code of Conduct. By contributing to this project, you agree to abide by its terms.

🏛️ Governance

This project is primarily maintained by Andrew Bruce. Other authors may occasionally assist with some of these duties.