Table 4 Examples of claims where autoencoder model predictions were consistent with manual annotations. Italicized cells denote model predictions for overutilization
Claim # | ICD-10 Code | Diagnosis | CPT Code | Procedure | Age | Gender | FWA SMS comments |
|---|---|---|---|---|---|---|---|
1 | L82 | Seborrheic keratosis | 11401 | Removal of growth (0.6 to 1.0 centimeters) of the trunk arms or legs | 65 | F | CPT 11401 and 11400 are questionable if there is only one growth. One removal - units and detailed diagnosis would need further review |
99212 | Established patient outpatient visit total time 10-19 minutes | ||||||
11400 | Removal of growth (0.5 centimeters or less) of the trunk arms or legs | ||||||
2 | M54 | Dorsalgia | 99213 | Established patient outpatient visit total time 20-29 minutes | 36 | F | CPT 97811 and 97814 appears to be overutilized in the presence of the other CPT codes |
97813 | Acupuncture 1 or more needles with electrical stimulation first 15 minutes | ||||||
97814 | Acupuncture 1 or more needles with electrical stimulation and re-insertion of needles | ||||||
97811 | Acupuncture 1 or more needles |