Matching Case Data with CPT Codes

Below are instructions for matching case data in the Graphium system with corresponding CPT codes as required by CMS for MACRA compliance.

Objective

  • Once a CPT code file has been uploaded, ensure each record within the CPT file successfully matches a case within the Graphium system, so the corresponding CPT code can be added to the case before submitting to the QCDR for MACRA.

  • If there is not a match, utilize the Patient Forms feature of the Graphium Dashboard to research case data and make corrections to the CPT file record as necessary, ensuring all submitted cases are matched with their appropriate CPT code before submission to the QCDR.

Goals

  • Review first quarter CPT file uploads and ensure all cases are successfully matched to a CPT code by April 30th. 

  • Review second quarter CPT file uploads and ensure all cases are successfully matched to a CPT code by July 31st.

  • Review third quarter CPT file uploads and ensure all cases are successfully matched to a CPT code by October 31st. 

  • Review fourth quarter CPT file uploads and ensure all cases are successfully matched to a CPT code by January 13th. 

Directions

  1. Reviewing Status of Records 

  2. Reprocessing Records

  3. Ignoring Records

  4. Editing Records

Reviewing Status of Records 

  1. Login to the Graphium EMR Dashboard™. If you do not have access to the dashboard, please contact your organization's Administrator.

  2. Click on the settings icon in the upper right corner and then choose "Import".

  3. From the Import Batch screen, click on "View Details" next to your uploaded file.

  4. The import details for each form will appear. Pay attention to the “Status”, “Errors”, and “Actions” columns. The information within those columns determines your next step in the review process, as your data may need to be reprocessed, ignored, or edited.

  5. Below is a table which explains the "Status" of your record (in sequential order) during the importing process, as well as any "Errors" associated with that status, and the "Actions" you should take.

  6. Below are matching scenarios that will be attempted during import of your CPT file. Note: one of these scenarios must exist with complete accuracy in order for the record within your CPT file to be successfully matched to a case within the Graphium system, and thus applicable CPT code(s) added.

    • Graphium Form ID

    • Encounter Number + Date of Service + Anesthesia Start Time

    • Patient MRN + Date of Service + Anesthesia Start Time

    • Encounter Number + Date of Service + Surgeon NPI

    • Patient MRN + Date of Service + Surgeon NPI

    • Encounter Number + Date of Service + Anesthesia Provider NPI

    • Patient MRN + Date of Service + Anesthesia Provider NPI

    • Date of Service + Anesthesia Start Time + Anesthesia Provider NPI

Reprocessing Records 

  1. From the Import Batch screen, click on "View Details" next to your uploaded file.

  2. Records which indicate "Processing Error" or "Processing Match Error" under the status column and contain a notebook icon under the error column, need to be reprocessed.

  3. Simply click the red "Reprocess" button to the right of these records.

  4. If there are multiple records which need to be reprocessed, click the check box next to all applicable records, and then click the red "Reprocess Selected Records" button.

  5. If the processing error(s) and notebook icon(s) do not disappear, please email Graphium Support at support@graphiumhealth.com.

Ignoring Records 

  1. From the Import Batch screen, click on "View Details" next to your uploaded file.

  2. If there are records you would like to ignore (i.e. duplicate cases, canceled cases, etc.) simply click the "Ignore" button to the right of those records. 

  3. If there are multiple records which need to be ignored, click the check box next to all applicable records, and then click the red "Ignore Selected Records" button.

  4. If you have chosen to ignore a record by accident, click the red "Unignore" button next to that record. 


    PLEASE NOTE: Records (cases) which have been ignored will NOT be submitted to the QCDR for MACRA reporting.

Editing Records 

  1. From the Import Batch screen, click on "View Details" next to your uploaded file.

  2. A record labeled "No Match" under the status column, indicates there is no case in the Graphium system which matches, and thus no CPT code can be added. Please submit the applicable patient case to Graphium via SFTP (for paper cases) or by using Graphium's iOS software or app.

  3. After the case has been submitted to Graphium, please log back into the Dashboard and "Reprocess" the applicable record.

    PLEASE NOTE: Records (cases) labeled "No Match" will NOT be submitted to the QCDR for MACRA reporting.

  4. A record labeled "Match Error" under the status column, indicates the data provided within the CPT file for that specific record, did not match enough case data (see required matching scenarios above) in the Graphium system to add the CPT code. 

  5. Click on the "Edit Record" button next to the "Match Error" record.


  6. A popup window will appear containing details from the CPT file for that specific record. 



  7. Use the data provided within the pop up window and compare it with your internal data for the patient case.
  8. If there are any discrepancies, simply correct the data within the Edit Record popup window and then click “Save” in the bottom right hand corner. 
  9. Next, "Reprocess" the record to ensure a successful match was created and the "Match Error" no longer appears. 
  10. If you cannot find or do not have easy access to patient case data within your own organization, please reference our “How to Find Patient Cases in the Dashboard” help article. 

    https://help.graphiumhealth.com/how-to-find-patient-cases-in-the-dashboard

PLEASE NOTE: Records (cases) labeled "Match Error" will NOT be submitted to the QCDR for MACRA reporting.