updated pins, fun: reference

R/calculations.R

@@ -21,7 +21,7 @@ calc_nonpar_amount <- function(participating_amount) {
 
   stopifnot("`participating_amount` must be numeric" = is.numeric(participating_amount))
 
-  participating_amount * 1.0925
+  participating_amount * 0.95
 }
 
 #' Calculate Physician Fee Schedule Payment Amounts
@@ -63,7 +63,7 @@ calc_amounts <- function(wrvu,
   glue::glue("Participating Amount:    {gt::vec_fmt_currency(x$par)}\n",
              "Non-Particpating Amount: {gt::vec_fmt_currency(x$nonpar)}\n",
              "Limiting Charge:         {gt::vec_fmt_currency(x$limit)}",
-             par = x$par,
+             par    = x$par,
              nonpar = x$nonpar,
-             limit = x$limit)
+             limit  = x$limit)
 }

R/reference.R

@@ -0,0 +1,16 @@
+#' @noRd
+global <- dplyr::tibble(
+  glob_days = c("000", "010", "090", "MMM", "XXX", "YYY", "ZZZ"),
+  description = c(
+    "Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount. Evaluation and Management services on the day of the procedure generally not payable.",
+    "Minor procedure with preoperative relative values on the day of the procedure and postoperative relative values during a 10-day postoperative period included in the fee schedule amount. Evaluation and Management services on the day of the procedure and during the 10-day postoperative period generally not payable.",
+    "Major surgery with a 1-day preoperative period and 90-day postoperative period included in the fee schedule amount.",
+    "Maternity codes; usual global period does not apply.",
+    "Global concept does not apply.",
+    "Carrier determines whether the global concept applies and establishes postoperative period, if appropriate, at time of pricing.",
+    "Code is related to another service and is always included in the global period of the other service."
+  )
+) |>
+  dplyr::mutate(
+    glob_days = forcats::fct_relevel(glob_days, "000", "010", "090", "MMM", "XXX", "YYY", "ZZZ")
+  )

README.Rmd

@@ -37,16 +37,16 @@ library(dplyr)
 ```
 
 
-```{r}
+```{r eval=FALSE}
 rvu() |> 
   filter(status   == "A",
-         work.rvu == max(work.rvu, na.rm = TRUE)) |> 
+         wrvu == max(wrvu, na.rm = TRUE)) |> 
   select(hcpcs, 
          description,
-         work.rvu, 
-         pe.rvu_nonfac, 
-         pe.rvu_fac, 
-         mp.rvu, 
+         wrvu, 
+         prvu_nf, 
+         prvu_f, 
+         mrvu, 
          cf) |>
   glimpse()
 ```
@@ -68,15 +68,15 @@ calc_amounts(wrvu  = 108.91,
              cf    = 32.7442)
 ```
 
-```{r}
+```{r eval=FALSE}
 payment() |> 
   filter(hcpcs      == "39503", 
          carrier_no == "10212",
          locality   == "01") |> 
   select(hcpcs,
-         mac = carrier_no,
+         mac,
          locality,
-         fee_nonfac,
-         fee_fac) |> 
+         fee_nf,
+         fee_f) |> 
   glimpse()
 ```

README.md

@@ -28,27 +28,17 @@ library(dplyr)
 ``` r
 rvu() |> 
   filter(status   == "A",
-         work.rvu == max(work.rvu, na.rm = TRUE)) |> 
+         wrvu == max(wrvu, na.rm = TRUE)) |> 
   select(hcpcs, 
          description,
-         work.rvu, 
-         pe.rvu_nonfac, 
-         pe.rvu_fac, 
-         mp.rvu, 
+         wrvu, 
+         prvu_nf, 
+         prvu_f, 
+         mrvu, 
          cf) |>
   glimpse()
 ```
 
-    > Rows: 1
-    > Columns: 7
-    > $ hcpcs         <chr> "39503"
-    > $ description   <chr> "Repair of diaphragm hernia"
-    > $ work.rvu      <dbl> 108.91
-    > $ pe.rvu_nonfac <dbl> 35.14
-    > $ pe.rvu_fac    <dbl> 35.14
-    > $ mp.rvu        <dbl> 26.95
-    > $ cf            <dbl> 32.7442
-
 ``` r
 gpci() |> 
   filter(state    == "GA", 
@@ -77,7 +67,7 @@ calc_amounts(wrvu  = 108.91,
 ```
 
     > Participating Amount:    $5,708.76
-    > Non-Particpating Amount: $6,236.82
+    > Non-Particpating Amount: $5,423.32
     > Limiting Charge:         $6,236.82
 
 ``` r
@@ -86,17 +76,9 @@ payment() |>
          carrier_no == "10212",
          locality   == "01") |> 
   select(hcpcs,
-         mac = carrier_no,
+         mac,
          locality,
-         fee_nonfac,
-         fee_fac) |> 
+         fee_nf,
+         fee_f) |> 
   glimpse()
 ```
-
-    > Rows: 1
-    > Columns: 5
-    > $ hcpcs      <chr> "39503"
-    > $ mac        <chr> "10212"
-    > $ locality   <chr> "01"
-    > $ fee_nonfac <dbl> 5708.76
-    > $ fee_fac    <dbl> 5708.76

data-raw/pfs.R

@@ -3,14 +3,12 @@ library(tidyverse)
 library(janitor)
 
 root <- c("C:/Users/Andrew/Desktop/payer_guidelines/data/")
-
-# NATIONAL PHYSICIAN FEE SCHEDULE RELATIVE VALUE FILE CALENDAR YEAR 2024
-# rvu_xl <- here::here("data/RVU24A-010323/PPRRVU24_JAN.xlsx")
-
 rvu_xl     <- glue::glue("{root}RVU24A-010323/PPRRVU24_JAN.xlsx")
 pfs_pay_xl <- glue::glue("{root}PFREV24A_0/PFALL24.csv")
 gpci_xl    <- glue::glue("{root}RVU24A-010323/GPCI2024.xlsx")
 
+# NATIONAL PHYSICIAN FEE SCHEDULE RELATIVE VALUE FILE CALENDAR YEAR 2024
+# rvu_xl <- here::here("data/RVU24A-010323/PPRRVU24_JAN.xlsx")
 
 rvu <- read_excel(rvu_xl, col_types = "text") |>
   row_to_names(row_number = 9) |>
@@ -27,67 +25,69 @@ rvu <- read_excel(rvu_xl, col_types = "text") |>
                   post_op,
                   non_facility_pe_used_for_opps_payment_amount,
                   facility_pe_used_for_opps_payment_amount,
-                  mp_used_for_opps_payment_amount
-  ),
-  readr::parse_number)) |>
+                  mp_used_for_opps_payment_amount), readr::parse_number)) |>
   rename(
-    status = status_code,
-    unused = not_used_for_medicare_payment,
-    work.rvu = work_rvu,
-    pe.rvu_nonfac = non_fac_pe_rvu,
-    nonfac_ind_na = non_fac_na_indicator,
-    pe.rvu_fac = facility_pe_rvu,
-    fac_ind_na = facility_na_indicator,
-    mp.rvu = mp_rvu,
-    total_nonfac = non_facility_total,
-    total_fac = facility_total,
-    pctc = pctc_ind,
-    endo = endo_base,
-    cf = conv_factor,
-    phys_sup_diag_proc = physician_supervision_of_diagnostic_procedures,
-    calc_flag = calculation_flag,
-    diag_img_fm_ind = diagnostic_imaging_family_indicator,
-    pe.rvu_nonfac_opps = non_facility_pe_used_for_opps_payment_amount,
-    pe.rvu_fac_opps = facility_pe_used_for_opps_payment_amount,
-    mp.rvu_opps = mp_used_for_opps_payment_amount
-  )
+    status       = status_code,
+    notused      = not_used_for_medicare_payment,
+    wrvu         = work_rvu,
+    prvu_nf      = non_fac_pe_rvu,
+    prvu_f       = facility_pe_rvu,
+    nf_ind_na    = non_fac_na_indicator,
+    f_ind_na     = facility_na_indicator,
+    mrvu         = mp_rvu,
+    total_nf     = non_facility_total,
+    total_f      = facility_total,
+    pctc         = pctc_ind,
+    endo         = endo_base,
+    cf           = conv_factor,
+    phys_dxpx    = physician_supervision_of_diagnostic_procedures,
+    calc         = calculation_flag,
+    dximgfm_ind  = diagnostic_imaging_family_indicator,
+    prvu_nf_opps = non_facility_pe_used_for_opps_payment_amount,
+    prvu_f_opps  = facility_pe_used_for_opps_payment_amount,
+    mrvu_opps    = mp_used_for_opps_payment_amount)
+
+# [18,500 x 31]
 
 rvu |>
   filter(hcpcs == "A0021")
 
 # ANNUAL PHYSICIAN FEE SCHEDULE PAYMENT AMOUNT FILE
 # pfs_pay_xl <- here::here("data/PFREV24A_0/PFALL24.csv")
 
-pfs_pay <- readr::read_csv(pfs_pay_xl, col_types = strrep("c", 16)) |>
+pfs_pay <- readr::read_csv(pfs_pay_xl,
+                           col_types = strrep("c", 16)) |>
   slice(-c(990483:990487))
 
 names(pfs_pay) <- c(
   "year",
-  "carrier_no",
+  "mac",
   "locality",
   "hcpcs",
   "mod",
-  "fee_nonfac", # "non_fac_fee_sched_amount"
-  "fee_fac", # "facility_fee_sched_amount"
+  "fee_nf", # "non_fac_fee_sched_amount"
+  "fee_f", # "facility_fee_sched_amount"
   "pctc",
   "status",
   "mult_surg",
-  "ther_red_nonfac", # "therapy_reduction_nonfac"
-  "flat_visit", # flat_visit_fee
-  "ther_red_fac", # "therapy_reduction_fac"
+  "therapy_nf", # "therapy_reduction_nonfac"
+  "flatfee_visit", # flat_visit_fee
+  "therapy_f", # "therapy_reduction_fac"
   "opps", # "opps_indicator"
-  "opps_nonfac",
-  "opps_fac"
+  "opps_nf",
+  "opps_f"
 )
 
 pfs_pay <- pfs_pay |>
   mutate(across(c(
     year,
-    contains("fac"),
-    flat_visit
+    contains("fee"),
+    contains("therapy"),
+    contains("opps_"),
     ), readr::parse_number)) |>
   select(-pctc)
 
+# [990,482 x 15]
 pfs_pay |>
   filter(hcpcs == "A0021")
 
@@ -100,14 +100,17 @@ gpci <- read_excel(gpci_xl, col_types = "text") |>
   filter(!is.na(state)) |>
   rename(mac = medicare_administrative_contractor_mac,
          locality = locality_number,
-         gpci.pw_floor = x2024_pw_gpci_with_1_0_floor,
-         gpci.pe = x2024_pe_gpci,
-         gpci.mp = x2024_mp_gpci
+         wgpci = x2024_pw_gpci_with_1_0_floor,
+         pgpci = x2024_pe_gpci,
+         mgpci = x2024_mp_gpci
   ) |>
   mutate(across(contains("gpci"), readr::parse_number)) |>
-  mutate(locality_name = str_remove_all(locality_name, fixed("*")),
-         state = fct(state))
+  mutate(ftnote = str_extract_all(locality_name, fixed("*")),
+         locality_name = str_remove_all(locality_name, fixed("*")),
+         state = fct(state)) |>
+  unnest(ftnote, keep_empty = TRUE)
 
+# [114 x 8]
 gpci
 
 

pins/_pins.yaml

@@ -1,6 +1,6 @@
 gpci:
-- gpci/20240229T141339Z-56bda/
+- gpci/20240301T191529Z-046ae/
 pymt:
-- pymt/20240229T141334Z-f3472/
+- pymt/20240301T191527Z-8e4f8/
 rvu:
-- rvu/20240229T141242Z-b9bfe/
+- rvu/20240301T191525Z-74e8b/

pins/gpci/20240229T141339Z-56bda/data.txt → pins/gpci/20240301T191529Z-046ae/data.txt

@@ -1,11 +1,11 @@
 file: gpci.qs
-file_size: 3789
-pin_hash: 56bda82317bd4f61
+file_size: 3884
+pin_hash: 046ae03771b63f61
 type: qs
 title: GPCIs 2024
 description: Geographic Practice Cost Indices (GPCIs) by State and Medicare Locality
   2024
 tags: ~
 urls: ~
-created: 20240229T141339Z
+created: 20240301T191529Z
 api_version: 1

pins/pymt/20240229T141334Z-f3472/data.txt → pins/pymt/20240301T191527Z-8e4f8/data.txt

@@ -1,10 +1,10 @@
 file: pymt.qs
-file_size: 8590506
-pin_hash: f347237b879b8c9a
+file_size: 8590491
+pin_hash: 8e4f837562588fdf
 type: qs
 title: PFS Payment Amount 2024
 description: Annual Physician Fee Schedule Payment Amount File 2024
 tags: ~
 urls: ~
-created: 20240229T141334Z
+created: 20240301T191527Z
 api_version: 1

pins/rvu/20240229T141242Z-b9bfe/data.txt → pins/rvu/20240301T191525Z-74e8b/data.txt

@@ -1,10 +1,10 @@
 file: rvu.qs
-file_size: 487417
-pin_hash: b9bfe6b2b6fbc381
+file_size: 487390
+pin_hash: 74e8b40657e5df8d
 type: qs
 title: PFS RVU 2024
 description: National Physician Fee Schedule Relative Value File January 2024 Release
 tags: ~
 urls: ~
-created: 20240229T141242Z
+created: 20240301T191525Z
 api_version: 1