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Updating existing code (Change_Type: C and U) : Change or Unrecognized change

Updated on April 23, 2021

This change types are used for adding new record into the system and also updating existing record.

Pega Foundation for Healthcare

For each change record a new version will get added to the system.

(Functionally for both change types are similar i.e. Change and Un-recognized change)

Property mappings:
CodeSetTypePega propertyBase File/Change FileFile property (Base file or Change file)Is mandatory (From files)Note
CPT .CodeChange FileCPT_CodeYesMandatory in both base and change files
.CodeDescriptionBase FileSHORT_DESCRIPTIONYes

Mandatory, because we can show atleast one description for each code on UI

.EffectiveDateChange FileRevised_Start/Release_DateYesIf Revised_start is not available, Release_Date is considered as effective date
.ExpirationDateChange FileDate_Terminated/"Version_End- 1"/Release_DateIf version_End is not available, Release_Date is considered as end date

Version_End is decrement by -1 because in case we receive same value for Version_End and Release_Date, we don't want any conflicts with the dates. Refer example for more details

.FAC_TOTAL_RVUBase FileFAC_TOTAL_RVU
.FullDescriptionBase FileFULL_DESCRIPTION
.LongDescriptionBase FileLONG_DESCRIPTION
.NF_TOTAL_RVUBase FileNF_TOTAL_RVU
.Seq_OrderBase FileSEQ_ORDER
.StatusChange FileRelease_DateYes"Changed as part of Release"+Release_Date
.StatusIndicatorChange FileStatus_indicator
.ResequencedBase FileResequenced
.VersionNAPrevious version+"0.1"System will take previous version of the code and increment it by +"0.1"
ICD10 Dx .CodeChange FileCODEYesMandatory in both base and change files
.EffectiveDateChange FileRevised_Start/Release_DateYesIf Revised_start is not available, Release_Date is considered as effective date
.ExpirationDateChange FileDate_Terminated/"Version_End- 1"/Release_DateIf version_End is not available, Release_Date is considered as end date Version_End is decrement by -1 because in case we receive same value for Version_End and Release_Date, we don't want any conflicts with the dates. Refer example for more details
.ShortDescriptionBase FileSHORT_DESCRIPTIONYes

Mandatory, because we can show atleast one description for each code on UI

.Full_DescriptionBase FileFULL_DESCRIPTION
.LongDescriptionBase FileLONG_DESCRIPTION
.ValidityBase FileVALIDITY

If Validity is "C", value is set to "1", if

Validity=="I", value is set

to "0".

.StatusChange FileRelease_Date

"Changed as part of Release"+Release_Date

.StatusIndicatorChange FileStatus_indicator
.CodeTypeBase FileCODE_TYPE
.VersionNAPrevious version+"0.1"

System will take previous version of the code and increment it by +"0.1"

HCPCS.HCPCChange FileHCPCS_CODEYesMandatory in both base and change files
.EffectiveDateChange FileRevised_Start/Release_DateYesIf Revised_start is not available, Release_Date is considered as effective date
.ExpirationDateChange FileDate_Terminated/"Version_End- 1"/Release_Date

If version_End is not available, Release_Date is considered as end date Version_End is decrement by -1 because in case we receive same value for Version_End and Release_Date, we don't want any conflicts with the dates. Refer example for more details.

.ShortDescBase FileSHORT_DESCRIPTIONYes

Mandatory, because we can show atleast one description for each code on UI

.FullDescriptionBase FileFULL_DESCRIPTION
.LongDescBase File.LONG_DESCRIPTION
.StatusChange FileRelease_DateYes

"Changed as part of Release"+Release_Date

.StatusIndicatorChange FileStatus_indicator
.VersionNAPrevious version+"0.1"System will take previous version of the code and increment it by +"0.1"
Example: Importing CPT files
Base file:

Change file: (we have two scenarios here as well; we can give Date_Teminated or not. Both are valid scenarios).

This is the valid combination to import with “C” or “U”.

After importing: New version gets added into the system with Version: 1.1 (New record).

EffectiveDate: Revised_Start, EndDate: Default date given by system.

Existing record with Version 1.0, gets updated with End date (Version_End - 1). EndDate: Version_End.

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