Abstract:
A computer-implemented method for profiling medical claims to assist health care managers in determining the cost-efficiency and service quality of health care providers. The method allows an objective means for measuring and quantifying health care services. An episode treatment group (ETG) is a patient classification unit, which defines groups that are clinically homogenous (similar cause of illness and treatment) and statistically stable. The ETG grouper methodology uses service or segment-level claim data as input data and assigns each service to the appropriate episode. The program identifies concurrent and recurrent episodes, flags records, creates new groupings, shifts groupings for changed conditions, selects the most recent claims, resets windows, makes a determination if the provider is an independent lab and continues to collect information until an absence of treatment is detected.

Description:
REFERENCE TO RELATED APPLICATIONS  
       [0001]    This patent application is a divisional application of U.S. patent application Ser. No. 09/188,986 filed Nov. 9, 1998, which is a continuation patent application of U.S. patent application Ser. No. 08/493,728, filed on Jun. 22, 1995, issued as U.S. Pat. No. 5,835,897 on Nov. 10, 1998. 
     
    
     
       FIELD OF THE INVENTION  
         [0002]    The present invention relates generally to computer-implemented methods for processing medical claims information. More particularly, the present invention relates to a computer- implemented method for receiving input data relating to a person&#39;s medical claim, establishing a management record for the person, establishing episode treatment groups to define groupings of medical episodes of related etiology, correlating subsequent medical claims events to an episode treatment group and manipulating episode treatment groups based upon time windows for each medical condition and co-morbidities.  
         BACKGROUND OF THE INVENTION  
         [0003]    Due to an increase in health care costs and inefficiency in the health care system, health care providers and service management organizations need health care maintenance systems which receive input medical claim data, correlate the medical claim data and provide a means for quantitatively and qualitatively analyzing provider performance. Because of the complex nature of medical care service data, many clinicians and administrators are not able to efficiently utilize the data. A need exists for a computer program that transforms inpatient and out patient claim data to actionable information, which is logically understood by clinicians and administrators.  
           [0004]    Performance is quickly becoming the standard by which health care purchasers and informed consumers select their health care providers. Those responsible for the development and maintenance of provider networks search for an objective means to measure and quantify the health care services provided to their clients. Qualitative and quantitative analysis of medical provider performance is a key element for managing and improving a health care network. Operating a successful health care network requires the ability to monitor and quantify medical care costs and care quality. Oftentimes, success depends on the providers&#39; ability to identify and correct problems in their health care system. A need exists, therefore, for an analytical tool for identifying real costs in a given health care management system.  
           [0005]    To operate a more efficient health care system, health care providers need to optimize health care services and expenditures. Many providers practice outside established utilization and cost norms. Systems that detect inappropriate coding, eliminate potentially inappropriate services or conduct encounter-based payment methodology are insufficient for correcting the inconsistencies of the health care system. When a complication or comorbidity is encountered during the course of treatment, many systems do not reclassify the treatment profile. Existing systems do not adjust for casemix, concurrent conditions or recurrent conditions. A system that compensates for casemix should identify the types of illnesses treated in a given population, determine the extent of resource application to specific types of illnesses, measure and compare the treatment patterns among individual and groups of health care providers and educate providers to more effectively manage risk. When profiling claims, existing systems establish classifications that do not contain a manageable number of groupings, are not clinically homogeneous or are not statistically stable. A need exists, therefore, for a patient classification system that accounts for differences in patient severity and establishes a clearly defined unit of analysis.  
           [0006]    For many years, computer-implemented programs for increasing health care efficiency have been available for purchase. Included within the current patent literature and competitive information are many programs that are directed to the basic concept of health care systems.  
           [0007]    The Mohlenbrock, et al. patent, U.S. Pat. No. 4,667,292, issued in 1987, discloses a medical reimbursement computer system which generates a list identifying the most appropriate diagnostic-related group (DRG) and related categories applicable to a given patient for inpatient claims only. The list is limited by a combination of the characteristics of the patient and an initial principal diagnosis. A physician can choose a new designation from a list of related categories while the patient is still being treated. The manually determined ICD-9 numbers can be applied to an available grouper computer program to compare the working DRG to the government&#39;s DRG.  
           [0008]    The Mohlenbrock, et al. patent, U.S. Pat. No. 5,018,067, issued in 1991, discloses an apparatus and method for improved estimation of health resource consumption through the use of diagnostic and/or procedure grouping and severity of illness indicators. This system is a computer-implemented program that calculates the amount of payment to the health provider by extracting the same input data as that identified in the Mohlenbrock &#39;292 Patent teaching the DRG System. The system calculates the severity of the patient&#39;s illness then classifies each patient into sub-categories of resource consumption within a designated DRG. A computer combines the input data according to a formula consisting of constants and variables. The variables are known for each patient and relate to the number of ICD codes and the government weighing of the codes. The software program determines a set of constants for use in the formula for a given DRG that minimizes variances between the actual known outcomes and those estimated by use of the formula. Because it is based upon various levels of illness severity within each diagnosis, the results of this system provide a much more homogenous grouping of patients than is provided by the DRGs. Providers can be compared to identify those providers whose practice patterns are of the highest quality and most cost efficient. A set of actual costs incurred can be compared with the estimated costs. After the initial diagnosis, the system determines the expected costs of treating a patient.  
           [0009]    The Schneiderman patent, U.S. Pat. No. 5,099,424, issued in 1992, discloses a model user application system for clinical data processing that tracks and monitors a simulated out-patient medical practice using database management software. The system allows for a database of patients and the entry of EKG and/or chest x-ray (CXR) test results into separate EKG/CXR records as distinct logical entities. This system requires entry of test results that are not part of the medical claim itself. If not already present, the entry creates a separate lab record that may be holding blood work from the same lab test request. Portions of the information are transferred to the lab record for all request situations. Although the lab record data routine is limited to blood work, each time the routine is run, historical parameter data are sent to a companion lab record along with other data linking both record types. The system also includes a revision of the system&#39;s specialist record and the general recommendation from an earlier work for more explicit use in information management.  
           [0010]    The Tawil patent, U.S. Pat. No. 5,225,976, issued in 1993, discloses an automated health benefit processing system. This system minimizes health care costs by informing the purchasers of medical services about market conditions of those medical services. A database includes, for each covered medical procedure in a specific geographic area, a list of capable providers and their charges. A first processor identifies the insured then generates a treatment plan and the required medical procedures. Next, the first processor retrieves information related to the medical procedures and appends the information to the treatment plan. A second processor generates an actual treatment record including the actual charges. A third processor compares the plan and the actual records to determine the amounts payable to the insured and the provider.  
           [0011]    The Ertel patent, U.S. Pat. No. 5,307,262, issued in 1994, discloses a patient data quality review method and system. The system performs data quality checks and generates documents to ensure the best description of a case. The system provides file security and tracks the cases through the entire review process. Patient data and system performance data are aggregated into a common database that interfaces with existing data systems. Data profiles categorize data quality problems by type and source. Problems are classified as to potential consequences. The system stores data, processes it to determine misreporting, classifies the case and displays the case-specific patient data and aggregate patient data.  
           [0012]    The Holloway, et al. patent, U.S. Pat. No. 5,253,164, issued in 1993, discloses a system and method for detecting fraudulent medical claims via examination of service codes. This system interprets medical claims and associated representation according to specific rules and against a predetermined CPT-4 code database. A knowledge base interpreter applies the knowledge base using the rules specified. The database can be updated as new methods of inappropriate coding are discovered. The system recommends appropriate CPT codes or recommends pending the claims until additional information is received. The recommendations are based on the decision rules that physician reviewers have already used on a manual basis.  
           [0013]    The Cummings patent, U.S. Pat. No. 5,301,105, issued in 1994, discloses an all care health management system. The patient-based system includes an integrated interconnection and interaction of essential health care participants to provide patients with complete support. The system includes interactive participation with the patients employers and banks. The system also integrates all aspects of the optimization of health-inducing diet and life style factors and makes customized recommendations for health-enhancing practices. By pre-certifying patients and procedures, the system enhances health care efficiency and reduces overhead costs.  
           [0014]    The Dorne patent, U.S. Pat. No. 5,325,293, issued in 1994, discloses a system and method for correlating medical procedures and medical billing codes. After an examination, the system automatically determines raw codes directly associated with all of the medical procedures performed or planned to be performed with a particular patient. The system allows the physician to modify the procedures after performing the examination. By manipulating the raw codes, the system generates intermediate and billing codes without altering the raw codes.  
           [0015]    The Kessler, et al. patent, U.S. Pat. No. 5,324,077, issued in 1994, discloses a negotiable medical data draft for tracking and evaluating medical treatment. This system gathers medical data from ambulatory visits using a medical data draft completed by the provider to obtain payment for services, to permit quality review by medical insurers. In exchange for immediate partial payment of services, providers are required to enter data summarizing the patient&#39;s visit on negotiable medical drafts. The partial payments are incentives to providers for participating in the system.  
           [0016]    The Torma, et al. patent, U.S. Pat. No. 5,365,425, issued in 1994, discloses a method and system for measuring management effectiveness. Quality, cost and access are integrated to provide a holistic description of the effectiveness of care. The system compares general medical treatment databases and surveyed patient perceptions of care. Adjustments based on severity of illness, case weight and military costs are made to the data to ensure that all medical facilities are considered fairly.  
           [0017]    Health Chex&#39;s PEER-A-MED computer program is a physician practice profiling system that provides case-mix adjusted physician analysis based on a clinical severity concept. The system employs a multivariate linear regression analysis to appropriately adjust for case-mix. After adjusting for the complexity of the physician&#39;s caseload, the system compares the relative performance of a physician to the performance of the peer group as a whole. The system also compares physician utilization performance for uncomplicated, commonly seen diagnosis. Because the full spectrum of clinical care that is rendered to a patient is not represented in its databases, the system is primarily used as an economic performance measurement tool. This system categorizes the claims into general codes including acute, chronic, mental health and pregnancy. Comorbidily and CPT-4 codes adjust for acuity level. The codes are subcategorized into twenty cluster groups based upon the level of severity. The system buckets the codes for the year and contains no apparent episode building methodology. While the PEER-A-MED system contains clinically heterogeneous groupings, the groupings are not episode-based and recurrent episodes cannot be accounted.  
           [0018]    Ambulatory Care Groups (ACG) provides a patient-based system that uses the patient and the analysis unit. Patients are assigned to an diagnosis group and an entire year&#39;s claims are bucketed into thirty-one diagnosis groups. By pre-defining the diagnosis groups, this is a bucketing-type system and claim management by medical episode does not occur. The system determines if a claim is in one of the buckets. Because different diseases could be categorized into the same ACG, this system is not clinically homogeneous. An additional problem with ACGs is that too many diagnosis groups are in each ACG.  
           [0019]    Ambulatory Patient Groups (APGs) are a patient classification system designed to explain the amount and type of resources used in an ambulatory visit. Patients in each APG have similar clinical characteristics and similar resource use and cost. Patient characteristics should relate to a common organ system or etiology. The resources used are constant and predictable across the patients within each APG. This system is an encounter-based system because it looks at only one of the patient&#39;s encounters with the health care system. This system mainly analyzes outpatient hospital visits and does not address inpatient services.  
           [0020]    The GMIS system uses a bucketing procedure that profiles by clumps of diagnosis codes including 460 diagnostic episode clusters (DECs). The database is client specific and contains a flexible number and type of analytic data files. This system is episode-based, but it does not account for recurrent episodes, so a patient&#39;s complete data history within a one-year period is analyzed as one pseudo-episode. Signs and symptoms do not cluster to the actual disease state, e.g. abdominal pain and appendicitis are grouped in different clusters. This system does not use CPT-4 codes and does not shift the DEC to account for acuity changes during the treatment of a patient.  
           [0021]    Value Health Sciences offers a value profiling system, under the trademark VALUE PROFILER, which utilizes a DB2 mainframe relational database with 1,800 groups. The system uses ICD9 and CPT-4 codes, which are bucket codes. Based on quality and cost-effectiveness of care, the system evaluates all claims data to produce case-mix-adjusted profiles of networks, specialties, providers arid episodes of illness. The pseudo-episode building methodology contains clinically pre-defined time periods during which claims for a patient are associated with a particular condition and designated provider. The automated practice review system analyzes health care claims to identify and correct aberrant claims in a pre-payment mode (Value Coder) and to profile practice patterns in a post-payment mode (Value Profiler). This system does not link signs and symptoms and the diagnoses are non-comprehensive because the profiling is based on the exclusion of services. No apparent shifting of episodes occurs and the episodes can only exist for a preset time because the windows are not recurrent.  
           [0022]    The medical claim profiling programs described in foregoing patents and non-patent literature demonstrate that, while conventional computer-implemented health care systems exist, they each suffer from the principal disadvantage of not identifying and grouping medical claims on an episodic basis or shifting episodic groupings based upon complications or co-morbidities. The present computer-implemented health care system contains important improvements and advances upon conventional health care systems by identifying concurrent and recurrent episodes, flagging records, creating new groupings, shifting groupings for changed clinical conditions, selecting the most recent claims, resetting windows, making a determination if the provider is an independent lab and continuing to collect information until an absence of treatment is detected.  
         SUMMARY OF THE INVENTION  
         [0023]    Accordingly, it is a broad aspect of the present invention to provide a computer-implemented medical claims profiling system.  
           [0024]    It is a further object of the present invention to provide a medical claims profiling system that allows an objective means for measuring and quantifying health care services.  
           [0025]    It is a further object of the present invention to provide a medical claims profiling system that includes a patient classification system based upon episode treatment groups.  
           [0026]    It is a further object of the present invention to provide a medical claims profiling system that groups claims to clinically homogeneous and statistically stable episode treatment groups.  
           [0027]    It is a further object of the present invention to provide a medical claims profiling system that includes claims grouping utilizing service or segment-level claim data as input data.  
           [0028]    It is a further object of the present invention to provide a medical claims profiling system that assigns each claim to an appropriate episode.  
           [0029]    It is a further object of the present invention to provide a medical claims profiling system that identifies concurrent and recurrent episodes.  
           [0030]    It is a further object of the present invention to provide a medical claims profiling system that shifts groupings for changed clinical conditions.  
           [0031]    It is a further object of the present invention to provide a medical claims profiling system that employs a decisional tree to assign claims to the most relevant episode treatment group.  
           [0032]    It is a further object of the present invention to provide a medical claims profiling system that resets windows of time based upon complications, co-morbidities or increased severity of clinical conditions.  
           [0033]    It is a further object of the present invention to provide a health care system that continues to collect claim information and assign claim information to an episode treatment group until an absence of treatment is detected.  
           [0034]    It is a further object of the present invention to provide a health care system that creates orphan records.  
           [0035]    It is a further object of the present invention to provide a health care system that creates phantom records.  
           [0036]    The foregoing objectives are met by the present system that allows an objective means for measuring and quantifying health care services based upon episode treatment groups (ETGs). An episode treatment group (ETG) is a clinically homogenous and statistically stable group of similar illness etiology and therapeutic treatment. ETG grouper method uses service or segment-level claim data as input data and assigns each service to the appropriate episode.  
           [0037]    ETGs gather all in-patient, ambulatory and ancillary claims into mutually exclusive treatment episodes, regardless of treatment duration, then use clinical algorithms to identify both concurrent and recurrent episodes. ETG grouper method continues to collect information until an absence of treatment is detected for a predetermined period of time commensurate with the episode. For example, a bronchitis episode will have a sixty-day window, while a myocardial infarction may have a one-year window. Subsequent records of the same nature within the window reset the window for an additional period of time until the patient is asymptomatic for the pre-determined time period.  
           [0038]    ETGs can identify a change in the patient&#39;s condition and shift the patient&#39;s episode from the initially defined ETG to the ETG that includes the change in condition. ETGs identify all providers treating a single illness episode, allowing the user to uncover specific treatment patterns. After adjusting for case-mix, ETGs measure and compare the financial and clinical performance of individual providers or entire networks.  
           [0039]    Medical claim data is input as data records by data entry into a computer storage device, such as a hard disk drive. The inventive medical claims profiling system may reside in any of a number of computer system architectures, i.e., it may be run from a stand-alone computer or exist in a client-server system, for example a local area network (LAN) or wide area network (WAN).  
           [0040]    Once relevant medical claim data is input, claims data is processed by loading the computer program into the computer system memory. During set-up of the program onto the computer system, the computer program will have previously set pointers to the physical location of the data files and look-up tables written to the computer storage device. Upon initialization of the inventive computer program, the user is prompted to enter an identifier for a first patient. The program then checks for open episodes for the identified patient, sets flags to identify the open episodes and closes any episodes based upon a predetermined time duration from date of episode to current date. After all open episodes for a patient are identified, the new claims data records are read to memory and validated for type of provider, CPT code and ICD-9 (dx) code, then identified as a management, surgery, facility, ancillary, drug or other record.  
           [0041]    As used herein, “Management records” are defined as claims that represent a service by a provider engaging in the direct evaluation, management or treatment or a patient. Examples of management records include office visits and therapeutic services. Management records serve as anchor records because they represent focal points in the patient treatment as well as for related ancillary services.  
           [0042]    “Ancillary records” are claims which represent services which are incidental to the direct evaluation, management and treatment of the patient. Examples of ancillary records include X-ray and laboratory tests.  
           [0043]    “Surgery records” are specific surgical claims. Surgery records also serve as anchor records.  
           [0044]    “Facility records” are claims for medical care facility usage. Examples of facility records include hospital room charges or outpatient surgical room charges.  
           [0045]    “Drug records” are specific for pharmaceutical prescription claims.  
           [0046]    “Other records” are those medical claim records which are not management, surgery, ancillary, facility or drug records.  
           [0047]    Invalid records are flagged and logged to an error output file for the user. Valid records are then processed by an ETG Assignor Sub-routine and, based upon diagnosis code, is either matched to existing open episodes for the patient or serve to create new episodes.  
           [0048]    Management and surgery records serve as “anchor records.” An “anchor record” is a record which originates a diagnosis or a definitive treatment for a given medical condition. Management and surgery records serve as base reference records for facility, ancillary and drug claim records relating to the diagnosis or treatment which is the subject of the management or surgery record. Only management and surgery records can serve to start a given episode.  
           [0049]    If the record is a management record or a surgery record, the diagnosis code in the claim record is compared with prior related open episodes in an existing look-up table for a possible ETG match. If more than one open episode exists, the program selects the most recent open episode. A positive match signifies that the current episode is related to an existing open episode. After the match is determined, the time window is reset for an additional period of time corresponding to the episode. A loop shifts the originally assigned ETG based on the additional or subsequent diagnoses. If any of the additional or subsequent diagnoses is a defined co-morbidity diagnosis, the patient&#39;s co-morbidity file updated. If no match between the first diagnosis code and an open episode is found, a new episode is created.  
           [0050]    Grouping prescription drug records requires two tables, a NDC (National Drug Code) by GDC (Generic Drug Code) table and a GDC by ETG table. Because the NDC table has approximately 200,000 entries, it has been found impracticable to directly construct an NDC by ETG table. For this reason the NDC by GDC table serves as a translation table to translate NDCs to GDCs and construct a smaller table based upon GDCs. Reading, then from these tables, the NDC code in the claim data record is read and translated to a GDC code. The program then identifies all valid ETGs for the GDC codes in the claim data record then matches those valid ETGs with active episodes.  
           [0051]    These and other objects, features and advantages of the present invention will become more apparent to those skilled in the art from the following more detailed description of the non-limiting preferred embodiment of the invention taken with reference to the accompanying Figures. 
       
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0052]    Briefly summarized, a preferred embodiment of the invention is described in conjunction with the illustrative disclosure thereof in the accompanying drawings, in which:  
         [0053]    [0053]FIG. 1 is a diagrammatic representation of a computer system used with the computer-implemented method for analyzing medical claims data in accordance with the present invention.  
         [0054]    [0054]FIG. 2 is a flow diagram illustrating the general functional steps of the computer implemented method for analyzing medical claims data in accordance with the present invention.  
         [0055]    [0055]FIG. 3 is a flow diagram illustrating an Eligible Record Check routine which validates and sorts patient claim data records.  
         [0056]    [0056]FIGS. 4A to  4 F are flow diagrams illustrating the Management Record Grouping Sub-routine of the ETG Assignor Routine in accordance with the computer-implemented method of the present invention.  
         [0057]    FIGS.  5 A- 5 D are flow diagrams illustrating a Surgery Record Grouping Sub-routine of the ETG Assignor Routine in accordance with the computer-implemented method of the present invention.  
         [0058]    FIGS.  6 A- 6 E are flow diagrams illustrating a Facility Record Grouping Sub-routine of the ETG Assignor Routine in accordance with the computer-implemented method of the present invention.  
         [0059]    FIGS.  7 A-B are flow diagrams illustrating an Ancillary Record Grouping Sub-routine of the ETG Assignor Routine in accordance with the computer-implemented method of the present invention.  
         [0060]    FIGS.  8 A- 8 C are flow diagrams illustrating a Drug Record Grouping Sub-routine of the ETG Assignor Routine in accordance with the computer-implemented method of the present invention.  
         [0061]    [0061]FIG. 9 is a flow diagram illustrating the Episode Definer Routine in accordance with the computer-implemented method of the present invention.  
         [0062]    [0062]FIG. 10 is diagrammatic timeline illustrating a hypothetical patient diagnosis and medical claims history during a one year period and grouping of claim records as management records and ancillary records with cluster groupings.  
         [0063]    [0063]FIG. 11 is a diagrammatic representation of a I-9 Diagnosis Code (dx) X ETG table illustrating predetermined table values called by the Episode Definer Routine of the present invention.  
         [0064]    [0064]FIG. 12 is a diagrammatic representation of an I-9 Diagnosis Code 9 (dx) X CPT Code table illustrating predetermined table values called by the Episode Definer Routine of the present invention.  
         [0065]    [0065]FIG. 13 is a diagrammatic representation of a National Drug Code (NDC) to Generic Drug Code (GDC) conversion table illustrating predetermined Generic Drug Code values called by the Drug Record Grouping Sub-routine of the Episode Definer Routine of the present invention.  
         [0066]    [0066]FIG. 14 is a diagrammatic representation of a Generic Drug Code (GDC) to Episode Treatment Group (ETG) table illustrating predetermined table values called by the Drug Record Grouping Sub-routine of the Episode Definer Routine of the present invention. 
     
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT  
       [0067]    Referring particularly to the accompanying drawings, the basic structural elements of a health care management system of the present invention are shown. Health care management system consists generally of a computer system  10 . Computer system is capable of running a computer program  12  that incorporates the inventive method is shown in FIG. 1. The computer system  10  includes a central processing unit (CPU)  14  connected to a keyboard  16  which allows the user to input commands and data into the CPU  14 . It will be understood by those skilled in the art that CPU  14  includes a microprocessor, random access memory (RAM), video display controller boards and at least one storage means, such as a hard disk drive or CD-ROM. The computer system  10  also contains a video display  18  which displays video images to a person using the computer system  10 . The video display screen  18  is capable of displaying video output in the form of text or other video images.  
         [0068]    Episode Treatment Groups (ETGs) are used to define the basic analytical unit in the computer-implemented method of the present invention. ETGs are episode based and conceptually similar to Diagnostic Related Groups (DRGs), with a principal difference being that DRGs are inpatient only. ETGs encompass both inpatient and outpatient treatment.  
         [0069]    Using ETGs as the basic episodic definer permits the present invention to track concurrently and recurrently occurring illnesses and correctly identify and assign each service event to the appropriate episode. Additionally, ETGs account for changes in a patient&#39;s condition during a course of treatment by shifting from the initially defined ETG to one which includes the changed condition once the changed condition is identified.  
         [0070]    The inventive medical claims profiling system defines Episode Treatment Groups (ETGs). The number of ETGs may vary, depending upon the definitional specificity the health care management organization desires. Presently, the inventive system defines 558 ETGs, which are assigned ETG Numbers 1-900 distributed across the following medical areas: Infectious Diseases, Endocrinology, Hematology, Psychiatry, Chemical Dependency, Neurology, Ophthalmology, Cardiology, Otolaryngology, Pulmonology, Gastroenterology, Hepatology, Nephrology, Obstetrics, Gynecology, Dermatology, Orthopedics and Rheumatology, Neonatology, Preventative and Administrative and Signs and Isolated Signs, Symptoms and Non-Specific Diagnoses or Conditions. Under the presently existing system, ETG  900  is reserved to “Isolated Signs, Symptoms and Non-Specific Diagnoses or Conditions,” and is an ETG designation used where the diagnosis code is incapable of being assigned to another ETG. A listing of exemplary ETGs for typical episodes is found at Table 1, below. Those skilled in the art will understand, however, that the number of ETGs may change, the ETG numbering system is variable, the ETG classifications may be defined with relatively broader or narrower degrees of specificity and the range of medical specialties may be greater or fewer, as required may be require by the management organization in their medical claims data analysis protocols.  
         [0071]    An episode may be considered a low outlier or high outlier. Low outliers are episodes with dollar values below the minimum amount which is specific to each ETG. Examples of low outliers include patients which drop from a plan during mid-episode and patients who use out-of-network providers and do not submit claims. High outliers are those episodes with high dollar values greater than the 75th percentile plus 2.5 times the interquartile range, based upon a predefined database. The low and high outlier points are pre-determined and hard-coded into the inventive system and will vary across analysis periods.  
         [0072]    If no ICD-9 (diagnosis code) on a given record matches the CPT4 code, i.e., a diagnosis of bronchitis and a CPT of knee x-ray, an invalid code segment results. The inventive system outputs invalid records and discontinues the processing of these records. An invalid ICD-9 code is assigned to ETG  997 , an invalid CPT-4 code is assigned to ETG  996  and an invalid provider type is assigned to ETG  995 . A sequential anchor count and a sequential episode count are incremented after each ETG assignment. Active open and closed ETG files include ETG number, sequential episode number, most recent anchor from date of service and most recent sequential anchor record count. An alternative embodiment creates a single record for each individual episode containing ETG number, patient age, patient sex, episode number, total charges, total payments, earlier anchor record, last anchor record, whether the episode was closed (“clean finish”), number of days between database start date and earliest anchor record, whether a number of days between database start date and earliest anchor record exceeds the ETG&#39;s days interval, patient identification, physician identification, management charges, management paid, surgery charges, surgery paid, ancillary charges and ancillary paid.  
         [0073]    The inventive system uses clinical algorithms to identify both concurrent and recurrent episodes. Subsequent episodes of the same nature within a window reset the window for an additional period of time until the patient is asymptomatic for a pre-determined time period. If an ETG matches a prior ETG, a recurrent ETG is created and the window is reset. The most recent claim is selected if more than one matched claim exists. If the ETG does not match an active ETG, a new concurrent ETG is created.  
         [0074]    Comorbidities, complications or a defining surgery could require an update of the patient&#39;s condition to an ETG requiring a more aggressive treatment profile. ETG&#39;s changes in the patient&#39;s clinical condition and shift the patient&#39;s episode from the initially defined ETG to an ETG which includes the change in clinical condition.  
         [0075]    If the claim is an ancillary record and it does not match an active ETG it is designated an “orphan” ancillary record.  
         [0076]    Termination of an episode is detected by an absence of treatment for a period of time commensurate with the episode.  
         [0077]    If the claim is a prescription drug record, two pre-defined tables written to the computer data storage medium, are read. The first of the tables is a National Drug Code (NDC) by Generic Drug Code (GDC) table. The GDC code is equivalent to the Generic Drug Code table known in the art. This table acts as a translator table to translate a large number of NDCs to a smaller set of GCNs. A second pre-defined table is employed and is constructed as a GDC by ETG table. The GDC by ETG table is used, in conjunction with the NDC by GDC translator table, to identify all valid ETGs for a particular NDC code in the claim record.  
         [0078]    To determine specific treatment patterns and performance contributions, the computer-implemented method identifies all providers treating a single illness episode. If a network of providers contains Primary Care Physicians (PCP), the ETGs clearly identify each treatment episode by PCP. Financial and clinical performance of individual providers or entire networks may be monitored and analyzed. To monitor health care cost management abilities of providers, components of a provider&#39;s treatment plan may be analyzed by uncovering casemix-adjusted differences in direct patient management, the use of surgery and the prescribing of ancillary services. By identifying excessive utilization and cost areas, continuous quality improvement protocols are readily engineered based on internally or externally derived benchmarks. After adjusting for location and using geographically derived normative charge information, ETG-based analysis compares the cost performance of providers or entire networks. By using geographically derived utilization norms, the present invention forms the methodology base for measuring both prevalence and incidence rates among a given population by quantifying health care demand in one population and comparing it to external utilization norms. This comparison helps to identify health care providers who practice outside established utilization or cost norms.  
         [0079]    Turning now to FIG. 2, there is illustrated the general operation of the computer-implemented method of the present invention. Those skilled in the art will understand that the present invention is first read from a removable, transportable recordable medium, such as a floppy disk, magnetic tape or a CD-ROM onto a recordable, read-write medium, such as a hard disk drive, resident in the CPU  14 . Upon a user&#39;s entry of appropriate initialization commands entered via the keyboard  16 , or other input device, such as a mouse or trackball device, computer object code is read from the hard disk drive into the memory of the CPU  14  and the computer-implemented method is initiated. The computer-implemented method prompts the user by displaying appropriate prompts on display  18 , for data input by the user.  
         [0080]    Those familiar with medical claims information processing will understand that medical claims information is typically received by a management service organization on paper forms. If this is the case, a user first manually sorts claim records by patient, then input patient data through interfacing with the CPU  14  through the keyboard  16  or other input device.  
         [0081]    Prior to being submitted to the grouping algorithm, records must be sorted by patient by chronological date of service. An Eligible Record Check routine  48  to verify the validity and completeness of the input data. As each record is read by the software, it first checks the date of service on the record and compares it to the last service date of all active episodes to evaluate which episodes have expired in terms of an absence of treatment. These episodes are closed at step  50 . Next the record is identified as either a management  52 , surgery  54 , facility  56 , ancillary  58  or drug  60  record. These types of records are categorized as follows:  
         [0082]    “Management records” are defined as claims which represent a service by a provider engaging in the direct evaluation, management or treatment or a patient. Examples of management records include office visits, surgeries and therapeutic services. Management records serve as anchor records because they represent focal points in the patient treatment as well as for related ancillary services.  
         [0083]    “Ancillary records” are claims which represent services which are incidental to the direct evaluation, management and treatment of the patient. Examples of ancillary records include X-ray and laboratory tests.  
         [0084]    “Surgery records” represent surgical procedures performed by physicians and other like medical allied personnel. Like management records, surgery records also serve as anchor records.  
         [0085]    “Facility records” are claims for medical care facility usage. Examples of facility records include hospital room charges or ambulatory surgery room charges.  
         [0086]    “Drug records” are specific for pharmaceutical prescription claims.  
         [0087]    A “cluster” is a grouping of one, and only one, anchor record, management or surgery, and possibly ancillary, facility and/or drug records. A cluster represents a group of services in which the focal point, and therefore the responsible medical personnel, is the anchor record. An episode is made up of one or more clusters.  
         [0088]    After the management, surgery, facility, ancillary and drug records are identified at steps  52 ,  54 ,  56 ,  58  and  60 , respectively, an ETG Assignor Sub-routine is executed at step  62 . The ETG Assignor Sub-routine  62  assigns patient medical claims to ETGs based one or more cluster of services related to the same episode, and provides for ETG shifting upon encountering a diagnosis code or CPT code which alters the relationship between the diagnosis or treatment coded in the claim record and an existing ETG assignment. For example, ETG&#39;s may be shifted to account for changes in clinical severity, for a more aggressive ETG treatment profile if a complication or comorbidity is encountered during the course of treatment for a given ETG or where a defining surgery is encountered during the course of treatment for a given ETG.  
         [0089]    When the last claim data record for a given patient is processed by the ETG Assignor Routine  62 , the Episode Definer Routine is executed at step  64 . Episode Definer Routine  64  identifies all open and closed ETG episodes for the patient and appropriately shifts any episodes to a different ETG if such ETG is defined by age and/or the presence or absence of a co-morbidity. The patient records are then output to a file with each record containing the ETG number, a sequential episode number, and a sequential cluster number. Upon input of an identifier for the next patient, the processing of medical claims for the next patient is initiated at step  66  by looping back to check for eligible records for the new patient at step  48 .  
         [0090]    Operation of the Eligible Record Check routine  100  is illustrated in FIG. 3. The patient records input by the user are read from the recordable read-write data storage medium into the CPU  14  memory in step  102 . From the patient records read to memory in step  102 , a record validation step  104  is carried out to check provider type, treatment code and diagnosis code against pre-determined CPT code and diagnosis code look up tables. The diagnosis code is preferably the industry standard ICD- 9  code and the treatment code is preferably the industry standard CPT-4 code. All valid patient records are assigned as one of a) management record, b) ancillary record, c) surgery record, d) facility record, e) drug record or f) other record, and coded as follows:  
         [0091]    m=management record;  
         [0092]    a=ancillary record;  
         [0093]    s=surgery record;  
         [0094]    f=facility record;  
         [0095]    d=drug record; or  
         [0096]    o=other record.  
         [0097]    A sort of valid records  106  and invalid records  108  from step  104  is made. For valid records  106  in step  110 , patient age is then read to memory from the first patient record from step  106 . All valid records are then sorted by record type in step  112 , i.e., record type m, a, s, f, d or o by a date of service from date (DOS-from). A sort index of all record-type sorted records from step  116  is generated arid written to the hard disk, and the ETG Assignor routine  120  is initialized.  
         [0098]    For invalid records  108  identified at step  104 , the records are assigned ETG designations reserved for records having invalid provider data, invalid treatment code, or invalid diagnosis code, e.g., ETG  995 ,  996  and  997 , respectively, at step  111 . An error log file is output identifying the invalid records by reserved ETG and written to disk or displayed for the user and processing of the invalid records terminates at step  113 .  
         [0099]    The computer-implemented method of the present invention then initializes an Episode Assignor Routine  200 , the operation of which is illustrated in FIGS.  4 A- 8 C. Episode Assignor Routine  200  consists generally of five Sub-routine modules for processing management records, surgery records, facility records, ancillary records and drug records and assigning claims to proper ETGs. FIGS.  4 A- 4 F illustrate initial identification of records as management, surgery, facility ancillary and drug records and the Management Record Grouping Sub-Routine. FIGS.  5 A- 5 E illustrate operation of the Surgery Record Grouping routine  400  for matching surgery claim records to proper ETGs. FIGS.  6 A- 6 E illustrate operation of the Facility Record Grouping routine  500  for matching facilities records to proper ETGs. FIGS.  7 A- 7  illustrate operation of the Ancillary Record Grouping routine  600  for matching ancillary records to proper ETGs. Finally, FIGS.  8 A- 8 C illustrate operation of the Drug Records Grouping routine  700  for matching drug records to proper ETGs.  
         [0100]    Management Records  
         [0101]    The Episode Assignor routine begins by executing a Management Records Grouping Sub-routine  200 , illustrated in FIGS.  4 A- 4 F, first reads the input claim record for a given patient in step  202 . The first processing of the input claim record entails categorizing the record as a management, surgery, facility, ancillary or drug record at step  204 . A series of logical operands  208 ,  210 ,  212  and  214 , read the record and determine whether the record is a management record at step  204 , a surgery record at step  208 , a facility record at step  210 , an ancillary record at step  212  or a drug record at step  214 . If an affirmative response is returned in response to logical operand  204 , grouping of the management record to an ETG is initialized and processing of the management record proceeds to step  215 . If, however, a negative response is returned in response to the logical operand  206 , logical operand  208  is executed to determine whether the record is a surgery record. If an affirmative response is returned from logical operand  208 , the Surgery Record Grouping routine  400  is initialized. If, however, a negative response to logical operand  208  is returned, logical operand  210  is executed to determine whether the record is a facility record. If an affirmative response is returned in response to logical operand  210 , the Facility Record Grouping Sub-routine  500  is executed. If, however, a negative response is returned in response to the logical operand  210 , logical operand  212  is executed to determine whether the record is an ancillary record. If an affirmative response is returned from logical operand  212 , the Ancillary Record Grouping Sub-routine  600  is executed. If, however, a negative response to logical operand  212  is returned, logical operand  214  is executed to determine whether the record is a facility record. At this point all records except drug records have been selected. Thus, all the remaining records are drug records and the Drug Record Grouping Sub-routine  700  is executed.  
         [0102]    Returning now to the initialization of the Management Record Grouping routine  200 , and in particular to step  215 . Once the record has been categorized as a management record in step  206 , the DOS-to value is compared to active episodes for the patient to determine if any active episodes should be closed. Closed episodes are moved to an archive created on the storage means, such as a hard disk or CD-ROM.  
         [0103]    The management record is examined and the first diagnosis code on record is read, a diagnosis code (dx) by ETG table  201  is read from the storage means and all valid ETGs for the first diagnosis code on record are identified at step  216 . The dx by ETG table  201  consists of a table matrix having diagnosis codes on a first table axis and ETG numbers on a second table axis. At intersection cells of the dx by ETG table are provided table values which serve as operational flags for the inventive method. In accordance with the preferred embodiment of the invention, dx by ETG table values are assigned as follows:  
         [0104]    P=primary, with only one P value existing per ETG;  
         [0105]    S=shift;  
         [0106]    I=incidental;  
         [0107]    A=shift to ETG with C value; and  
         [0108]    C=P, where P′ is a shiftable primary value.  
         [0109]    An illustrative example of a section of a dx by ETG table is found at FIG. 11.  
         [0110]    ETG validation in step  216  occurs where for a given diagnosis code on record, the code has either a P, S, I, A or C dx-ETG table value. The ETGs identified as valid for the first diagnosis code on record in step  216 , are then matched with active open ETGs in step  217  by comparing the valid ETGs with the open ETGs identified in step  215 . A logical operand is then executed at step  218  to determine whether a match exists between the valid ETG from the management record and any open ETGs. A negative response at step  218  causes execution of another logical operand at step  220  to determine whether for the first diagnosis code is the P value in the dx-ETG table equal to the ETG for non-specific diagnosis, i.e., ETG  900 . If an affirmative response is returned at step  216 , ETG identifiers for the second to the fourth diagnosis codes in the management record are established from the dx-ETG table and the ETG identifier value is matched to active specific ETGs in step  222  and execution of the program continues as represented by designator AA  236  bridging to FIG. 5B. If, however, a negative response is returned from logical operand  220 , a value of one is added to the management record or anchor count and to the episode count and the ETG with a P value on the dx-ETG table is selected and a new episode is initialized. Further processing of the new episode by the program continues as represented by designator F  236  bridging to FIG. 5C.  
         [0111]    If an affirmative response is returned at logical operand step  218 , the matched active ETG with the most recent DOS-to are selected at step  230 . If a tie is found based upon most recent DOS-to values, then the most recent DOS-from value is selected for matching with active ETGs. If a tie is found at most recent DOS-from values is found, the first encountered ETG is selected and matched. A value of one is then added to the management record or anchor record counter at step  232  and further processing continues as represented by designator G  238  bridging to FIG. 5C.  
         [0112]    Turning now to FIG. 4B, which is a continuation from designator AA  236  of FIG. 4A, identifier ETGs for the second to fourth diagnoses in the management record are matched to active ETGs in logical operand  237 . If an affirmative response is returned in response to logical operand  237 , the matched active ETG with the most recent DOS-to is selected in step  240 . If there is a tie between two or more ETGs with the most recent DOS-to value, the most recent DOS-from ETG is selected. If, however, there is a tie between two or more active ETGs with the most recent DOS-from value, then the first encountered ETG is selected in step  240 . A value of  5  one is then added to the sequential anchor record counter in step  241  and operation of the computer-implemented method continues as indicated by designator G  243  bridging to FIG. 5C.  
         [0113]    From logical step  237 , if a negative response is returned, the ETG with the second diagnosis value of P is selected at step  242 , then a logical query is made to determine whether the selected ETG is a non-specific ETG, i.e., ETG  900  at step  244 . A negative response to logical query  244  causes a value of one to be added to the sequential anchor count and to the sequential episode count at step  254 . If an affirmative response to logical query  244  is returned, logical queries  246  and  248  are sequentially executed to select ETGs with the third and fourth diagnosis values of P from the dx-ETG table written on the storage means, respectively, and logical query  244  is executed to determine whether the selected ETG is the non-specific ETG, i.e., ETG  900 .  
         [0114]    If a negative response is returned to logical query  244  for the ETG selected in step  248 , a value of one is added to the sequential anchor count and to the sequential episode count in step  254 . If an affirmative response is returned from logical query  244 , a value of one is added to the sequential anchor count and the sequential episode count at step  250 .  
         [0115]    From step  250 , the non-specific ETG, i.e., ETG  900  is selected and a new episode is started in the active ETG file. The updated sequential episode number, the updated sequential anchor count, the DOS-from and the DOS-to from the record are written to the new episode in the active ETG file in step  252 .  
         [0116]    From step  254 , the ETG with a dx-ETG table value of P is selected and a new episode is started in the active ETG file. The updated sequential episode number, the updated sequential anchor count, the DOS-from and the DOS-to from the record are written to the new episode in the active ETG file in step  256 . A comorbidity file written on the storage means is then updated with all the dx codes in the management record in step  258 .  
         [0117]    From each of steps  252  and steps  258  a check is made to determine whether the processed management record is the last record for the patient at logical step  260 . An affirmative response returned to logical step  260  prompts the program operation to the Episode Definer Sub-routine  264 , bridging to FIG. 9 with identifier GG, while a negative response to logical step  260  returns program operation to the beginning of the ETG Assignor routine  200  and the next patient record is read at step  262 .  
         [0118]    Turning now to FIG. 4C, the bridge reference G  238  is continued from FIG. 4A. For those records having a match with an open ETG, a query is made at step  270  of the dx-ETG table  201  to determine the table value of the dx code for the selected ETG. Again, valid table values are one of P, S, I, A, or C. If the table value returned from step  270  is A, the selected ETG in the active file is changed at step  272  to the ETG number having an equivalent table value of C for the diagnosis on record. If the table value returned from step  270  is S, the selected ETG in the active file is shifted at step  274  to an ETG value having a table value of P for the diagnosis code on record. If the table value is one of P, I or C, the ETG remains the same and the selected active ETG&#39;s most recent DOS-to is updated by writing the record date to the ETG DOS-to field, and the sequential anchor count in the selected active ETG is updated to reflect writing of the record to the ETG at step  276   
         [0119]    At step  278 , the record is then written with a sequential episode number and the sequential anchor court of the selected ETG from the selected active ETG. In this manner, the record is identified with the ETG and the specific episode. The patient&#39;s co-morbidity file is flagged with the output read from bridge designator F at step  234 . A patient&#39;s comorbidity file is a predefined list of diagnoses which have been identified as comorbidities. If during the course of grouping a patient&#39;s records, a management record is encountered which is a comorbidity diagnosis, the ETG for that diagnosis is flagged or “turned on” in the comorbidity file. Then, during the execution of the Episode Definer Routine, all the patient&#39;s episodes with an ETG which can shift based on the presence of a comorbidity and which are “turned on” are appropriately shifted to the ETG “with comorbidity”.  
         [0120]    A loop beginning at step  282  is then executed to determine whether the ETG assigned by the first diagnosis code should be shifted to another ETG based upon the second, third and fourth diagnoses on record. At step  282 , the second diagnosis is read from the patient&#39;s claim record and all valid ETGs for tie second diagnosis are read from the dx-ETG table  20   1 . A logical operand  284  is executed to determine whether one of the valid ETGs for the second diagnosis matches the primary diagnosis ETG. If a negative response is returned to logical operand  284 , a loop back at step  285  is executed to step  282  for the next sequential diagnosis code on record, i.e., the third and forth diagnosis codes on record. If an affirmative response is returned to the logical operand  284 , the a logical operand  286  queries the table value of the matched ETG to determine if a value of A is returned from the dx-ETG table. If a negative response is returned, the loop back step  285  is initialized. If an affirmative response is returned, the first dx ETG is flagged for change to a second dx ETG having an equivalent table value of C for the second diagnosis code on record at step  288  and all valid ETGs for the current diagnosis code on record are identified at step  290  from the dx-ETG table. The identified C-value ETG is then matched with any open active ETGs at step  292 . Program operation then continues at bridge H  292  to FIG. 4D.  
         [0121]    At FIG. 4D the continued operation of the Management Grouping Sub-routine from bridge H  292  of FIG. 4C. Logical operand  296  queries the open active ETGs to determine whether a valid match with the identified C-value ETG exists. If a negative response is returned to logical operand  296 , a value of 1 is added to the sequential episode count at step  297  and a new episode having a P value ETG is started in the patient&#39;s master active ETG file at step  299 . The new episode is written with a sequential episode number, DOS-from and DOS-to values and forms a phantom management record. A phantom record is an anchor record, management or surgery, with more than one diagnosis, which is assigned to one episode and its corresponding ETG based on one diagnosis, but can start a new episode(s) or update the most recent date of another active episode(s) based on other diagnoses on the record.  
         [0122]    If an affirmative response is returned from logical operand  296 , the matched active ETG with the most recent DOS-to value is selected at step  298 . If a tie is found based upon most recent DOS-to values, then the most recent DOS-from value is selected for matching with active ETGs. If a tie is found at most recent DOS-from values is found, the first encountered ETG is selected and matched. The selected ETG&#39;s most recent DOS-to and sequential anchor count are updated in the patient&#39;s master active ETG file in step  300 .  
         [0123]    For either the new episode created at step  299  or the updated ETG from step  300 , the patient&#39;s co-morbidity file is then updated with the second diagnosis code on-record at step  302 . Processing then continues to identify all valid ETGs for a third diagnosis code on record at step  304  and the identified valid ETGs from step  304  are compared to the active ETGs in the patient&#39;s master active ETG file in step  306 .  
         [0124]    Bridge 1  308  continues to FIG. 4E, and a logical operand  310  is executed to query the patient&#39;s master active ETG file to determine whether a match exists between the valid ETGs identified in step  304  with any active ETG from the patients master active ETG file. If a negative response is returned to logical operand  310 , a value of 1 is added to the sequential episode count at step  311  and a new episode having a P value ETG is started in the patient&#39;s master active ETG file at step  313 . The new episode is written with a sequential episode number, DOS-from and DOS-to values and forms a phantom management record.  
         [0125]    If an affirmative response is returned from logical operand  310 , the matched active ETG with the most recent DOS-to value is selected at step  312 . Again a decisional hierarchy is executed. If a tie is found based upon most recent DOS-to values, then the most recent DOS-from value is selected for matching with active ETGs. If a tie is found at most recent DOS-from values is found, the first encountered ETG is selected and matched. The selected ETG&#39;s most recent DOS-to and sequential anchor count are updated in the patient&#39;s master active ETG file in step  314 .  
         [0126]    For either the new episode created at step  311  or the updated ETG from step  314 , the patient&#39;s co-morbidity file is then updated with the third diagnosis code on-record at step  316 . Processing then continues to identify all valid ETGs for a fourth diagnosis code on record at step  318  and the identified valid ETGs from step  3318  are compared to the active ETGs in the patient&#39;s master active ETG file in step  320 . Bridge reference 1  322 , bridges to FIG. 4F.  
         [0127]    Turning to FIG. 4F, a logical operand  324  is executed to query the patient&#39;s master active ETG file to determine whether a match exists between the valid ETGs identified in step  320  with any active ETG from the patients master active ETG file. If a negative response is returned to logical operand  324 , a value of 1 is added to the sequential episode count at step  325  and a new episode having a P value ETG is started in the patient&#39;s master active ETG file at step  337 . The new episode is written with a sequential episode number, DOS-from and DOS-to values and forms a phantom management record.  
         [0128]    If an affirmative response is returned from logical operand  324 , the matched active ETG with the most recent DOS-to value is selected at step  326 . Again a decisional hierarchy is executed. If a tie is found based upon most recent DOS-to values, then the most recent DOS-from value is selected for matching with active ETGs. If a tie is found at most recent DOS-from values is found, the first encountered ETG is selected and matched. The selected ETG&#39;s most recent DOS-to and sequential anchor count are updated in the patient&#39;s master active ETG file in step  328 .  
         [0129]    For either the new episode created at step  337  or the updated ETG from step  324 , the patient&#39;s co-morbidity file is then updated with the fourth diagnosis code on-record at step  330 . A check is then made to determine whether the processed record is the last record for the patient by execution of logical operand  332  and reading the input claim records from the storage means. If logical operand  332  returns an affirmative value, the ETG Definer Sub-routine is called at step  334 , as represented by bridge reference GG. If, however, a negative response is returned to logical operand  332 , program execution returns to the step  204  of the Episode Assignor routine  200  and the next patient claim record is read from the storage means.  
         [0130]    Surgery Records  
         [0131]    Grouping of Surgery Records to ETGs is governed by the Surgery Record Grouping Sub-routine  400 , the operation of which is illustrated in FIGS.  5 A- 5 D.  
         [0132]    For those patient claim records identified as Surgery Records at step  208 , the DOS-from value on-record is compared with the DOS-to value read from the patient master active ETG file at step  402 . This identifies and flags those active ETGs which are to be closed, the flagged ETGs are then moved to the patient master closed ETG file. The first diagnosis code on-record is then read and compared to the dx-ETG table  201  to identify all possible valid ETGs for the first diagnosis code on-record in step  404 .  
         [0133]    Surgery records are coded with treatment codes (CPT codes). Each surgery record has a single CPT code value. The CPT code on-record is then read, and compared to a CPT by ETG table  401  previously written to the storage means. The CPT-ETG table will have pre-determined table values. For example, in accordance with the preferred embodiment of the invention, the CPT-ETG table  401  has table values of R, W and X, where R is a value shiftable to W and X is a validator value. All valid ETGs for the on-record CPT code are identified by this comparison at step  406 . A logical operand  408  is then executed to determine whether there is a match of valid ETGs returned from the dx-ETG table  201  and the CPT-ETG table  401 . If an affirmative response is returned to logical operand  408 , a second logical operand  410  is executed to determine whether a match of valid specific ETGs exists. Again, if an affirmative response is returned from second logical operand  410 , the valid specific ETGs matched in step  410  are then compared at step  414  with the open active ETGs for the patient read from the patient&#39;s master active ETG file at step  412 . If an affirmative response is returned from step  414 , the matched ETG with the most recent DOS-to is selected at step  416  and a value of  1  is added to the sequential anchor count in the selected ETG at step  418 . In step  416 , if a tie is found based upon most recent DOS-to values, then a decisional hierarchy is followed to select the most recent DOS-from value for matching with active ETGs. If a tie is found at most recent DOS-from a values is found, the first encountered ETG is selected and matched. If a negative response is returned to any of logical operands  408 ,  410  or  414 , second, third and fourth dx codes on-record are read and all possible valid ETGs are read in step  411  from the dx-ETG table  201 . Further processing of the valid ETGs output from step  411  is continued at FIG. 5B identified by bridge reference P,  413 .  
         [0134]    Turning to FIG. 5B, a logical operand  415  compares the valid ETGs for the second, third and fourth dx codes with the valid ETGs for the CPT code on-record in step  411 . If a negative response is returned from logical operand  415 , the patient claim record is assigned to an ETG reserved for match errors between dx code and CPT code, e.g., ETG  998 , and further processing of the match error ETG bridges at reference R,  431 , to FIG. 5D.  
         [0135]    If an affirmative response is returned from logical operand  415 , the matched ETGs are compared with active ETGs read from the patient master active ETG file at step  417  and logical operand  419  is executed at step  419  to determine whether any valid matches between matched ETGs and active ETGs. If a negative response is returned to logical operand  419 , a value of 1 is added to the sequential anchor count and to the sequential episode count at step  425  and a new episode is started at step  437  with the first dx code on-record having a P value for a specific ETG in the dx-ETG table  201 . If no specific ETG has a P value, a non-specific ETG having a P value for the dx code on record is used to start the new episode. The new episode is started by writing the sequential episode number, the sequential anchor count, the DOS-from and the DOS-to values on the record.  
         [0136]    If an affirmative response is returned from logical operand  419 , the matched specific ETG with the most recent DOS-to is selected at step  421 . If a tie is found based upon most recent DOS-to values, then the most recent DOS-from value is selected for matching with active ETGs. If a tie is found at most recent DOS-from values is found, the first encountered ETG is selected and matched. A value of 1 is added to the sequential anchor count at step  423 . Processing the new episode started at step  427  or of the selected matched specific ETG at step  421  continues to bridge Q,  420 , continued at FIG. 5C.  
         [0137]    Turning to FIG. 5C, bridged from reference Q,  420 , logical operand  422  is executed which reads the CPT-ETG table  401  and determines the table value of the selected ETG from step  421  and step  427  based on the CPT value on-record. If a table value of R is returned from the read of the CPT-ETG table  401  at step  422 , the matched ETG in the master active ETG file is shifted at step  424  to the ETG with an equivalent value of W for the CPT code on-record. If a table value of X or W is returned from step  422  or from step  242 , the dx-ETG table  201  is read at step  426  and the dx code for the selected matched ETG from the CPT-ETG table  401  or the shifted ETG from step  424  is read. From the dx-ETG table  201 , if a value of S is returned, the matched ETG in the patient master active ETG file is shifted at step  428  to the ETG with a table value of P for the dx code on-record. If a table value of A is returned, the matched ETG in the patient master active ETG file is changed in step  430  to an equivalent value of C for the dx code on-record. If a table value of P, I or C is returned either from logical operand  426 , or from the ETG change step  428  or the ETG shift step  430 , the DOS-to and the sequential anchor count of the ETG in the patient master active ETG file are updated in step  432 . The patient claim record is then assigned and written with the sequential episode number and the sequential anchor count of the selected ETG at step  434 . The patient co-morbidity file is then updated with all diagnosis codes on-record at step  436 .  
         [0138]    [0138]FIG. 5D bridges from FIG. 5C with bridge reference BB,  438 . In FIG. 5D, the diagnosis codes on-record which were not used in the ETG selection described above, are then read from the patient claim record to identify all possible valid ETGs in the dx-ETG table  201 .  
         [0139]    The identified possible valid ETGs are then matched against the patient master active ETG file in step  442  and logical operand  444  is executed to validate the matches. If an affirmative response is returned to logical operand  444 , for each matched dx code on-record, the matched active ETG with the most recent DOS-to is selected at step  446 . If a tie is found based upon most recent DOS-to values, then the most recent DOS-from value is selected for matching with active ETGs. If a tie is found at most recent DOS-from values is found, the first encountered ETG is selected and matched. The selected ETG&#39;s most recent DOS-to value is updated to the date of the patient medical claim, and the sequential anchor count in the active ETG is updated in step  448 .  
         [0140]    If a negative response is returned to logical operand  444 , a value of 1 is added to sequential episode count at step  456  and a new episode having a P value ETG is started in the patient&#39;s master active ETG file at step  458 . The new episode is written with a sequential episode number, DOS-from and DOS-to values and forms a phantom surgery record. If an affirmative response is returned to logical operand  444 , the matched active ETG for each diagnosis code is selected at step  446  on the basis of the most recent DOS-to value. If a tie is found based upon most recent DOS-to values, then the most recent DOS-from value is selected for matching with active ETGs. If a tie is found at most recent DOS-from values is found, the first encountered ETG is selected and matched. The DOS-to field of the selected ETG from step  446  is updated in step  448  to the date of service on-record and the sequential anchor count in the active ETG file is updated. From either step  458  or from step  448 , the patient co-morbidity file is updated to reference the selected ETG and a check is made to determine whether the patient claim record processed in step  429 , which assigned an invalid dx-CPT code match to the record, or from step  450 , which updated the co-morbidity file, is the last record for the patient at logical operand  462 . If an affirmative response is returned to logical operand  462 , record processing proceeds to the Episode Definer Sub-routine at step  464 , bridged by reference GG, to FIG. 9. If, however, a negative response is returned to logical operand  462 , a loop back  468  to the beginning of the ETG Assigner routine  200  is executed and the next patient claim record is read.  
         [0141]    Facility Records  
         [0142]    The Facility Record Grouping Sub-routine  500  assigns facility records to ETGs on the basis of diagnosis codes on-record. The patient claim record is read and the first diagnosis code on-record is read to the dx-ETG table  201  to identify all valid ETGs for the first dx code at step  502 . The identified valid ETGs are then compared to the open active ETGs in the patient master active ETG file in step  504 . Logical operand  506  executes to determine whether any valid matches exist between identified ETGs for the dx code and the active ETGs for the patient. If a negative response is returned to step  506 , a value of  1  is added to the sequential episode count at step  507  and a new episode is started in step  509  in the patient active ETG file with the ETG -corresponding to the dx-ETG table value of P. If logical operand  507  returns an affirmative response, a query of the matched ETG value is made at step  508  to determine whether the matched ETG has a table value of P, C, A or S. If a negative response is returned to step  508 , the matched active ETG with the most recent DOS-from value is selected at step  511 . If a tie is found based upon most recent DOS-to values, then the most recent DOS-from value is selected for matching with active ETGs. If a tie is found at most recent DOS-from values is found, the first encountered ETG is selected and matched. If an affirmative response is returned at step  508 , the table value of the matched ETG table value is identified at step  510 . If the table value for the matched ETG in the dx-ETG table  201  is S, the matched ETG is shifted at step  514  to the ETG having a table value of P for the dx code. If the table value for the matched ETG returns a value of A, the matched ETG in the patient master active ETG file is changed at step  512  to an ETG having an equivalent table value of C for the dx code. If a table value of either P or C is returned at step  510 , the most recent DOS-to is updated at step  516  in the ETG to the on-record claim date. Further processing of the claim record from steps  509 ,  511  and  516  bridges at reference 1,  520 , to FIG. 6B.  
         [0143]    Turning to FIG. 6B, bridged from reference 1,  520 , in FIG. 6A, the patient&#39;s co-morbidity file is updated with the first dx code at step  522 . A loop beginning at step  524  is then executed to determine whether the ETG assigned by the first diagnosis code should be shifted to another ETG based upon the second, third and fourth diagnoses on record. At step  524 , the second diagnosis is read from the patient&#39;s claim record and all valid ETGs for the second diagnosis are read from the dx-ETG table  201 . A logical operand  526  is executed to determine whether one of the valid ETGs for the second diagnosis matches the primary diagnosis ETG. If a negative response is returned to logical operand  526 , a loop back at step  527  is executed to step  524  for the next sequential diagnosis code on record, i.e., the third and forth diagnosis codes on record. If an affirmative response is returned to the logical operand  524 , the logical operand  528  queries the table value of the matched ETG to determine if a value of A is returned from the dx-ETG table. If a negative response is returned, the loop back step  527  is initialized. If an affirmative response is returned, the first dx ETG is flagged for change to a second dx ETG having an equivalent table value of C for the second diagnosis code on record at step  530 . All valid ETGs for the second diagnosis code on record are identified at step  532  from the dx-ETG table. The identified ETGs are then matched with any open active ETGs at step  532 . Program operation then continues at bridge 2,  536  to FIG. 6C.  
         [0144]    At FIG. 6C the continued operation of the Facility Record Grouping Sub-routine  500  from bridge 2 of FIG. 6 b  is illustrated. Logical operand  538  queries the open active ETGs to determine whether a valid match with the identified ETGs exists. If a negative response is returned to logical operand  538 , the patient co-morbidity file is updated with the second diagnosis code at step  544 . If an affirmative response is returned from logical operand  538 , the matched active ETG with the most recent DOS-to value is selected at step  540 . If a tie is found based upon most recent DOS-to values, then the most recent DOS-from value is selected for matching with active ETGs. If a tie is found at most recent DOS-from values is found, the first encountered ETG is selected and matched. The selected ETG&#39;s most recent DOS-to and sequential anchor count are updated in the patient&#39;s master active ETG file in step  542 .  
         [0145]    Processing then continues to identify all valid ETGs for a third diagnosis code on record at step  546  and the identified valid ETGs from step  546  are compared to the active ETGs in the patient&#39;s master active ETG file in step  548 .  
         [0146]    Bridge 3,  550 , continues to FIG. 6D, and a logical operand  552  is executed to query the patient&#39;s master active ETG file to determine whether a match exists between the valid ETGs identified in step  548  with any active ETG from the patients master active ETG file. If a negative response is returned to logical operand  538 , the patient&#39;s comorbidity file is updated with the third diagnosis code at  558 .  
         [0147]    If an affirmative response is returned from logical operand  552 , the matched active ETG with the most recent DOS-to value is selected at step  554 . Again a decisional hierarchy is executed. If a tie is found based upon most recent DOS-to values, then the most recent DOS-from value is selected for matching with active ETGs. If a tie is found at most recent DOS-from values is found, the first encountered ETG is selected and matched.  
         [0148]    The patient&#39;s co-morbidity file is then updated with the third diagnosis code on-record at step  558 . Processing then continues to identify all valid ETGs for a fourth diagnosis code on record at step  560  and the identified valid ETGs from step  3318  are compared to the active ETGs in the patient&#39;s master active ETG file in step  562 . Bridge reference 4,  564 , bridges to FIG. 6D.  
         [0149]    Turning to FIG. 6D, a logical operand  566  is executed to query the patient&#39;s master active ETG file to determine whether a match exists between the valid ETGs identified in step  562  with any active ETG from the patients master active ETG file. If a negative response is returned to logical operand  566 , the patient&#39;s comorbidity file is updated with the fourth diagnosis code.  
         [0150]    If an affirmative response is returned from logical operand  566 , the matched active ETG with the most recent DOS-to value is selected at step  568 . In the event of a tie, a decisional hierarchy is executed. If a tie is found based upon most recent DOS-to values, then the most recent DOS-from value is selected for matching with active ETGs. If a tie is found at most recent DOS-from values is found, the first encountered ETG is selected and matched. The selected ETG&#39;s most recent DOS-to are updated in the patient&#39;s master active ETG file in step  570  and the patient&#39;s co-morbidity file is then updated with the fourth diagnosis code on-record at step  572 . A check is then made to determine whether the processed record is the last record for the patient by execution of logical operand  574  and reading the input claim records from the storage means. If logical operand  574  returns an affirmative value, the ETG Definer Sub-routine is called at step  576 , as represented by bridge reference GG. If, however, a negative response is returned to logical operand  574 , program execution returns to the step  204  of the Episode Assignor routine  200  and the next patient claim record is read from the storage means at step  578 .  
         [0151]    Ancillary Records  
         [0152]    Operation of the Ancillary Record Grouping Sub-routine  600  is illustrated in FIGS.  7 A- 7 B. Like surgery records, ancillary records are grouped to ETGs on the basis of both dx codes and CPT code on record. First all valid ETGs for the treatment or CPT code on-record are identified in step  602  from the CPT-ETG table  401 . Then all valid ETGs for the first dx code on record are identified in step  604  from the dx-ETG table  201 . The ETGs from the CPT-ETG table  401  are then compared at step  606  to the ETGs from the dx-ETG table  201  and a logical operand  608  determines whether there is an ETG match. An affirmative response returned from logical operand  608  continues record processing at bridge D,  610 , which continues on FIG. 7B. A negative response returned from logical operand  608  prompts a look up on the dx-ETG table to determine all valid ETGs for the second diagnosis code on record in step  611 . Step  613  again compares the valid ETGs for the CPT code on record and with the valid ETGs for the second dx code on record and a logical operand  614  is executed to match the second dx code ETG with the CPT code ETG. Again, an affirmative response returned from logical operand  614  continues record processing at bridge D,  610 , which continues on FIG. 7B. If a negative response is returned to logical operand  614 , a look up on the dx-ETG table occurs to determine all valid ETGs for the third diagnosis code on record in step  615 . Step  616  again compares the valid ETGs for the CPT code on record and with the valid ETGs for the third dx code on-record, which bridges E,  619 , to FIG. 7B for identification of all valid ETGs for the fourth dx code on-record at step  625 .  
         [0153]    Step  627  then compares the valid ETGs for the CPT code on record and with the valid ETGs for the fourth dx code on record and a logical operand  629  is executed to match the fourth dx code ETG with the CPT code ETG. An affirmative response returned from logical operand  629  continues to step  616  which compares the matched ETGs with the ETGs in the patient master active ETG file and a query is made at logical operand  618  to determine whether any valid matches exist. If a negative response is returned to logical operand  629 , the record is output to the ETG reserved for a CPT code-dx code mismatch at step  631  and a check is made at step  635  to determine whether the record is the last record for the patient.  
         [0154]    If a match is found between the matched ETGs from the dx code-CPT code comparison in step  616 . The matched active ETG with the most recent DOS-to value is selected. In the event of a tie, a decisional hierarchy is executed. If a tie is found based upon most recent DOS-to values, then the most recent DOS-from value is selected for matching with active ETGs. If a tie is found at most recent DOS-from values is found, the first encountered ETG is selected. The sequential episode number of the selected ETG is assigned to the record and the most recent sequential anchor count of the episode from the active ETG file is assigned to the record at step  622 .  
         [0155]    If the response to logical operand  618  is negative, the record is assigned to an orphan record ETG at step  633  and maintained in the claims records until subsequent record processing either matches the record to an ETG or the orphan record DOS-from exceeds a one-year time period, at which time the record is output to an error log file.  
         [0156]    A check is then made to determine whether this record is the last record for the patient at step  635 . If logical operand  635  returns an affirmative value, the ETG Definer Sub-routine is called at step  642 , as represented by bridge reference GG. If, however, a negative response is returned to logical operand  635 , program execution returns to the step  204  of the Episode Assignor routine  200  and the next patient claim record is read from the storage means at step  644 .  
         [0157]    Prescription Drug Records  
         [0158]    FIGS.  8 A- 8 C illustrate the operation of the Drug Record Grouping Sub-routine  700 . Drug Record Grouping Sub-routine  700  references two predetermined tables previously written to the storage means. The first of the tables is a National Drug Code (NDC) by Generic Drug Code (GDC) table  800 . This table acts as a translator table to translate a large number of NDCs to a smaller set of GDCs. A second pre-defined table is employed and is constructed as a GDC by ETG table  900 . The GDC by ETG table is used, in conjunction with the NDC by GDC translator table, to identify all valid ETGs for a particular NDC code in the claim record.  
         [0159]    Once identified as a drug record in the initial operation of the Episode Assignor Routine  200 , the drug record is read from storage to memory in step  702 . The NDC code on-record is converted to a GDC code by reading from the NDC-GDC table  800  in step  704 . Using the GDC number so identified, all possible valid ETGs for the GDC code are identified in step  706 . The possible valid ETGs for the GDC code are then compared to the patient master active ETG file in step  708 . Following bridge LL,  710 , to FIG. 8B, a logical operand is executed in step  712  based upon the comparison executed in step  708 , to determine whether a match occurs having a table value of P, A, C or S.  
         [0160]    If a negative response is returned to logical operand  712 , a check is made to determine whether a match having table value I in the GDC-ETG table  900  exists in step  713 . If another negative response is returned to logical operand  713 , the record is flagged an orphan drug record and assigned to an orphan drug record ETG in step  715 . If an affirmative response is returned to logical operand  713 , the ETG with the highest second value is selected in step  718  (e.g. I1, I2, I3 and so on). If more than one ETG having the highest second value exists, the ETG having the most recent DOS-from value is selected. If a tie is again encountered, the first encountered ETG is selected. A sequential episode number and the most recent sequential anchor count of the episode from the patient master active ETG file is assigned to the drug record for the selected ETG in step  720 .  
         [0161]    If an affirmative response is returned to logical operand  712 , the ETG having the highest second value, in order of P, S, A, C is selected in step  714  (e.g. P1, then P2 . . . then S1, then S2 . . . and so on). The record is then assigned a sequential episode number of the selected ETG and the most recent sequential anchor count of the episode from the patient master active ETG file in step  716 .  
         [0162]    Further processing of the drug record continues from steps  716 ,  715  and  720  through bridge MM,  724  and is described with reference to FIG. 8C. A check is made in step  726  to determine whether the drug record is the last drug record for the patient on the record date. If a negative response is returned, a loop back to the top of the Drug Record Grouping Sub-routine  700  is executed. If an affirmative response is returned at step  726 , a check is made to determine whether the drug record is the last record for the patient in step  728 . If logical operand  728  returns an affirmative value, the ETG Definer Sub-routine is called at step  732 , as represented by bridge reference GG. If, however, a negative response is returned to logical operand  728 , program execution returns to the step  204  of the Episode Assignor routine  200  and the next patient claim record is read from the storage means at step  730 .  
         [0163]    The Episode Definer Sub-routine is illustrated with reference to FIG. 9. Episode Definer Routine  118  is employed to assign all non-specific claims records, i.e., those initially assigned to ETG  900 , to specific more appropriate ETGs. Episode Definer routine  750 . Once all episodes have been grouped to ETGs, all ETG episodes in both active and closed ETGs are then identified in step  752  by patient age and presence or absence of a comorbidity. The ETG number for each episode is then shifted and re-written to an ETG appropriate for the patient age and/or presence or absence of a comorbidity in step  754 . All patient records are then output in step  756  to the display, to a file or to a printer, along with their shifted ETG number, sequential episode number of the record and in patient master active and closed ETG file for the patient. The Episode Definer routine  750  then writes a single record at step  758  for each episode containing key analytical information, for example: the ETG number, patient age, patient sex, the sequential episode number, the total sum charges, the total sum paid, the earliest anchor record DOS-from value, the last anchor record DOS-to value, patient identification, physician identification, management charges, management charges paid, surgery charges, surgery charges paid, ancillary charges, and ancillary charges paid.  
         [0164]    After the single record for each episode is written in step  758  for the patient, processing for the next patient begins by initialization of the next patient master active and closed ETG file, the next patient co-morbidity file, and the patient age file in step  760  and the Eligible Record Check Routine is re-initiated for processing claims records for the next patient at step  762 .  6005 - 010 / 1   
       EXAMPLE  
       [0165]    [0165]FIG. 10 provides an example of Management and Ancillary record clustering over a hypothetical time line for a single patient over a one year period from January,  1995  to December,  1995 . FIG. 10 depicts time frames of occurrences for claims classified as management records, i.e., office visit  84 , hospital or emergency room visit  85 , and surgery and surgical follow-up  86  and for claims records classified as ancillary records, i.e., laboratory tests  87 , X-ray and laboratory tests  88  and x-ray  89 . Two time lines are provided. A first timeline  71  includes the diagnosis and the time duration of the diagnosed clinical condition. A second timeline  72  includes the claim events which gave rise to the medical claims. Where claim events occur more than once, an alphabetic designator is added to the reference numeral to denote chronological order of the event. For example, the first office visit is denoted  84   a , the second office visit is denoted  84   b , the third denoted  84   c , etc. Vertical broken lines denote the beginning and end of each Episode Treatment Group  90 , and facilitate correlation of the episode event, e.g., office visit, with the resulting diagnosis, e.g., bronchitis.  
         [0166]    A first office visit  84   a  resulted in a diagnosis of bronchitis  76 . Office visit  84   a  started an episode  90   a  for this patient based upon the bronchitis diagnosis  76 . A second office visit  84   b  occurred concurrently with the bronchitis episode  90   a , but resulted in a diagnosis of eye infection  77 . Because the eye infection  77  is unrelated to the open bronchitis episode ETG  90   a , a new eye infection episode ETG  90   b  is started. An X-ray and lab test  88  was taken during the time frame of each of the bronchitis episode  90   a  and the eye infection  90   b . Based upon the CPT-ETG table, discussed above, the X,-ray and lab test  88  is assigned to the eye infection episode  90   b . A third office visit  84   c  and x-ray  89   a  occured and related to the bronchitis episode  90   a  rather than the eye infection episode  90   b.    
         [0167]    A fourth office visit  84   d  occured and resulted in a diagnosis of major infection  78  unrelated to the bronchitis diagnosis  76 . Because the major infection  78  is unrelated to the bronchitis, the fourth office visit  84   d  opened a new ETG  90   c . Two subsequent lab tests  87   a  and  87   b  were both assigned to the only open episode, i.e., ETG  90   c.    
         [0168]    A fifth office visit  84   e  resulted in a diagnosis of benign breast neoplasm  79 , which is unrelated to the major infection ETG  90   c . A fifth office visit  84   e  opened a new ETG  90   d  because the benign breast neoplasm is unrelated to either the bronchitis episode ETG  90   a , the eye infection episode ETG  90   b , or the major infection episode  90   c . Sixth office visit  84   f  was assigned then to the only open episode, i.e., ETG  90   d . Similarly, the surgery and follow-up records  86   a  and  86   b  related to the benign neoplasm ETG  90   d  and are grouped to that ETG.  
         [0169]    Some months later, the patient has a seventh office visit  84   g  which resulted in a diagnosis of bronchitis  80 . However, because the time period between the prior bronchitis episode  76  and the current bronchitis episode  80  exceeds a pre-determined period of time in which there was an absence of treatment for bronchitis, the bronchitis episode  90   a  is closed and the bronchitis episode  90   e  is opened. A hospital record  85  occurs as a result of an eye trauma and eye trauma  81  is the resulting diagnosis. Because the eye trauma  85  is unrelated to the bronchitis  80 , a new eye trauma ETG  90   f  is started which is open concurrently with the bronchitis ETG  90   e . An eighth office visity  84   h  occurs during the time when both ETG  90   e  and ETG  90   f  are open. Eighth office visity  84   h  is, therefore, grouped to the ETG most relevant to the office visity  84   h , i.e., ETG  90   e . A subsequent x-ray record  89   b  occurs and is related to the eye trauma diagnosis and is, therefore, grouped to ETG  90   f . Because and absence of treatment has occured for the bronchitis ETG  90   e , that ETG  90   e  is closed.  
         [0170]    Finally, while the eye trauma ETG  90   f  is open, the patient has a routine office visit  84   h  which is unrelated to the open ETG  90   f  for the eye trauma diagnosis  91 . Because it is unrelated to the open ETG  90   f , the routine office visity  84   i  starts and groups to a new episode  90   g  which contains only one management record  84   i . An x-ray record  89   c  occurs after and is unrelated to the routine office visity  84   i . The only open episode is the eye trauma episode  90   f  and the x-ray record  89   c  is, therefore, grouped to the eye trauma episode  90   f . At the end of the year, all open episodes, i.e., the eye trauma ETG  90   f  are closed.  
         [0171]    It will be apparent to those skilled in the art, that the foregoing detailed description of the preferred embodiment of the present invention is representative of a type of health care system within the scope and spirit of the present invention. Further, those skilled in the art will recognize that various changes and modifications may be made without departing from the true spirit and scope of the present invention. Those skilled in the art will recognize that the invention is not limited to the specifics as shown here, but is claimed in any form or modification falling within the scope of the appended claims. For that reason, the scope of the present invention is set forth in the following claims.  
                             TABLE 1                       ETG   DESCRIPTION                                1   AIDS with major infectious complication       2   AIDS with minor infectious complication       3   AIDS with inflammatory complication       4   AIDS with neoplastic complication, with surgery       5   AIDS with neoplastic complication, w/o surgery       6   HIV sero-positive without AIDS       7   Major infectious disease except HIV, with comorbidity       8   Septicemia, w/o comorbidity       9   Major infectious disease except HIV and septicemia, w/o comorbidity       10   Minor infectious disease       11   Infectious disease signs &amp; symptoms       20   Diseases of the thyroid gland, with surgery       21   Hyper-functioning thyroid gland       22   Hypo-functioning thyroid gland       23   Non-toxic goiter       24   Malignant neoplasm of the thyroid gland       25   Benign neoplasm of the thyroid gland       26   Other diseases of the thyroid gland       27   Insulin dependent diabetes, with comorbidity       28   Insulin dependent diabetes, w/o comorbidity       29   Non-insulin dependent diabetes, with comorbidity       30   Non-insulin dependent diabetes, w/o comorbidity       31   Malignant neoplasm of the pancreatic gland       32   Benign endocrine disorders of the pancreas       33   Malignant neoplasm of the pituitary gland       34   Benign neoplasm of the pituitary gland       35   Hyper-functioning adrenal gland       36   Hypo-functioning adrenal gland       37   Malignant neoplasm of the adrenal gland       38   Benign neoplasm of the adrenal gland       39   Hyper-functioning parathyroid gland       40   Hypo-functioning parathyroid gland       41   Malignant neoplasm of the parathyroid gland       42   Benign neoplasm of the parathyroid gland       43   Female sex gland disorders       44   Male sex gland disorders       45   Nutritional deficiency       46   Gout       47   Metabolic deficiency except gout       48   Other diseases of the endocrine glands or metabolic disorders, with surgery       49   Other diseases of the endocrine glands or metabolic disorders, w/o surgery       50   Endocrine disease signs &amp; symptoms       70   Leukemia with bone marrow transplant       71   Leukemia with splenectomy       72   Leukemia w/o splenectomy       73   Neoplastic disease of blood and lymphatic system except leukemia       74   Non-neoplastic blood disease with splenectomy       75   Non-neoplastic blood disease, major       76   Non-neoplastic blood disease, minor       77   Hematology signs &amp; symptoms       90   Senile or pre-senile mental condition       91   Organic drug or metabolic disorders       92   Autism and childhood psychosis       93   Inorganic psychoses except infantile autism       94   Neuropsychological &amp; behavioral disorders       95   Personality disorder       96   Mental disease signs &amp; symptoms       110   Cocaine or amphetamine dependence with complications age less than 16       111   Cocaine or amphetamine dependence with complications age 16+       112   Cocaine or amphetamine dependence w/o complications age less than 16       113   Cocaine or amphetamine dependence w/o complications age 16+       114   Alcohol dependence with complications, age less than 16       115   Alcohol dependence with complications, age 16+       116   Alcohol dependence w/o complications, age less than 16       117   Alcohol dependence w/o complications, age 16+       118   Opioid and/or barbiturate dependence, age less than 16       119   Opioid and/or barbiturate dependence, age 16+       120   Other drug dependence, age less than 16       121   Other drug dependence, age 16+       140   Viral meningitis       141   Bacterial and fungal meningitis       142   Viral encephalitis       143   Non-viral encephalitis       144   Parasitic encephalitis       145   Toxic encephalitis       146   Brain abscess, with surgery       147   Brain abscess, w/o surgery       148   Spinal abscess       149   Inflammation of the central nervous system, with surgery       150   Inflammation of the central nervous system, w/o surgery       151   Epilepsy, with surgery       152   Epilepsy, w/o surgery       153   Malignant neoplasm of the central nervous system, with surgery       154   Malignant neoplasm of the central nervous system, w/o surgery       155   Benign neoplasm of the central nervous system, with surgery       156   Benign neoplasm of the central nervous system, w/o surgery       157   Cerebral vascular accident, hemorrhagic, with surgery       158   Cerebral vascular accident, hemorrhagic, w/o surgery       159   Cerebral vascular accident, non-hemorrhagic, with surgery       160   Cerebral vascular accident, non-hemorrhagic, w/o surgery       161   Major brain trauma, with surgery       162   Major brain trauma, w/o surgery       163   Minor brain trauma       164   Spinal trauma, with surgery       165   Spinal trauma, w/o surgery       166   Hereditary and degenerative diseases of the central nervous system, with surgery       167   Hereditary and degenerative diseases of the central nervous system, w/o surgery       168   Migraine headache, non-intractable       169   Migraine headache, intractable       170   Congenital and other disorders of the central nervous system, with surgery       171   Congenital and other disorders of the central nervous system, w/o surgery       172   Inflammation of the cranial nerves, with surgery       173   Inflammation of the cranial nerves, w/o surgery       174   Carpal tunnel syndrome, with surgery       175   Carpal tunnel syndrome, w/o surgery       176   Inflammation of the non-cranial nerves, except carpal tunnel, with surgery       177   Inflammation of the non-cranial nerves, except carpal tunnel, w/o surgery       178   Peripheral nerve neoplasm, with surgery       179   Peripheral nerve neoplasm, w/o surgery       180   Traumatic disorder of the cranial nerves, with surgery       181   Traumatic disorder of the cranial nerves, w/o surgery       182   Traumatic disorder of the non-cranial nerves, with surgery       183   Traumatic disorder of the non-cranial nerves, w/o surgery       184   Congenital disorders of the peripheral nerves       185   Neurological disease signs &amp; symptoms       200   Internal eye infection with surgery       201   Internal eye infection w/o surgery       202   External eye infection, with surgery       203   External eye infection, except conjunctivitis, w/o surgery       204   Conjunctivitis       205   Inflammatory eye disease, with surgery       206   Inflammatory eye disease, w/o surgery       207   Malignant neoplasm of the eye, internal, with surgery       208   Malignant neoplasm of the eye, internal, w/o surgery       209   Malignant neoplasm of the eye, external       210   Benign neoplasm of the eye, internal       211   Benign neoplasm of the eye, external       212   Glaucoma, closed angle with surgery       213   Glaucoma, closed angle w/o surgery       214   Glaucoma, open angle, with surgery       215   Glaucoma, open angle, w/o surgery       216   Cataract, with surgery       217   Cataract, w/o surgery       218   Trauma of the eye, with surgery       219   Trauma of the eye, w/o surgery       220   Congenital anomaly of the eye, with surgery       221   Congenital anomaly of the eye, w/o surgery       222   Diabetic retinopathy, with surgery       223   Diabetic retinopathy, w/o surgery with comorbidity       224   Diabetic retinopathy, w/o surgery w/o comorbidity       225   Non-diabetic vascular retinopathy, with surgery       226   Non-diabetic vascular retinopathy, w/o surgery       227   Other vascular disorders of the eye except retinopathies, with surgery       228   Other vascular disorders of the eye except retinopathies, w/o surgery       229   Macular degeneration, with surgery       230   Macular degeneration, w/o surgery       231   Non-macular degeneration, with surgery       232   Non-macular degeneration, w/o surgery       233   Major visual disturbances, with surgery       234   Major visual disturbances, w/o surgery       235   Minor visual disturbances, with surgery       236   Minor visual disturbances, w/o surgery       237   Other diseases and disorders of the eye and adnexa       250   Heart transplant       251   AMI, with coronary artery bypass graft       252   AMI or acquired defect, with valvular procedure       253   AMI, with angioplasty       254   AMI with arrhythmia, with pacemaker implant       255   AMI, with cardiac catheterization       256   AMI, anterior wall with complication       257   AMI, anterior wall w/o comlication       258   AMI, inferior wall with complication       259   AMI, inferior wall w/o complication       260   Ischemic heart disease, w/o AMI, with coronary artery bypass graft       261   Ischemic heart disease, w/o AMI, with valvular procedure       262   Ischemic heart disease, w/o AMI, with angioplasty       263   Isehemic heart disease, w/o AMI, with arrhythmia, with pacemaker implant       264   Ischemic heart disease, w/o AMI, with cardiac catheterization       265   Ischemic heart disease, w/o AMI       266   Pulmonary heart disease, w/o AMI       267   Aortic aneurysm, with surgery       268   Aortic aneurysm, w/o surgery       269   Cardiac infection, with surgery       270   Cardiac infection, w/o surgery       271   Valvular disorder, with complication       272   Valvular disorder, w/o complication       273   Major conduction disorder, with pacemaker/defibrillator implant       274   Major conduction disorder, w/o pacemaker/defibrillator implant       275   Minor conduction disorder       276   Malignant hypertension with comorbidity       277   Malignant hypertension w/o comorbidity       278   Benign hypertension with comorbidity       279   Benign hypertension w/o comorbidity       280   Cardiac congenital disorder, with surgery       281   Cardiac congenital disorder, w/o surgery       282   Major cardiac trauma, with surgery       283   Major cardiac trauma, w/o surgery       284   Minor cardiac trauma       285   Other cardiac diseases       286   Arterial inflammation, with surgery       287   Major arterial inflammation, w/o surgery       288   Minor arterial inflammation, w/o surgery       289   Major non-inflammatory arterial disease with surgery       290   Arterial embolism/thrombosis, w/o surgery       291   Major non-inflammatory arterial disease, except embolism/thrombosis, w/o surgery       292   Atherosclerosis, with surgery       293   Atherosclerosis, w/o surgery       294   Arterial aneurysm, except aorta, with surgery       295   Arterial aneurysm, except aorta, w/o surgery       296   Other minor non-inflammatory arterial disease, with surgery       297   Other minor non-inflammatory arterial disease, w/o surgery       298   Arterial trauma, with surgery       299   Arterial trauma, w/o surgery       300   Vein inflammation, with surgery       301   Embolism and thrombosis of the veins       302   Disorder of the lymphatic channels       303   Phlebitis and thrombophlebitis of the veins       304   Varicose veins of the lower extremity       305   Other minor inflammatory disease of the veins       306   Venous trauma, with surgery       307   Venous trauma, w/o surgery       308   Other diseases of the veins       309   Cardiovascular disease signs &amp; symptoms       320   Infection of the oral cavity       321   Inflammation of the oral cavity, with surgery       322   Inflammation of the oral cavity, w/o surgery       323   Trauma of the oral cavity, with surgery       324   Trauma of the oral cavity, w/o surgery       325   Other diseases of the oral cavity, with surgery       326   Other diseases of the oral cavity, w/o surgery       327   Otitis media, with major surgery       328   Otitis media, with minor surgery       329   Otitis media, w/o surgery       330   Tonsillitis, adenoiditis or pharyngitis, with surgery       331   Tonsillitis, adenoiditis or pharyngitis, w/o surgery       332   Sinusitis and Rhinitis, with surgery       333   Sinusitis and Rhinitis, w/o surgery       334   Other ENT infection, with surgery       335   Other ENT infection, w/o surgery       336   Major ENT inflammatory conditions with surgery       337   Major ENT inflammatory conditions w/o surgery       338   Minor ENT inflammatory conditions with surgery       339   Minor ENT inflammatory conditions w/o surgery       340   ENT malignant neoplasm, with surgery       341   ENT malignant neoplasm, w/o surgery       342   ENT benign neoplasm, with surgery       343   ENT benign neoplasm, w/o surgery       344   ENT congenital anomalies, with surgery       345   ENT congenital anomalies, w/o surgery       346   Hearing disorders, with surgery       347   Hearing disorders, w/o surgery       348   ENT trauma, with surgery       349   ENT trauma, w/o surgery       350   Other ENT disorders, with surgery       351   Other ENT disorders, w/o surgery       352   Otolaryngology disease signs &amp; symptoms       371   Viral pneumonia, with comorbidity       372   Viral pneumonia, w/o comorbidity       373   Bacterial lung infections, with comorbidity       374   Bacterial lung infections, w/o comorbidity       375   Fungal and other pneumonia, with comorbidity       376   Fungal and other pneumonia, w/o comorbidity       377   Pulmonary TB with comorbidity       378   Pulmonary TB w/o comorbidity       379   Disseminated TB with comorbidity       380   Disseminated TB w/o comorbidity       381   Acute bronchitis, with comorbidity, age less than 5       382   Acute bronchitis, with comorbidity, age 5+       383   Acute bronchitis, w/o comorbidity, age less than 5       384   Acute bronchitis, w/o comorbidity, age 5+       385   Minor infectious pulmonary disease other than acute bronchitis       386   Asthma with comorbidity, age less than 18       387   Asthma with comorbidity, age 18+       388   Asthma w/o comorbidity, age less than 18       389   Asthma w/o comorbidity, age 18+       390   Chronic bronchitis, with complication with comorbidity       391   Chronic bronchitis with complication w/o comorbidity       392   Chronic bronchitis, w/o complication with comorbidity       393   Chronic bronchitis w/o complication w/o comorbidity       394   Emphysema, with comorbidity       395   Emphysema w/o comorbidity       396   Occupational and environmental pulmonary diseases, with comorbidity       397   Occupational and environmental pulmonary diseases, w/o comorbidity       398   Other inflammatory lung disease, with surgery       399   Other inflammatory lung disease, w/o surgery       400   Malignant pulmonary neoplasm, with surgery       401   Malignant pulmonary neoplasm, w/o surgery       402   Benign pulmonary neoplasm, with surgery       403   Benign pulmonary neoplasm, w/o surgery       404   Chest trauma, with surgery       405   Chest trauma, open, w/o surgery       406   Chest trauma, closed, w/o surgery       407   Pulmonary congenital anomalies, with surgery       408   Pulmonary congenital anomalies, w/o surgery       409   Other pulmonary disorders       410   Pulmonology disease signs &amp; symptoms       430   Infection of the stomach and esophagus with comorbidity       431   Infection of the stomach and esophagus w/o comorbidity       432   Inflammation of the esophagus, with surgery       433   Inflammation of the esophagus, w/o surgery       434   Gastritis and/or duodenitis, complicated       435   Gastritis and/or duodenitis, simple       436   Ulcer, complicated with surgery       437   Ulcer, complicated w/o surgery       438   Ulcer, simple       439   Malignant neoplasm of the stomach and esophagus, with surgery       440   Malignant neoplasm of the stomach and esophagus, w/o surgery       441   Benign neoplasm of the stomach and esophagus, with surgery       442   Benign neoplasm of the stomach and esophagus, w/o surgery       443   Trauma or anomaly of the stomach or esophagus, with surgery       444   Trauma of the stomach or esophagus, w/o surgery       445   Anomaly of the stomach or esophagus, w/o surgery       446   Appendicitis, with rupture       447   Appendicitis, w/o rupture       448   Diverticulitis, with surgery       449   Diverticulitis, w/o surgery       450   Other infectious diseases of the intestines and abdomen       451   Inflammation of the intestines and abdomen with surgery       452   Inflammation of the intestines and abdomen, w/o surgery       453   Malignant neoplasm of the intestines and abdomen, with surgery       454   Malignant neoplasm of the intestines and abdomen, w/o surgery       455   Benign neoplasm of the intestines and abdomen, with surgery       456   Benign neoplasm of the intestines and abdomen, w/o surgery       457   Trauma of the intestines and abdomen, with surgery       458   Trauma of the intestines and abdomen, w/o surgery       459   Congenital anomalies of the intestines and abdomen, with surgery       460   Congenital anomalies of the intestines and abdomen, w/o surgery       461   Vascular disease of the intestines and abdomen       462   Bowel obstruction with surgery       463   Bowel obstruction w/o surgery       464   Irritable bowel syndrome       465   Hernias, except hiatal, with surgery       466   Hernias, except hiatal, w/o surgery       467   Hiatal hernia, with surgery       468   Hiatal hernia, w/o surgery       469   Other diseases of the intestines and abdomen       470   Infection of the rectum or anus, with surgery       471   Infection of the rectum or anus, w/o surgery       472   Hemorrhoids, complicated, with surgery       473   Hemorrhoids, complicated, w/o surgery       474   Hemorrhoids, simple       475   Inflammation of the rectum or anus, with surgery       476   Inflammation of the rectum or anus, w/o surgery       477   Malignant neoplasm of the rectum or anus, with surgery       478   Malignant neoplasm of the rectum or anus, w/o surgery       479   Benign neoplasm of the rectum or anus, with surgery       480   Benign neoplasm of the rectum or anus. w/o surgery       481   Trauma of the rectum or anus, open, with surgery       482   Trauma of the rectum or anus, open, w/o surgery       483   Trauma of the rectum or anus, closed       484   Other diseases and disorders of the rectum and anus, with surgery       485   Other diseases and disorders of the rectum and anus, w/o surgery       486   Gastroenterology disease signs &amp; symptoms       510   Liver Transplant       511   Infectious hepatitis, high severity with comorbidity       512   Infectious hepatitis, high severity w/o comorbidity       513   Infectious hepatitis, low severity with comorbidity       514   Infectious hepatitis, low severity w/o comorbidity       515   Non-infectious hepatitis, with complications       516   Non-infectious hepatitis, w/o complications       517   Cirrhosis, with surgery       518   Cirrhosis, w/o surgery       519   Acute pancreatitis       520   Chronic pancreatitis       521   Cholelithiasis, complicated       522   Cholelithiasis, simple, with surgery       523   Cholelithiasis, simple, w/o surgery       524   Malignant neoplasm of the hepato-biliary system, with surgery       525   Malignant neoplasm of the hepato-biliary system, w/o surgery       526   Benign neoplasm of the hepato-biliary system, with surgery       527   Benign neoplasm of the hepato-biliary system, w/o surgery       528   Trauma of the hepato-biliary system, complicated, with surgery       529   Trauma of the hepato-biliary system, complicated, w/o surgery       530   Trauma of the hepato-biiary system, simple       531   Other diseases of the hepato-biliary system, with surgery       532   Other diseases of the hepato-biliary system, w/o surgery       533   Hepatology disease signs &amp; symptoms       550   Kidney Transplant       551   Acute renal failure, with comorbidity       552   Acute renal failure, w/o comorbidity       553   Chronic renal failure, with ESRD       554   Chronic renal failure, w/o ESRD       555   Acute renal inflammation, with comorbidity       556   Acute renal inflammation, w/o comorbidity       557   Chronic renal inflammation, with surgery       558   Chronic renal inflammation, w/o surgery       559   Nephrotic syndrome, minimal change       560   Nephrotic syndrome       561   Other renal conditions       562   Nephrology disease signs &amp; symptoms       570   Infection of the genitourinary system with surgery       571   Infection of the genitourinary system w/o surgery       572   Sexually transmitted infection of the lower genitourinary system       573   Infection of the lower genitourinary system, not sexually transmitted       574   Kidney stones, with surgery with comorbidity       575   Kidney stones, with surgery w/o comorbidity       576   Kidney stones, w/o surgery with comorbidity       577   Kidney stones, w/o surgery w/o comorbidity       578   Inflammation of the genitourinary tract except kidney stones, with surgery       579   Inflammation of the genitourinary tract except kidney stones, w/o surgery       580   Malignant neoplasm of the prostate, with surgery       581   Malignant neoplasm of the prostate, w/o surgery       582   Benign neoplasm of the prostate, with surgery       583   Benign neoplasm of the prostate, w/o surgery       584   Malignant neoplasm of the genitourinary tract, except prostate, with surgery       585   Malignant neoplasm of the genitourinary tract, except prostate, w/o surgery       586   Benign neoplasm of the genitourinary tract, except prostate with surgery       587   Benign neoplasm of the genitourinary tract, except prostate, w/o surgery       588   Trauma to the genitourinary tract, with surgery       589   Trauma to the genitourinary tract, w/o surgery       590   Urinary incontinence, with surgery       591   Urinary incontinence, w/o surgery       592   Other diseases of the genitourinary tract, with surgery       593   Other diseases of the genitourinary tract, w/o surgery       594   Urological disease signs &amp; symptoms       610   Normal pregnancy, normal labor &amp; delivery, with cesarean section       611   Normal pregnancy, normal labor &amp; delivery, w/o cesarean section       612   Complicated pregnancy, with cesarean section       613   Complicated pregnancy, w/o cesarean section       614   Hemorrhage during pregnancy, with cesarean section       615   Hemorrhage during pregnancy, w/o cesarean section       616   Other condition during pregnancy, with cesarean section       617   Other condition during pregnancy, w/o cesarean section       618   Fetal problems during pregnancy, with cesarean section       619   Fetal problems during pregnancy, w/o cesarean section       620   Ectopic pregnancy, with surgery       621   Ectopic pregnancy, w/o surgery       622   Spontaneous abortion       623   Non-spontaneous abortion       624   Obstetric signs &amp; symptoms       630   Infection of the ovary and/or fallopian tube, with surgery       631   Infection of the ovary and/or fallopian tube, w/o surgery, with comorbidity       632   Infection of the ovary and/or fallopian tube, w/o surgery, w/o comorbidity       633   Infection of the uterus, with surgery       634   Infection of the uterus, w/o surgery, with comorbidity       635   Infection of the uterus, w/o surgery, w/o comorbidity       636   Infection of the cervix, with surgery       637   Infection of the cervix, w/o surgery       638   Vaginal infection, with surgery       639   Monilial infection of the vagina (yeast)       640   Infection of the vagina except monilial       641   Inflammation of the female genital system, with surgery       642   Endometriosis, w/o surgery       643   Inflammatory condition of the female genital tract except endometriosis, w/o surgery       644   Malignant neoplasm of the female genital tract, with surgery       645   Malignant neoplasm of the female genital tract, w/o surgery       646   Benign neoplasm of the female genital tract, with surgery       647   Benign neoplasm of the female genital tract, w/o surgery       648   Conditions associated with menstruation, with surgery       649   Conditions associated with menstruation, w/o surgery       650   Conditions associated with female infertility, with surgery       651   Conditions associated with female infertility, w/o surgery       652   Other diseases of the female genital tract, with surgery       653   Other diseases of the female genital tract, w/o surgery       654   Malignant neoplasm of the breast, with surgery       655   Malignant neoplasm of the breast, w/o surgery       656   Benign neoplasm of the breast, with surgery       657   Benign neoplasm of the breast, w/o surgery       658   Other disorders of the breast, with surgery       659   Other disorders of the breast, w/o surgery       660   Gynecological signs &amp; symptoms       670   Major bacterial infection of the skin, with surgery       671   Major bacterial infection of the skin, w/o surgery       672   Minor bacterial infection of the skin       673   Viral skin infection       674   Fungal skin infection, with surgery       675   Fungal skin infection, w/o surgery       676   Parasitic skin infection       677   Major inflammation of skin &amp; subcutaneous tissue       678   Minor inflammation of skin &amp; subcutaneous tissue       679   Malignant neoplasm of the skin, major, with surgery       680   Malignant neoplasm of the skin, major, w/o surgery       681   Malignant neoplasm of the skin, minor       682   Benign neoplasm of the skin       683   Major burns, with surgery       684   Major burns, w/o surgery       685   Major skin trauma, except burns, with surgery       686   Major skin trauma, except burns, w/o surgery       687   Minor burn       688   Minor trauma of the skin except burn, with surgery       689   Open wound of the skin, w/o surgery       690   Minor trauma of the skin except burn and open wound, w/o surgery       691   Other skin disorders       692   Dermatological signs &amp; symptoms       710   Infection of the large joints with comorbidity       711   Infection of the large joints w/o comorbidity       712   Infection of the small joints with comorbidity       713   Infection of the small joints w/o comorbidity       714   Degenerative orthopedic diseases with hip or spine surgery       715   Degenerative orthopedic diseases with large joint surgery       716   Degenerative orthopedic diseases with hand or foot surgery       717   Juvenile rheumatoid arthritis with complication with comorbidity       718   Juvenile rheumatoid arthritis with complication w/o comorbidity       719   Juvenile rheumatoid arthritis w/o complication with comorbidity       720   Juvenile rheumatoid arthritis w/o complication w/o comorbidity       721   Adult rheumatoid arthritis with complication with comorbidity       722   Adult rheumatoid arthritis with complication w/o comorbidity       723   Adult rheumatoid arthritis w/o complication with comorbidity       724   Adult rheumatoid arthritis w/o complication w/o comorbidity       725   Lupus, with complication       726   Lupus, w/o complication       727   Autoimmune rheumatologic disease except lupus       728   Inflammation of the joints other than rheumatoid arthritis, with comorbidity       729   Inflammation of the joints other than rheumatoid arthritis, w/o comorbidity       730   Degenerative joint disease, generalized       731   Degenerative joint disease, localized with comorbidity       732   Degenerative joint disease, localized w/o comorbidity       733   Infections of bone, with surgery       734   Infections of bone, w/o surgery       735   Maxillofacial fracture or dislocation, with surgery       736   Maxillofacial fracture or dislocation, w/o surgery       737   Pelvis fracture or dislocation, with surgery       738   Pelvis fracture or dislocation, w/o surgery       739   Hip and/or femur fracture or dislocation, with surgery       740   Hip and/or femur fracture or dislocation, open, w/o surgery       741   Hip and/or femur fracture or dislocation, closed, w/o surgery       742   Upper extremity fracture or dislocation, with surgery       743   Upper extremity fracture or dislocation, open, w/o surgery       744   Upper extremity fracture or dislocation, closed, w/o surgery       745   Lower extremity fracture or dislocation, with surgery       746   Lower extremity fracture or dislocation, open, w/o surgery       747   Lower extremity fracture or dislocation, closed, w/o surgery       748   Trunk fracture or dislocation, with surgery       749   Trunk fracture or dislocation, open, w/o surgery       750   Trunk fracture or dislocation, closed, w/o surgery       751   Malignant neoplasm of the bone and connective tissue, head and neck       752   Malignant neoplasm of the bone and connective tissue other than head and neck       753   Benign neoplasm of the bone and connective tissue, head and neck       754   Benign neoplasm of the bone and connective tissue other than head and neck       755   Internal derangement of joints, with surgery       756   Internal derangement of joints, w/o surgery       757   Major orthopedic trauma other than fracture or dislocation, with surgery       758   Major orthopedic trauma other than fracture or dislocation, w/o surgery       759   Major neck and back disorders, with surgery       760   Major neck and back disorders, w/o surgery       761   Bursitis and tendinitis, with surgery       762   Bursitis and tendinitis, w/o surgery       763   Minor orthopedic disorder except bursitis and tendinitis, with surgery       764   Minor neck and back disorder, except bursitis and tendinitis, w/o surgery       765   Minor orthopedic disorder other than neck and back, except bursitis and tendinitis, w/o           surgery       766   Orthopedic congenital and acquired deformities, with surgery       767   Orthopedic congenital and acquired deformities, w/o surgery       768   Orthopedic and rheumatological signs &amp; symptoms       780   Uncomplicated neonatal management       781   Chromosomal anomalies       782   Metabolic related disorders originating the antenatal period       783   Chemical dependency related disorders originating in the antenatal period       784   Mechanical related disorders originating in the antenatal period       785   Other disorders originating in the antenatal period       786   Other major neonatal disorders, perinatal origin       787   Other minor neonatal disorders, perinatal origin       788   Neonatal signs &amp; symptoms       790   Exposure to infectious diseases       791   Routine inoculation       792   Non-routine inoculation       793   Prophylactic procedures other than inoculation and exposure to infectious disease       794   Routine exam       795   Contraceptive management, with surgery       796   Contraceptive management, w/o surgery       797   Conditional exam       798   Major specific procedures not classified elsewhere       799   Minor specific procedures not classified elsewhere       800   Administrative services       801   Other preventative and administrative services       810   Late effects and late complications       811   Environmental trauma       812   Poisonings and toxic effects of drugs       900   Isolated signs, symptoms and non-specific diagnoses or conditions       990   Drug record, no drug module       991   Orphan drug record       992   Non-Rx NDC code       993   Invalid NDC code       994   Invalid provider type, e.g., dentist       995   Record outside date range       996   Invalid CPT-4 code       997   Invalid Dx code       998   Inappropriate Dx-CPT-4 matched record       999   Orphan record