The Core Challenge: Invisible Productivity
This section outlines the disparity between the critical clinical work performed by APCs and its absence in current reporting systems, specifically regarding CPT 77427.
Problem Statement
The current system **prevents accurate APC productivity tracking** for radiation treatment management care (CPT 77427) in Power BI. Although APCs are critically involved in patient management, they are non-billable providers for this physician professional service, leaving their effort unrecorded.
Why Tracking Time is Not Enough
The "Blocked Time" Fallacy
Simply tracking "blocked time" in Epic is insufficient for production metrics. It fails to tie the effort to the specific **service provided (77427-related care)** or its complexity, making the data non-actionable for resource planning.
The Power BI Gap
Without a specific procedure code to track, Power BI dashboards remain incomplete, incorrectly showing APCs as having low productivity for high-volume, necessary work.
The APC Contribution to CPT 77427
APCs perform the essential clinical tasks that enable the physician to bill the professional component (26) of the weekly treatment management code.
Core Non-Billable Responsibilities
The APC's role is hands-on and essential for maintaining the quality and safety of the radiation treatment course. These tasks directly support the physician's required weekly review and decision-making.
Weekly Patient Examination: Detailed patient assessment and progress review.
Side Effect Management: Proactive intervention for acute treatment symptoms.
Symptom & Palliative Control: Timely adjustments for patient comfort.
Care Coordination: Orchestrating necessary follow-ups and specialist referrals.
APC Effort Allocation (Illustrative)
Proposed System Solution: Tracking Mechanism
We must create a mechanism that is documentable, extractable, and non-charge-generating. The best practice favors a controlled, internal solution.
Concept: Internal "Z" Code
Create a new, non-standard procedure code (e.g., "ZAPC77427") within Epic's system build. This code must be flagged as non-billable to the chargemaster to prevent unwanted claims.
Analogy: Similar to how Cardiology tracks physician overreads—a vital, bundled service tracked for productivity only.
Pros
- Full control and ownership over the code's logic.
- Lowest risk of billing errors or audits.
Cons
- Requires initial ITD build and maintenance.
- Potential for internal user confusion if training is insufficient.
Standardized APC Workflow and Documentation
A consistent process ensures data integrity and successful extraction into Power BI.
The 4-Step Documentation Flow
Step 1: Standardized Encounter
Define a consistent encounter type (e.g., "Rad Onc APC Visit") for the schedule, ensuring uniformity across the department.
Step 2: Smart Documentation
Implement a standardized Epic SmartForm/Template tied to the encounter to capture necessary details and, critically, a **Time-In/Time-Out** stamp for effort data.
Step 3: Auto-Application of Tracking Code
The custom tracking code is automatically or easily applied (e.g., via a SmartLink) within the template, linking the documented effort to the custom code.
Step 4: Power BI Mapping
ITD specifically pulls the data field for this custom code from Epic Chronicles/Clarity and maps it into the APC Productivity Dashboard, separate from MD metrics.
Fusion / Data Requirements
The chosen tracking code must be a scheduleable, documentable encounter type/procedure code in Epic's build to ensure successful data capture.
Varian Integration Note
The APC tracking must be contained within Epic's scheduling/documentation to avoid adding unnecessary complexity to the existing Varian-to-Epic data flow project.
Non-Compensatory Tracking
This data is solely for operational productivity metrics and resource allocation. It **must not** trigger changes to physician compensation packages, as per policy requirements.
Work Group Action Items
A prioritized roadmap to implement the solution framework.
ITD/Chargemaster Action
Task: Finalize the choice and build of a Custom Non-Billable Tracking Code in Epic's test environment.
ITD/Power BI Action
Task: Confirm the new tracking code field can be extracted from Epic Clarity/Chronicles and successfully mapped into the Power BI production dashboard.
Clinical/APC Leadership Action
Task: Design, build, and test the Standardized Epic Workflow (schedule type, documentation template, and custom code application) in a controlled test environment.
Compensation Assurance
Task: Communicate and assure stakeholders that this tracking is strictly for internal productivity measurement and will not be used to adjust existing physician compensation structures.