Home Forums Discussions Feedback and Recommendations Common Diagnoses List/Template

I'm playing with v5 as I don't want to take the leap unless its worth it.
I have always created templates for the Assessment section of my most common diagnosis. Its quick and intuitive. Then I just check the diagnosis on a paper superbill.

Well, I want to start using the orders section. So I'm trying to begin entering the ICD-9 codes/Diagnoses on the patients by using the Diagnosis section. It's mildly painful. Is there anyway that you can store your most common diagnoses (I use the same 25 diagnosis 90% of the time) so I don't have to click on "Search ICD-9", then type in the diagnosis, then click on the diagnosis, etc. It's tedious. I want to right click in the diagnoses field and click on one of my most common diagnoses.

Am I overlooking something? Wouldn't be the first time.

Do it w ICD codes. Make ICD list of those twenty five codes until you memorize them. Or have staff enter old codes at first electronic visit.

My partner came up with this:

Make a dummy patient. do your "Search DX" for the codes you use. Select the one you want, then click "Edit code" below the binoculars. Then name it something you will remember like "Abnormal LFT's" rather than "Abnormal laboratory test other than glucose" or whatever nonsense the book uses. Then when you do a real encounter, do a quick search for the name you use, and it will pop right up. Not quite as good as a real shortlist, but better than trying to remember what the book calls degenerative arthritis.

And, while we are at it, what do people use for uncomplicated essential hypertension since 401.1 is considered "incomplete"?

Travis, I think this is a good thread and one to be brought up at the ACUC. Philosophically, I think the difficulty finding the correct ICD-9 code is compounded by the ones you/we see when we look such as Falling From A Train and Injurying a Passenger vs an Employee (these are real).

The orders section is where this gets us. I, myself, really hate documenting quickly only to spend over two minutes looking for the right ICD-9 code. Adding the top 25 is helpful and a great idea. I have found, though, that there are still those two or three that come in with some strange diagnosis that doesn't fit.

Damn, it's hard enough to come up with an actual diagnosis to treat and then with your brain fried, have to find another.

This is where the bell-shaped curve comes in. I think I may try to search for a diagnosis, but as soon as I can't find it, just type it and then write my diagnosis on the Superbill. If I circle it, my biller will know to find three codes that were close to that diagnosis.

I think for the bell-shaped curve to really be effective, it would be help to have a second database where they move to.

The EMR, Praxis, bases its entire EMR on the bell shaped curve. What I am saying isn't really any different than one is already being suggested, just that every time you come up with a new ICD-9 code, it is getting closer to the center.

If none of this makes sense, I am not a statistician.

I'd like to offer a secret that lives deep in my dark little heart. I am a "Lumper"; hence I don't think it makes a lot of difference exactly what code you use. If I want a lipid panel, for example, is it going to make any difference at all if I code for 272.1, 272.2, 272.3 or 272.4, so why keep track of 4 of them? So, I use relatively few codes, and then amplify on the diagnosis in the assessment section.

DAVID,

I am right there with you. It is of no benefit to me whether it is .1, .2, .3, etc. The only ones to whom it matters are the epidemiologists and I do not have time to do their work for them.

Well except it will make a HUGE difference in reimbursement eventually. (Already does for us, in the managed care patients) The codes that "Risk Adjust" muse be coded, and the note must back it up when you are audited. (Don't even get me started on if any of this applies even one aspirin tablet to single headache).
I have a word document on my word processor that I open every day when I arrive at work. It has all of my coding notes on it. They are grouped by organ systems and include all of the little tips that I think might help. (few are actually helpful but it amuses me to read them at a later time, and marvel at what might have made me think it would ever be significant or useful). Sometimes this leads to awkward laughter when I am with a patient and in that case I forward the chart to myself and code it when I am back at my desk.
At least once or twice a day I am able to use it to find some code that I should have memorized long ago but still have to look up, like for abnormal liver test or mammographic microcalcifications etc.

I came across a list of the Top 100 ICD-9 codes for FP as well as the complete short list and long list.

Is there a way to search for most commonly used codes in AC? I know it gives us CPT codes based on ICD-9 codes. A running tally of most common ICD-9 codes would be good. I am so glad I found this thread. After 6 months I did not know or had forgotten that I could rename the code descriptions. Some other EMR's have this function working better. You can type in hypertension and it will pull up the code for 'benign essential hypertension' - you don't have to remember to type benign, or hit 'contains' and get 50 different items with the word Hypertension. I don't know if the techs ever sit down with another chart, say ECW, running and compare these things. I too have the AAFP common codes card and I may go through and do some more renaming. Unfortunately, my brain patterns have already been modified to match the book, rather than the other way around for many of the codes. I am starting to think UNSPECIFIED POLYARTHROPATHY OR POLYARTHRITIS INVOLVING SHOULDER REGION (716.51) rather than 'shoulder pain'.

When I type 719.41, I get Pain, Shoulder. Yes, you have the AAFP common codes, but you have a card, and I have them in AC.

Do you bother to go back and change ICD codes when alerted by billing that a more specific code is needed? We are being asked to do addendums and that seems clumsy at best.

This is a topic that has not been talked about for a long time. I suppose it stems from the fact that it wasn't relevant then, but is moreso now. For months, I just typed in the diagnosis, and I know those who still do. Unless one is going to actually print out the Superbill from AC or use some of the forms, I don't see the advantage, plus all of the wrong codes, etc.

I have started back again, given the orders section likes to put them in and we may interface with Medware, our billing software. I am not sure if we will use the new PM. I guess it depends on seeing it first.

So, for now, my biller changes the code to one that is more correct both for the billing and for AC. But, I would never go back and change the codes. It makes no sense.

Well, I do my own coding and the biller only charges 6% instead of 8%, so I need to put the right code.