Home Forums Discussions Problems DX Codes in Orders

Let's say you are doctor and you received a message in the inbox of Amazing Charts (AC) with the patient chart attached to the subject line. It says that a mammogram for patient XYZ is needed. So you right-click on the message in the inbox window to write the order and then select the necessary diagnosis codes to show in the order. HOWEVER, the dx code doesn't show in the preview window for the order. The only way to make it show (as it appears) is to go inside the patient chart and create an encounter. Anyway to fix that?

When I write an order for a test for which there isn't a diagnosis with code in the box above, I simply type in the diagnosis in the comment box next to the ordered test. You must type in the diagnosis before you click on the test or it won't show up even if you type it in. I click the order. Type in the DX and then unclick and reclick. I too would like to figure out how to add a coded diagnosis to the diagnosis chart when I'm in the order window. What I'm doing works so far. no complaints from xray or lab. If they have the written dx, they can code it themselves. After all they are the ones getting paid for the test...not me. They have enough info to do their billing if I give them the dx.

Open the chart, "Control N" for new visit, template in CC "As a consequence of labs" which is now my catch phrase for any event that offers me documentation (IE the lab, x-ray, ER note or Screening Mammo with micro calcifications) Then HPI box for brief explanation, "Routine mammo is returne with a finding of microcalcifications", then code the problem, 793.81 Mammographic Microcalcifications.
Only takes a minute and you have a solid record of the reason for the new Dx,and your action and when you took it.

I've edited the order sets and include the CPT code and for PSA, FOBT, and Mammograms, I include the appropriate ICD-9 in the order name.

Shows up as:
PSA, total (Prostate Specific Antigen) [CPT 84153] V76.44

We just updated to V5 and noticed that you no longer can add Dx's to orders on the spot - whereas we had that option in V4. Not sure if that's a CCHIT thing or not, but @DocMartin's solution makes a lot of sense (although it is an extra step if you're pressed for time). We might start doing that when we can, though.

- S.K.

You can add diagnosis codes - search for diagnosis and add - then click the order name / unclick and click which will add that diagnosis to that order.

I'm with Steven. I don't quite see why you can't do it. You open the orders window and look for the diagnoses which are already there. You click the box to clear them all, then select the one you want: Fever, then select the lab: CBC, and it is done after your print

If the diagnosis isn't there, you just use click on the Find A Diagnosis button at the top right and add the ICD-9 code. It will automatically be checked at the top.

Now, click on the lab you want and when you print, it will have the code where it should be and the lab where it should be.

A tip:

When you go into the order writer no matter how you get there, the first step should be to clear all diagnoses at the top. If there aren't any, then you are fine. After clearing them all, choose the one you want. If none are there to begin with or if after clearing them all, the right diagnosis isn't there, add the diagnosis as in the paragraph above, then choose your lab.

At first, we were unclicking and clicking, but there is no need of that as long as you don't select any labs until AFTER you have selected an ICD-9 code.

Ah! You're right! Didn't notice that little box... gave it a try today and it worked like a charm...

Thanks!

- S.K.

The frustrating thing is it works only for that req. If you close out and come back, it is gone. And, it doesn't add to the problems.

Order Question: Using AC for first time. While seeing patients I tried to send order to nurse for shots, labslips, etc. How does the nurse record that she has completed the order? Does documenting the vaccine accomplish this or does she just write "completed" in the comments and forward it back to me?

I am probably not the best one to answer this, as I pretty much do all the orders myself, e.g. print them and save them. I only send referrals to a staff member.

With the vaccines, it would be sent to your nurse in her inbox. She could then do whatever she wanted with that message. She could delete it, save it, or send it back to you and say OK. I think deleting it is OK, as she will be entering the vaccine in the record and this will go into the note, IF the chart has not been signed off yet. The advantage to her saving it, is it would give you something to compare it to if the wrong shots were given.

I guess I need more information to know the best work flow. Are you in the room seeing the patient at the time? Or are you seeing the chart before your nurse is. I ask because if you are in the room, then the flow is awkward (to me), because you have to send the order to her and wait for here to record the vaccines before signing off. Do you know how long you will be waiting for he/her? Of course, she can always record them later; they just won't be in the note.

For years, I figured out all the shots and then ordered them on the Superbill. But, I have found that once I delegated that to my MA, it is much better. In this scenario, she sees the patient, decides on the vaccines, records them so they are in the vaccine record and the bottom of the note. She forwards the chart to me, and if I am in agreement, I sign the note after I finish it. 95% of the time, she is right. If not, I delete it from the note, make the changes in what I want on the Superbill, and she gives those shots and makes the necessary changes in the shot record. Works for me. I just find the order setup a bit cumbersome. What if the nurse is in another room or what if she doesn't refresh her screen.

On the lab orders, she will get these in her inbox, but then she has to go back in and redo the requisition unless you had printed it out. In which case, she would just save it or delete it. For me, it has always worked best if I am the one printing out the order. I then send it to me and save it to the chart. I could send it to my MA, but I don't think that works as well. Again, I have the req in hand, the patient is in the room or leaving to get the specimen done somewhere else. If the nurse needs to get a urine sample or blood sample, I think leaving the patient in the room and hoping she reads her message is inefficient. It is just as easy for me to print an order for a CBC, save the order to the chart, put it in the rack on the door or give it to my MA verbally tell her I need a CBC in room 1.

Again, I am new to this order thing, and I have probably confused you, me and everyone.

Thanks so much! I understand it better now. We do our labslips on pre-printed labcorp/quest order slips so I am unclear how I would print a labslip from AC. Mainly I was unclear on the purpose of the order section and we were trying it out today. It is good to know that she can just delete the message. We are so used to keeping everything in the record that it never occurred to me to just delete. Thank you!

As to the labs to Quest, if you enter the labs and their codes into your system in the administrator's section, then when seeing the patient select the labs you want and hit "print", AC spits out a form with all the patient billing data, the diagnosis codes, and requested labs. Our Quest/Labcorp accepts that with no other forms or information, and I find it very quick.

There have also been some tricks developed to make the lab lists more user friendly. Check http://www.amazingcharts.com/ub/ubb...Re_Customizing_order_of_lab_te#Post20919

Wow! This is turning into a lot of saved time! Thanks for the shortcut! The nurses will be in heaven!

I can't believe that was helpful. I thought it was so confusing. David is completely right about the printouts. Plus, it cuts down on errors, and the lab can no longer say, that wasn't on the requisition. What they have is what you have.

I do have to say that I do not like the orders the way there are now. I have it on good authority that it is one of his priorities to clean it up a bit.

@David Thanks for the link. By the way, coming from someone with a Vitamin D3 level of 8 (now > 60 with 100,000 units weekly for two months), isn't D3 25-hydroxyvitamin D?

Now, all you need is my software program, Amazing Labels, and you'll be all set. But, you will need a Dymo 400 printer.

Bert, that's what you get for living in Maine. Same issues here. 25-OHD3 gets converted in the kidney to 1-25 Dihydroxy D3. Some of the renal guys look to that first. (And, score another .5 hrs CME on UpToDate for The Kid...)

I have a Dymo labelmaker. Tell us more about your program.

Cholecalciferol which is an inactive, unhydroxylated form of vitamin D3)

Calcifediol (also called 25-hydroxyvitamin D3), which is the form measured in the blood to assess vitamin D status

Calcitriol (also called 1,25-dihydroxyvitamin D3), which is the active form of D3

OK, so what is pediatrician to do? I always order 25, hydroxyvitamin D on my patients to assess their levels of Vitamin D. I have been told not to order the 1, 25.

I guess this is like T3, Reverses T3, T4, FT4, etc.

Next post for the software

OK, Amazing Labels is a small program which accesses the AC database. It also uses the Dymo print driver (if you have Dymo installed on your computer that you are running it on).

It then prints a lab label or a free text label or an address label, etc. The label includes:

Name of patient ##### Date/Time of specimen
Pt's DOB ######## Source: NP or throat, etc.

Between printing labs and using Amazing Labels, my lab error rate went down from just over 7% to under 1% You can also check a box to remove the Date/Time in case the patient is taking the specimen cup home like giving a urine sample, etc.

How do you handle the specimen labels?

Good point, and I don't have an answer. It comes up infrequently in my practice (adult males mostly), few paps, rare cultures, and the lab does the phlebotomy and urine collections. Maybe just staple a blank lab form to the request printed from AC and use the labels from that? Does Bert's labelmaker program suffice?

I know nothing about Quest (except for Johnny), but how does stapling a blank lab form to the AC req count as a label. I am asking, cause I don't know.

Our lab loves are labels because they can read them, and once again the beauty of it is it is exactly from AC so name spelled correctly, DOB correct, specimen date and time 100% accurate. The only chance for human error besides choosing the wrong patient is choosing the wrong source when you click on the drop down box.

My nurses tell me that if they just write the name and date of birth on a sticky label for the specimen and send it down with the lab slip from AC that our Quest lab accepts it. I didn't know if they needed the numbered tracking sticker from one of their lab slips or not, but so far, so good. I think they attach a bar code to the specimen downstairs in the lab anyway.