Home Forums ambiguous ICD-10 descriptions

I am concerned about multiple diagnoses. I will give specific examples: I10 and E78.5 both have multiple descriptions in COSTAR. Amazing Charts support thinks it is easier for us to put the description of a code in to search rather than the actual code. If I put the description in, I can have at least 4 types of hypertension and 2 types of hyperlipidemia that respectively each have the SAME ICD-10 code. I am very concerned about this thinking that it would be much better to condense the descriptions into 1 each. Amazing Charts does not seem to understand my concern, I could show you a screen shot, but I do not know how to upload.

If you think that is weird; ICD10 code Z00.129 is wellchild check without abnormalities and Z00.121 is well child check with abnormalities. If you check AC it states "seen by pediatrician" for Z00.129 and "seen by pediatric neurologist" for Z00.121 If you want to get the proper description you have to choose z00.1 and refine the selection to choose z00.129 or z00.121

To me this is rediculous, adding more clicks to get the proper diagnosis code and description.

I think Amazing Charts needs to refine a few of these commonly used codes for commonsense.I realize we cannot change ICD 10, but conversions and other can be customized for us by Amazing Charts, let us start the bandwagon going.

I think I know what you mean. I'm not sure what COSTAR is but AC told me they use SNOMED database for their ICD codes and descriptions. Apparently those are the multiple descriptions that are being shown when you are searching/adding Dx codes in the Encounter screen.

Because, as you say, they are not condensed into one description, it forces you to make extra clicks into "Lookup Dx" and select the right one.

This is what we are running into when giving Pneumonia and Influenza immunizations:


Its ridiculous. Especially when ICD 10 is supposed to be organized more "logically." This may be SNOMEDs fault for having multiple descriptions though because the official ICD 10 Code book does list Z23 as "Encounter for Immunization" only.

I hope AC can clarify here why the multiple descriptions as mkweiss stated.

If AC thinks that, please explain how typing out "Need for prophylactic vaccination and inoculation against __________" is easier than typing "Z23"?

For more confusion, if you are searching for Dx codes from the Main window of AC from View > Diagnoses Codes, none of these multiple descriptions show up. Instead, the exact descriptions from the ICD 10 Code book are listed.

It would be much easier if these results showed up while in the Encounter Screen's Diagnosis field.



And lastly, to upload a screenshot image you simply press the 5th button from the left in the quick reply:

With regard to the immunization coding issue, again I will preface my comments by stating that I don't give immunizations so I may be speaking out of turn. Oddly enough I think the confusion stems from the fact that ICD10 actually simplifies the coding, rather than making it worse. Take a look at this AAFP article which would seem to confirm this:
"ICD-10 recognizes that the type of vaccine you report with a CPT or HCPCS code gives sufficient detail about the type of immunization the patient needed. So rather than having you provide individual diagnosis codes for each vaccine, ICD-10 allows you to report code Z23 for an encounter involving immunization regardless of the type or number of vaccines. This is especially advantageous when reporting multiple childhood immunizations."
All of those descriptions you show above become irrelevant: the only code you need is Z23.

Jon,

What is of concern to me, and probably others, right now, is what is being entered under the assessment portion of the chart, when one selects the ICD 10 code from the search bar. It is extremely relevant what you record as a diagnosis in the chart as it is a legal, discoverable document. I would think that a lawyer and a jury are going to pay a lot more attention to what the verbal description of the problem is as opposed to a number. There is a big difference in charting a measles vaccination versus an influenza vaccination, even though the ICD 10 code is the same. I will give you another example of a real world problem right now. I am trying to code the diagnosis of "prostate nodule" on a patient I just diagnosed, who may have prostate cancer. If one goes on the web to research this, such a description no longer exists. The formal code now is Nodular prostate without lower urinary tract symptoms (N40.2). The two descriptions in the drop down menu of AC: "hard prostate" and "craggy prostate"!! (I wish Josue was here to help me take a screen shot of the descriptions, because I have not figured that part out yet). Neither of the two diagnosis descriptions conveys what I am finding on his physical exam.

Mel use snipping tool to take screen shots

http://windows.microsoft.com/en-us/...rc=ia&iaaid=50012900&ialnk=title

I cannot get the Snipping tool to work inside of an open note. Every time I try to snip the image, the ICD 10 descriptions disappear. HELP

In the meantime, I decided to cut and paste a more accurate descriptor for the prostate nodule (Nodular prostate without lower urinary tract symptoms) in the assessment portion with the same code, to take the place of "hard prostate". Theoretically, then, this should work, as the billing portion of AC will recognize only the ICD 10 code. Although cumbersome, this appears to be a work-around and I will try it for the influenza vaccine.

CRAGGY PROSTATE? Are you kidding me? Anybody ever wanted that diagnosis? Where did they get this ICD10 database?

Just out of curiosity, I typed craggy prostate into a conversion tool. Yup, no such thing in the official lists.

Once you have the Snipping Tool open, go back to AC with the ICD 10 descriptions showing, and then press the CTRL and PRT SCR keys. No you can use the mouse to snip the portion of the screen.

(Your keyboard should have the PRT SCR key near the top right.)

Josue: Every time I go to try to snip a picture of the drop down descriptions, they go away. Can you try doing it on a test patient and see if you can get it to work? I resorted to taking a screen shot with Paint to see if this will work. This is what comes up for the N40.2 code.

When I use the snipping tool I save the snip as an image give it easy to remember name then insert it into the reply box by choosing the 5th icon for "Enter inline image"

and here is a snip of a chart



I can get the diagnosis options to stay in the snip if I do the search from the Lookup Dx button but not if searched from in the Diagnosis box above the Problem List

I think it may be a good idea to ask all of the ICD-10 questions in one thread. I posted under Catherine Lehmann's Post at:

http://amazingcharts.com/ub/ubbthreads.php/topics/67190#Post67065

This may allow us to develop our own FAQs, and allow her to answer questions when she can. Obviously, there will be some threads that are very specific. I don't think I have ever tried anything like this. But, I don't think we have had to adjust to anythinig so confusing before. At least it is confusing for me.

Hi, N40.2 Nodular prostate without lower urinary tract symptoms will be placed on the list for being added to the ICD 10 Vocabulary. It has a SNOMED code which makes it an addition to COSTAR which is better than just adding ICD 10s that don't map. As regards the Flu Vaccine, we are working on that. We hope to have the Z23 code return " Encounter for Immunization" at the top of the list. We are also adding the well child codes so this frequently occurring encounter does not require a refinement. The transition to ICD 10 is... an interesting process and I thank you for your patience

Doctor Mel, I was able to using a Windows 7 and 8.1 computer. When you open Snipping Tool on Windows 7, you may need to press Esc first, then go back to AC. Then (just as you took that screenshot with the WINDOWS and PRT SCR keys) , instead you press the CTRL and PRT SCR keys while the green descriptions are still showing. (i.e. you should be typing N40.2 and immediately after pressing CTRL and PRT SCR). Now the little snipping tool window should come forward and you should be able to select New ___ Snip.

Here's the directions copied from Windows support page; it may explain it more clearly: