Flash Pulmonary Edema

bbogda@morrishospital.org

Our EHR is Meditech and they use the IMO to populate the Problem Dictionary.  We are running into an issue whereby the doctor is documenting the problem of flash pulmonary edema, which is included in the problem look-up with associated ICD-10 code of J81.0.  However, coding is saying that they cannot assume 'flash' to mean 'acute'.  Anyone else out there using Meditech and how are you handling problems/codes like this in Meditech?  It is frustrating for the doctors when it looks like they are picking an appropriate diagnosis only to be told they should be saying something else.

katysuegood@gmail.com

flash pulmonary edema does not code to acute pulmonary edema per the index. a query is needed for acuity.

morris-jeff@CooperHealth.edu

We've only been "live" with a fully electronic medical record since October 2017 but have found that the problem list is very problematic...no pun intended. The MD does believe that they are choosing the correct code or documenting correctly when they aren't.

evanspx@sutterhealth.org

IMO, the Problem List is woefully inadequate and nothing should be coded from this list unless supported consistently in the record - review all notes, assessments, evaluations, and so forth.  It should not be used for direct coding.

bbogda@morrishospital.org

I think some people may have different definitions of the Problem List and use it differently.  Meditech keeps a running list of Problems from visit to visit that can be designated as Active, Past, Resolved, etc.  Our doctors will pull pertinent problems from that list and add in new problems as necessary when documenting their daily progress notes.  They will then add any supporting documentation as needed.  The daily progress notes along with the dictated notes is what is used for coding.  We don't code anything unless it meets definition of a PDx or secondary diagnosis.  It becomes difficult when the doctors pick a diagnosis from the problem list that they think is appropriate (because it lives there) just to be told that we can't code that, we need them to say something different.  That is why I was wondering if using Meditch/IMO and how are they handling the issue of Problems that appear in the IMO like the Flash Pulmonary Edema associated with the ICD-10 code for Acute Pulmonary Edema.  Flash and Acute are not interchangeable, but we have had no luck with trying to get IMO to make any changes/corrections.

jackietouch@aol.com

bbogda@morrishospital.org said:

 That is why I was wondering if using Meditch/IMO and how are they handling the issue of Problems that appear in the IMO like the Flash Pulmonary Edema associated with the ICD-10 code for Acute Pulmonary Edema.  Flash and Acute are not interchangeable, but we have had no luck with trying to get IMO to make any changes/corrections.

I don't think the issue is just with Meditech. We also have the same problem with Cerner and the diagnosis assistant function. It assigns a clinical diagnosis (which does not populate the progress notes) that may or may not match the annotated display (which does populate the progress note).

Extremely frustrating for CDI and for physicians. We just keep clarifying and apologizing. I am sure the answer probably lies in the software and configuration/features, but seems like you have pursued that route already.

I wish I had a better answer for you

Jackie

lprescott1

Can you work with the vendor to change the wording from FLASH pulmonary edema to acute pulmonary edema?

bbogda@morrishospital.org

That is our problem.  We have found them to be unresponsive to our requests or just decline to make the change.

lprescott1

You likely need to incorporate some bigger guns to assist you. You should be very much involved in developing templates, drop down menus and choices. Look at your organizations reporting structure- and use your leadership to coordinate with your IT leaders to work with the vendor. this is not hard- but motivation needs to be applied.