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Electronic Medical Records

  1. #1
    Location
    Dover Seacoast New Hampshire
    Posts
    2,030
    Question Electronic Medical Records
    Medical Coding Books
    We've recently implemented the EMR component of our billing software with mixed results. Although the templates for HPI, ROS PFSH and Exam are wonderful, there are a couple of issues that are causing coder heartburn.

    The issue of billing a preventative visit with a sick visit at the same time has always been a sticky one, with our most recent, prior-EMR policy was that the provider must dictate two separate notes...one with the exam components(or a separate handwritten exam form) and the other for the sick visit in standard SOAP format. This worked pretty well, and helped support the whole "separately identifiable/additional work" thing that CPT outlines, but our new EMR product cannot clearly separate this data in a way that could be considered separately identifiable. Additional dictation is not an option, nor are we able to attach a preventative visit template onto the sick visit template. Basically, we view one SOAP note, which lists one CC (preventative), a list of chronic problems, occasionally an HPI, med list, PFSH, an examination, Assessment/Plan, (V70.0, and the same chronics that were listed previously, along with the update on meds, labs (these are sometimes linked to a chronic Dx), and occasionally a referral, but neither the meds or the referral show documentation of what condition they are related to. Occasionally the HPI and ROS don't even relate to each other...for example, HPI details foot pain, and the musculoskeletal ROS states, "no joint pain or swelling, no weakness, normal gait". That 's the "Normal" button on the ROS. Yikes! My solution was to create a separate EMR encounter, but other than the coders, I have very few supporters of this idea.

    I will admit that provider training is an issue, as is computer saavy. Still, our documentation guidelines have not changed, and in the above instance, I certainly cannot pull out either a separately identifiable visit, nor can I support additional work that would not normally have been done during a CPE. Any one else living this nightmare?

    Pam Brooks CPC
    WDH, Dover, NH

  2. Default
    We are currently in the process of EMR and would like to know what software you are currently using?

  3. #3
    Location
    Dover Seacoast New Hampshire
    Posts
    2,030
    Default
    We're using NextGen practice management software.

    Pam Brooks, CPC

  4. #4
    Default
    We are going live with our first site for outpatient EMR Feb. 08. We are getting our system built by Epic. I am sure we have the same concerns, what with smart text programs and the ability to document more than is really necessary for those "simple" visits.
    ___________________________________
    Michelle Wood, RHIT, CCS-P, CPC, CPMA, CEMC, AAPC Fellow
    2018 AAPC Columbus, Ohio Chapter Treasurer
    treasurer.aapc.colsoh@gmail.com

  5. #5
    Default
    I am a training coordinator for an EMR / PM system. My suggestion for billing a preventative and sick visit is to create two separate encounters. This way your system will recognize both the sick visit template and the preventative.
    The key to getting the most out of your EMR is to ask any and all questions when you are going through training. If you still are unsure you should have a "hotline" number to call for support. especially through the first couple of months when you will run into about a million senarios that you did not think about during training.

  6. Red face Sick/Well Encounter
    Tammy,
    As of 9-1-07 our facility became an FQHC (Federally Qualified Health Center), we are going to look at Nextgen software. Could you share you wow's and woe's of this program.

    Thank you,
    Dawn May, CPC

  7. #7
    Default
    Pam
    I am not real familiar with the Nextgen system. The only downfall that I can think of is that it is a web based system, that means if your internet goes down or even if their internet goes down, your practice goes down.
    The best systems are generally Lynix based. To date they have no known viruses, and they do not "go down". They also have an on site server and are backed up randomly several time a day off site. (This is something that you should find out if Nextgen does).
    A couple of the possitives about Nextgen are the customizations that they offer.
    I have actually never worked on this system so my suggestion would be to contact the company and find out if they have any clients that would be willing to sit down and talk about their personal experience with the program and the support that they recieve from the company, and what the turnaround time is for upgrade and customizations.
    I would also try to find out what type of training support you will have and if they put a timeframe on that support.

    Best wishes

  8. Cool re: EMR
    Hi Pam, I'm new to coding and just completing an externship---can feel the pain of coding and I don't have the job yet. That is a real problem with the EMR not having the correct components what a coder needs for documentation---nobody ever involves coders when they undertake a new M.I.S. system implementation---come one computer programmers write and code the program for the EMR---they don't understand a coders' job responsibilities fully. Also, the headaches with the electronic billing---I think coding is fading away---some day all the codes will be built into the system and up for acceptance and/or rejection of claims. One wonders if they should pursue the coding field?

    Terry
    CPC-A


    Quote Originally Posted by Pam Brooks View Post
    We've recently implemented the EMR component of our billing software with mixed results. Although the templates for HPI, ROS PFSH and Exam are wonderful, there are a couple of issues that are causing coder heartburn.

    The issue of billing a preventative visit with a sick visit at the same time has always been a sticky one, with our most recent, prior-EMR policy was that the provider must dictate two separate notes...one with the exam components(or a separate handwritten exam form) and the other for the sick visit in standard SOAP format. This worked pretty well, and helped support the whole "separately identifiable/additional work" thing that CPT outlines, but our new EMR product cannot clearly separate this data in a way that could be considered separately identifiable. Additional dictation is not an option, nor are we able to attach a preventative visit template onto the sick visit template. Basically, we view one SOAP note, which lists one CC (preventative), a list of chronic problems, occasionally an HPI, med list, PFSH, an examination, Assessment/Plan, (V70.0, and the same chronics that were listed previously, along with the update on meds, labs (these are sometimes linked to a chronic Dx), and occasionally a referral, but neither the meds or the referral show documentation of what condition they are related to. Occasionally the HPI and ROS don't even relate to each other...for example, HPI details foot pain, and the musculoskeletal ROS states, "no joint pain or swelling, no weakness, normal gait". That 's the "Normal" button on the ROS. Yikes! My solution was to create a separate EMR encounter, but other than the coders, I have very few supporters of this idea.

    I will admit that provider training is an issue, as is computer saavy. Still, our documentation guidelines have not changed, and in the above instance, I certainly cannot pull out either a separately identifiable visit, nor can I support additional work that would not normally have been done during a CPE. Any one else living this nightmare?

    Pam Brooks CPC
    WDH, Dover, NH

  9. #9
    Location
    Dover Seacoast New Hampshire
    Posts
    2,030
    Default
    Thanks, Tammy. Our Medical Information Director took one look at the one EMR note and immediately facilitated a policy to generate two encounters to support the 'separately identifiable' need. Phew!

    Terry, I just got back from the NextGen conference, and although the software works great right out of the box, it does require a great deal of template building and customization...both of which require coding expertise and training. I don't think I have to worry about a job for awhile! The trick is to stay up-to-date with coding changes and guidelines. Pam

  10. #10
    Location
    Stuart, FL
    Posts
    26
    Default
    We are currently in the market to purchase an EMR and I am glad you posted this comment because this will likely be an issue in our practice as well. Please keep me posted if you find resolution...in the meantime I will query the few vendors we are dealing with to see what there suggestions are.

    Rachael Milley, CPC
    Martin Memorial Medical Group

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