The problems list on the Problems tab displays a patient's current and historical health care problems entered by clinicians. The problems list allows each identified problem to be traced through the VISTA system.
If a problem is service connected, the problem's service connected status is displayed in parentheses in the Description column.
Service Connected Condition Abbreviations
· SC - Service Connected Condition
· AO - Agent Orange Exposure
· IR - Ionizing Radiation Exposure
· SWAC - Southwest Asia Conditions
· SHD - Shipboard Hazard and Defense
· MST - Military Sexual Trauma,
· HNC - Head or Neck Cancer
The problems list on the Problems tab can be configured to show active, inactive, both active and inactive combined, or removed problems. Treatment factors, SNOMED CT codes, and ICD-9-CM codes display right after the problem text. If they have been specified by the provider, ICD-10-CM codes can be seen in the detailed display.
Codes to Classify Problems
Problems in CPRS are classified using three kinds of codes:
International Classification of Diseases, Ninth Revision Clinical Modification (ICD-9-CM) codes:ICD-9-CM codes are currently used for diagnosis and billing purposes. The VA was recently mandated to begin using ICD-10-CM codes. Because the codes are based on the service date, sites will not be required to update existing ICD-9-CM codes. However, new Problem List entries will be expressed in SNOMED-CT and new Encounter form diagnoses will be expressed in ICD-10-CM codes. If a user tries to add an inactive ICD-9-CM code as a diagnosis for an encounter with a service date after the ICD-10 activation date, the user will have to update the code to ICD-10-CM.
International Classification of Diseases, Tenth Revision Clinical Modification (ICD-10-CM) codes: The VA will select a date to begin using ICD-10-CM codes for items in CPRS. On the Problems tab standard view, users may see SNOMED CT codes and ICD-9-CM codes. On the Problems tab, providers will usually enter problems as SNOMED CT terms with their code, but from the encounter form, a provider can enter a diagnosis as an ICD-10-CM code, but when the provider checks the box to add the problem to the Problem List, they are prompted to search for a SNOMED code. When the user selects a problem from the Problem List to view the details, both SNOMED CT and ICD-10-CM codes are shown.
Systematized Nomenclature of Medicine concept terms (SNOMED CT) codes: For diagnoses and problems entered from the Problems tab, providers will use SNOMED-CT terms.
International Classification of Diseases (ICD) codes and Systematized Nomenclature of Medicine concept terms (SNOMED CT). ICD codes are primarily used for billing purposes while SNOMED CT codes define problems in ways that health care provider would use. Previously, only ICD codes were used to define problems. The availability of SMOMED-CT codes should help providers better define problems, while also mapping to ICD codes in the background. With ICD-10-CM codes, more sharing of data with other healthcare organizations will also be possible.
ICD codes are still used on the Encounter form to define a problem (enter a diagnosis for billing purposes mostly) . SNOMED-CT may be mapped to ICD-9-CM codes, but does not include all possible terms a provider may want to use. Currently, the VA is not mapping SNOMED-CT terms to ICD-10-CM codes.
How Are ICD-9-CM Codes Terms or Codes Updated?
Every time a new and unmapped problem is selected from the Extended Search, a request is made for the problem to be added to the Problem List Core Set and the unmapped problems updated from the 799.9 to the appropriate ICD-9-CM code by the New Term Rapid Turnaround (NTRT) process. The NTRT deployment process, adds the term to the core set so that it is available for future searches as well as it updates the patient's record with the new ICD-9-CM code (s). The Problem List Audit History Log captures the update and can be viewed in the Problem List tab in the detail view of the problem. This takes place without the need for any further input from users or CAC's involvement.
When new terms are requested following an Extended Search or the user applies for a new term, a request is made for those terms to be found within SNOMED-CT. If there are already suitable terms in SNOMED-CT, then such a problem can be added quickly to the core. If the terms do not exist in SNOMED-CT, then the requested term(s) are forwarded to SNOMED-CT's curators at IHTSDO. If or when SNOMED CT has incorporated the term into the SNOMED CT release, new terms will be added to the core set.
Standards Development Organizations (SDO) make updates to their terminologies on a regular basis, and these changes are transmitted to the Problem List core set by the NTRT process. The SNOMED CT subset is updated through the Lexicon Utility Quarterly update process. Such updates require no input from users.
Are ICD-10 Codes Mapped to SNOMED Codes?
No, the VA does not use a mapping between ICD-10-CM terms and codes and SNOMED terms and codes. Providers must select the appropriate codes. Any updates to codes come from terminology updates and happen automatically. On the Problem List, providers define problems using SNOMED and those problems are automatically assigned an R69 ICD-10 code (an undefined diagnosis). Assigning an ICD-10 term and code along with the SNOMED term and code happens from the Encounter’s Diagnosis tab.
On the Encounter’s Diagnosis tab, providers assign one or more diagnoses for the encounter using the Lexicon search tool or prepopulated sources such as the Problem List Items or encounter forms assigned by the site. If the user selects an item from the Problem List Items that has a SNOMED code, but is undefined in ICD-10 (has an R69 code), CPRS will prompt the user for a more specific ICD-10 code because an encounter cannot be completed using an R69 code. The user can then select the Add to Problem List check box to associate the SNOMED and ICD-10 codes for this specific instance only and make the ICD-10 code show up in the problem’s detailed display.
Note: Assigning an ICD-10 code to a SNOMED term on the Problem List does not mean the terms are further connected. To link the SNOMED term and ICD-10 term, the provider will have to manually define the relationship each time.
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