Keeping Diagnostic and Procedure Codes Current

This section discusses use of the International Classification of Diseases, Tenth Revision Clinical Modification (ICD-10-CM) coding system in CPRS and how to identify inactive codes in CPRS.

Using ICD-10-CM Codes

As of October 1, 2014, CPRS will use ICD-10-CM codes to store diagnosis codes in several locations in CPRS. The ICD-10-CM codes will not replace diagnosis codes already entered as ICD-9-CM codes, but all new diagnosis codes in Clinical Reminders, Consults, and the encounter form, will be ICD-10-CM codes. There will be no requirement to update existing entries because the diagnosis codes will reflect the coding system that existed when the diagnosis was entered.

Diagnosis codes on the Problem List will primarily be SNOMED-CT codes, but will show ICD-10 or ICD-9 codes also, if they apply.

Identifying Which Coding System Is Displaying

Because there will be the possibility of several types of codes being visible in CPRS, each code will be followed by text stating what coding system is being displayed:

SNOMED-CT or Systematized Nomenclature of Medicine concept terms: Codes in the SNOMED-CT display with the Short Description (Coding system code). For example, Keratinous cyst (SCT 419603000)
ICD-9-CMor International Classification of Diseases, Ninth Revision Clinical Modification: The text format will be something like the following: Short Description (coding system code). For example, ILIAC (ICD-9-CM 451.81).
ICD-10-CM or International Classification of Diseases, Tenth Revision Clinical Modification: The text format will be something like the following: Short Description (coding system code). For example, Amyotrophic lateral sclerosis (ICD-10-CM G12.21).

ICD-9-CM	ICD-10-CM
3-5 characters in length	3-7 characters in length
1^st character is numeric (chapters 1-17) or alphabetic (E or V for supplemental chapters)	1^St character is alphabetic; 2^nd character is numeric
2^nd, 3^rd, 4^th, and 5^th characters are numeric	Characters 3-7 are alphabetic or numeric (alphabetic characters are not case sensitive)
Decimal after first three characters	Decimal after 3^rd character

Users will see changes in the areas where ICD-9-CM codes were used previously:

Cover Sheet– Under the Active Problems pane, users will see problems with SNOMED and ICD-9-CM codes. ICD-10-CM codes do not appear on the Problem List, except in the detailed view of a problem.
Problem List– On the Problem List tab’s list and detailed views
On the Encounter form’s Diagnosis tab – On the Diagnosis tab of the Encounter form, users now select diagnosis codes from the ICD-10-CM code set.
Consults tab– When selecting a provisional diagnosis, the user will use ICD-10-CM.
Reminder dialogs– When dialog are constructed to include the addition of codes, those codes will now use ICD-10-CM codes.

Identifying Inactive Codes in CPRS

Code set versioning (CSV) modifies VistA to comply with the Health Insurance Portability and Accessibility Act (HIPAA) stipulations that diagnostic and procedure codes used for billing purposes must be the codes that were applicable at the time the service was provided. Because the codes change, CPRS currently checks ICD and CPT code validity as of a specified date when codes are entered, when a new code set is implemented, and whenever Clinical Application Coordinators (CACs) or IRM personnel choose to run the option.

CPRS GUI users will see indicators for inactive codes on the Cover Sheet, Problems tab, Encounter form, and in Clinical Reminders (although the Clinical Reminders changes may be less apparent).

In these GUI locations, any diagnosis or procedure codes that are inactive or will become inactive by a specified date because a new code set has been installed display with the "#" symbol in front of them as shown in the following examples.

Cover Sheet Displays

On the Cover Sheet, the active problems display. Users can quickly see if the patient has any inactive codes for the active problems. The "#" symbol shows the user that this active problem has an inactive code.

If the user tries to get a detailed display of the problem, the user first gets a warning about the inactive code.

The warning message instructs the user to correct the inactive code from the Problems tab. When the user closes the warning dialog, the detailed display then comes up. The "#" symbol in the detailed display also shows that the code is inactive.

Problems Tab Display

On the Problems tab, users are alerted to inactive codes in two ways. The first time the user goes to the Problems tab if there are problems with inactive codes, a dialog displays that tells how many problems with inactive codes have been found.

Note: This dialog appears only the first time the user goes to the problems tab for that patient in a session. When the user closes the dialog, the Problems tab display. Problems with inactive codes have the "#" symbol in the status column.

The detailed display of a problem also indicates that the current code is inactive. Users should use the Change feature to associate the problem with an active code.

Encounter Form Display

The Diagnoses tab of the Encounter dialog displays a "#" next to the code if the code is inactive.

If the user tries to select that diagnosis the following warning displays that tells users about codes that need to be updated through the Problems tab.

Consults Tab Display

For Consults and Procedures, only active codes will be allowed for the following functions:

Lexicon look up for provisional diagnosis as of the ordering date
Copying or changing existing orders (the consult or procedure will not be accepted until a valid code is selected)
Edit/Resubmit, the original code will be checked to see if it is active, if it is inactive an active code will need to be entered before CPRS will accept it

Clinical Reminders

CPRS GUI will only display codes that were active in the reminder date range.