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[Gnumed-devel] How within GNUmed to use coding e.g. capturing the fact a
From: |
Jim Busser |
Subject: |
[Gnumed-devel] How within GNUmed to use coding e.g. capturing the fact and state of current pregnancies (?) |
Date: |
Sun, 25 Sep 2011 13:19:40 -0700 |
I am starting to think more how to use coding in GNUmed, from the point of view
of queries that will help in providing more-enlightened, evidence-based care.
Whichever way a particular pregnancy is entered (as an episode or as an issue)
it is desirable to be able to reliably determine, within a GNUmed praxis, who
is pregnant at any one time. Use cases include programs of vaccination where
pregnant women have been identified to be at special risk. Another use case
would be where it is newly identified that drug X confers previously
unrecognized dangers to the fetus.
In GNUmed, one could create a health issue
Pregnancies
where each of a series of gestations could be their own (rather long) episode.
Alternatively, each could be their own health issue wherein stages could each
be episodes…
… pre-conception
… conception confirmation / first trimester
… second trimester
… third trimester
… labor and delivery
… puerperium
Clinical problems which warrant separate status and tracking (Rh negative
patient, Rh positive father) likely warrant to be their own issue, even if they
would be identified within (in the course of) a pregnancy.
My question is how 'pregnancy state' would best be tracked?
ICD-9-CM and ICD-10-CM divide their codes based on whether a diagnosis or
problem was:
- a reason for the visit
(codes beginning with letters A through Y)
- vs whether a condition affecting health status was incidental
(codes beginning Z)
and also divides pregnancies into normal and high risk:
http://health-information.advanceweb.com/Article/Review-Obstetric-Newborn-Coding-Guidelines.aspx
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_022421.hcsp?dDocName=bok1_022421
http://en.wikipedia.org/wiki/List_of_ICD-9_codes_630–679:_complications_of_pregnancy,_childbirth,_and_the_puerperium
but what the patient *claims* to be (and what the doctor records to be) the
reason for the visit is sometimes affected by what will net the patient the
lowest out-of-pocket charges, on account of some care being 'covered' and other
care 'not'. Even if the entries were to be made 'consistently' there is a
problem in that the same biological state is being entered under two different
codes within the same coding system. Ugh!
Interesting from
https://www.cms.gov/ICD10/Downloads/7_Guidelines10cm2010.pdf
Page 96: Do not code diagnoses documented as “probable”, “suspected,”
“questionable,” “rule out,” or “working diagnosis” or other similar terms
indicating uncertainty. Rather, code the condition(s) to the highest degree of
certainty for that encounter/visit, such as symptoms, signs, abnormal test
results, or other reason for the visit. Please note: This differs from the
coding practices used by short-term, acute care, long-term care and psychiatric
hospitals.
Page 97: Chronic diseases treated on an ongoing basis may be coded and reported
as many times as the patient receives treatment and care for the condition(s).
Code all documented conditions that coexist at the time of the encounter/visit,
and require or affect patient care treatment or management. Do not code
conditions that were previously treated and no longer exist. However, history
codes (categories Z80- Z87) may be used as secondary codes if the historical
condition or family history has an impact on current care or influences
treatment.
Does there exist any 'best way forward' ?
-- Jim
- [Gnumed-devel] How within GNUmed to use coding e.g. capturing the fact and state of current pregnancies (?),
Jim Busser <=
- Re: [Gnumed-devel] How within GNUmed to use coding e.g. capturing the fact and state of current pregnancies (?), Jim Busser, 2011/09/25
- Re: [Gnumed-devel] How within GNUmed to use coding e.g. capturing the fact and state of current pregnancies (?), Karsten Hilbert, 2011/09/25
- Re: [Gnumed-devel] How within GNUmed to use coding e.g. capturing the fact and state of current pregnancies (?), Jim Busser, 2011/09/25
- Re: [Gnumed-devel] How within GNUmed to use coding e.g. capturing the fact and state of current pregnancies (?), Karsten Hilbert, 2011/09/25
- Re: [Gnumed-devel] How within GNUmed to use coding e.g. capturing the fact and state of current pregnancies (?), Jim Busser, 2011/09/25
- Re: [Gnumed-devel] How within GNUmed to use coding e.g. capturing the fact and state of current pregnancies (?), Karsten Hilbert, 2011/09/26
- Re: [Gnumed-devel] How within GNUmed to use coding e.g. capturing the fact and state of current pregnancies (?), Jim Busser, 2011/09/26
- Re: [Gnumed-devel] How within GNUmed to use coding e.g. capturing the fact and state of current pregnancies (?), Karsten Hilbert, 2011/09/26
- Re: [Gnumed-devel] How within GNUmed to use coding e.g. capturing the fact and state of current pregnancies (?), Karsten Hilbert, 2011/09/26