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ICPC, comparing the ICD9 or ICD10 codes, where is the logic taking us.

Pieter W
2013-10-05
2015-04-04
  • Pieter W
    Pieter W
    2013-10-05

    I try to include the ICPC codes into OpenEMR. This general Physician coding has chapters, divided into encounter, issues, diagnoses and procedures.

    By trying, I found CPT4 is more or less the same as ICPC procedures coding.

    Trying to find where ICD9 is used in OpenEMR I only can find the code in Fee-sheet and only the E000... codes are included during import of ICD9 codes.

    To make full use of the ICPC-code system, should I make my own Layout Based Visit Forms with List, Codes and NN?

    (These are only the first few steps for me to concur in using ICPC, next step will be how to retrieve the input in a nice layout output) Who is willing to give a helping hand and guide me with hints on how to continue to take my next steps.....

     
    Last edit: Pieter W 2013-10-05
  • Kevin Yeh
    Kevin Yeh
    2013-10-05

    You can make ICPC codes available anywhere other codes are available if you do three things.

    1. create a new table for your codes. It needs at a minimum the code and a description.

    2. create an entry in the code_types table for ICPC. The ct_id should be something greater than 100 that doesn't conflict with existing types, and give it a new non-conflicting number for ct_external.

    3. define metadata based on how you created the table in step one.
      See the relevant code here:
      https://github.com/openemr/openemr/blob/master/custom/code_types.inc.php#L113

    Hope this can get you started.

     
  • fsgl
    fsgl
    2013-10-06

    Hi Pimm,

    I presume that you don't have the ICPC codes yet in your copy of 4.1.2. because there would be no reason for your asking assistance with Layout Based Visit Forms. Therefore I understand the question to be about import.

    Speaking about imports, phpMyAdmin in 4.1.2 works fine (as you already observed) even if the corresponding Demo is a bit strange (also observed by you).

    The article on Code Types will guide you through setup in Administration/Lists/ Code Types and also with import.

    A quick look through this .pdf file suggests that the Process codes are used like CPT codes while the rest of the codes as diagnosis codes.

    It does not seem that the type of codes that you employ should have any bearing on your Layout Based Visit Forms. Your LBV Forms are tailored to the way you record your clinical notes irrespective of whether the codes are CPT, ICD, ICPC or whatever. Perhaps this may not be the case as my understanding of ICPC codes is limited.

     
    Last edit: fsgl 2013-10-06
  • Pieter W
    Pieter W
    2013-10-06

    Thnx for the info. Have to do some reading.

    Q1: Now for those of you who answered, and others with special interest in advise, do you have knowledge on what other places the ICD-codes are used in the regular OpenEMR versions? I only could find them back in Fee sheet?

    Q2: The ICPC-Procedure-Codes are more or less a part of different Chapters, depending on what chapter.

    (Chapters are: Blood, Digestive system, Ear, Eye.... to give a few examples. Should I make the Chapters choice available with procedures for the specific Chapter, or should I make it, as the first option, make a choice of Chapter followed by the choice of procedure?)

    Example: Test of vision has nothing to do with test of pregnancy to make a choice seems not so important, but on the other hand for registration purposes it might be important to know that the Hb test was done for menstrual problems or digestive tract bleeding.

     
  • Pieter W
    Pieter W
    2013-10-06

    Working my way deeper and deeper into the Fee sheet I encounter many great option. J and P if you want to make a connection for CPT4 (procedures.

    J is to include into the Journal of the patient, "running" issues (Nothing to do with Justify)
    P is to include into long term diagnosis like Allegy or High blood pressure (Something to do with Medical Diagnosis that stay or need to be deleted after cure)

    I reviewed this WIKI page and made some corrections for the Code-Types and clarification on Justify and related matter:

    http://www.open-emr.org/wiki/index.php/Code_Types#Configure.2FAdd_Code_Types

    Please review and correct where needed.

     
  • Stephen Waite
    Stephen Waite
    2013-10-06

    Hi Pieter. I'm checking out your handiwork on the demo and the wiki. Thanks for the investigation and the editing. I see that ICPC originally began in Australia, OI?!?

    Another important use here in the US is the tracking of clinical quality measures, many of which are enabled through the use of ICD-9 codes; when you add a medical problem from the main patient screen you can search the Diagnosis codes. By clicking once in the diagnosis field in the pop up window you can then search if you loaded them thru the External Data load option or like you are thru phpmyadmin.

    You'll see the clinical reminder widget on the right side of the patient screen come to life if you select a diabetes code.

     
  • Pieter W
    Pieter W
    2013-10-07

    I decided on Chapters (17) for first impression for Procedures.
    Procedures are divided in -30 to -69 and these will be connected to Chapters (just to get an impression what the relation is between test and problem and why the test were ordered in the first place)

    Chapters (17 in total) are also divided into:
    1) Uncertain Diagnoses, (example: chills, fever, skin itching, loss of appetite) Chapter character followed by code 01-29 (Could also be named reason for encounter or "S" in Soap)
    2) Diagnoses Codes (examples: rubella, appendicitis, foreign body in ear, Parkinson) Chapter followed by Code 71-99 (could also be called diagnosis or final result of the encounter, the "P" in SOAP)

     
  • fsgl
    fsgl
    2013-10-07

    The ICD9 codes are used in conjunction with CPT Category II codes to provide documentation for Meaningful Use Attestation. The Standard Measure should calculate the numerators and denominators but for the Eye related procedure codes that functionality is not yet available. A work-around is to use both ICD9 codes with the PQRS (CPT Category II) codes to render the numbers.

    From the Clinical Report one can pull up data for clinical trials and for epidemiological studies if ICD codes are used as parameters.

    In my own practice I use the ICD9 codes in Impression (Assessment of the SOAP) because it is a lot faster to type 366.16 instead of Nuclear Sclerosis. I could use the CPT code 92015 for Refraction, but it is not specific enough to use in Plan.

    Sometimes I give the patient the prescription for the glasses, sometimes I don't. Sometimes the prescription is for distance and near, distance or near and at other times the prescription is for glasses to be used at the computer.

    Diagnostic studies are ordered so rarely that I would not remember the CPT codes for entry into the LBV forms. I would have to look them up and therefore it would not save time to use those CPT codes in the clincal note.

    From your revision of the Wiki article, it appears that the ICPC codes can be deploy in all sections of the SOAP note except in Objective. That should make data entry into the clinical more efficient and more precise.

     
  • Pieter W
    Pieter W
    2013-10-07

    Wow this is important INFO fsgl! Are you sure about the relationships? Or is it just the opposite? CPT-II connected to ICD9. (can you post a screenshot of the Lists =>Codes-Types? Also important to see the other parameters used for Code-types)

    Theorizing: A=assessment P=planning (SOAP)

    S Patient comes in office with some kind of medical problem. I code as Chapter Eye-problem as first impression (a general code for complaint of the client), or I code something more specific like needs a referral to eye-specialist for glasses.

    O objectivation-process, can be short or long observations like: does the client really needs new glasses or is it an eye infection......

    A needs a code for assessment of the problem, You think what is really wrong and confirm this with your diagnosing approach. (could be your refraction-code of CPT-II)

    P needs a code for your diagnose. Give a prescription for new glasses or not. Yes the conclusion during A was to give glasses so during the code for P conclusion is to give the prescription for new glasses. (could be coding your prescription more specific with refraction particulars and other problems)

    Please correct me if my assumptions are wrong. I want to get my ICPC coding construct right before I ask Brady to guide me on how to include it in Import codes)

     
    Last edit: Pieter W 2013-10-07
  • fsgl
    fsgl
    2013-10-07

    Hi Pimm,

    When a Medical Problem is entered into Issues, the ICD9 code can be searched and added. It does not really help for Meaningful Use Calculation entering both the Description and the code in Issues. The ICD 9 and the CPT codes have to be searched independently in Clinical Report to give the numbers for MU.

    See attachments. Be certain that each line is checked and that No is selected, otherwise nothing will show up in Codes.

    Your SOAP schema seems fine.

    I've not downloaded the ICPC codes to get a good look at them. If they are in ASCII format, which I believe is the format for the CPT data set, you may find this section of Brady's article helpful with import of the ICPC codes. As you already know, External Data Loads is not available for the ICPC codes.

     
    Last edit: fsgl 2013-10-07
    Attachments
    • Kumara Mendis
      Kumara Mendis
      2015-04-04

      Hi fsgl

      Thanks for suggesting the methods to include ICPC

      I have done a LB Form for patient visit - text entry and coding - Fig 1 & 2 attached

      Facilities to search and enter a new 4 digit code is also possible at the time of the encounter -Fig 3 attached

      Hope this is helpful for ICPC users

      Kumara

       
  • Pieter W
    Pieter W
    2013-10-07

    Tnx for comment and image of Code-types. Will have to study a bit more. Wish ICPC was included, should have saved me a lot of trouble. Once I get the rules/semantics correct, I will try to convince Bray to guide me for inclusions of ICPC Codes. (He promised so, but that was some time age....)

     
  • Pieter W
    Pieter W
    2013-10-07

    Somebody changed (the Username and) Pass so I can't test today. Have to wait for reset. Also the alternative is not working with promised admin and pass

     
  • fsgl
    fsgl
    2013-10-07

    The 4.1.1 and 4.1.3 Demo's are available for experimentation with the Code Types.

    OK, components are all parts of the evaluation and treatment of the patients. It is clear that components don't need to go into the .sql file, therefore the above cited section of Brady's article should work for construction of the file with the Descriptions and the Codes.

     
    Last edit: fsgl 2013-10-07
    Attachments
  • Kumara Mendis
    Kumara Mendis
    2015-03-27

    Hi Peter

    I have been reading the very interesting tread about ICPC
    I need to get even a simple list of ICPC codes that is available for diagnosis and problem list (ICD-9 is too complicated) and we do not use it (only on hospitals and not for billing)

    I have been a member of the Wonca classification committee from 1998 and is familiar with coding reason for encounter, process and problems.
    However I have minimal knowledge of MySQL etc...programming and a newcomer to OpenEMR

    Not sure exactly how everything can be coded using a single drop down list as sometimes we have to combine a chapter and a rubric from different places to MAKE a code.

    Also ICPC has give the option of making the 4th digit codes for a particular instance (within a set of rules) e.g. snake bite (from Animal Human bite S13.1)

    So my question is can we get the CSV file icpc-2e-v4.4-all-csv into MySQL and allow codes to be searched from the 'Preferred title'
    AND
    we have to have the option of also making codes on the fly so that it goes into a supplementary list and can be reused.

    If we do this can we have ICPC installed from the option that we have for ICD-9 and the others?

    Hope this makes sense?
    Happy to continue this discussion until we find a solution

    Is there any other way to do this?

    Kumara

     
  • Pieter W
    Pieter W
    2015-03-27

    http://www.kith.no/templates/kith_WebPage____1110.aspx

    Now if you use the code for statistics and not for selling it is my interpretation it is FREE. Best thing to do is ask the owner of the website if my FREE ideas are the same as theirs.

    You make lot of sense. If you take a look at my ideas of importing ICPC code, you might come up with a better solution. I am a General Practitioner also not a Developer. Usually if OpenEMR crowd get the smell of something worthwhile, they will join in (our =>) your efforts to implement something.

    For the time being iam stuck and don't know how to continue to get ICPC implemented in a logic way.

     
  • Kumara Mendis
    Kumara Mendis
    2015-03-31

    I assume that we are all speaking and writing the same language - English. I agree that we are using ICPC for personal reporting and (maybe) decision support purposes.

    Ok I got ICPC into the OpenEMR - got a module written that allows ICPC to be accessed as we use ICD9. This also gives option of adding any 4th digit codes to the original ICPC database through the OpenEMR screen.

    In addition I designed a new SOAP form using the LBFs and included ICPC for RFE, POC and PD. I could code from the SOAP encounter form for any of the three.

    In addition I could also use ICPC to code medical problems on the summary screen.

    Will include a few screenshots.

    This is just a quick try...will have to test this in real-time.

    Kumara

     
    • Pieter W
      Pieter W
      2015-04-01

      Screenshots look promising, great work! Is it possible also to include inclusion-, and excluding- criteria?

      Also it would be nice to find the correct code by tractus search. If the User does not use the correct word, it is sometimes easy to look in a Chapter that most probably contains the Sx or Dx.

       
  • Kumara Mendis
    Kumara Mendis
    2015-04-04

    Think it should not be a problem at all.
    The module was written by a programmer and I have to look at what fields from the ICPC Excel sheet he has included.
    My requirements were - the CODE and long description and the ability to add new codes from the interface.
    From a single search box it will search the long description - for now.
    Its a simple search.