Fee Sheet Copy Diagnoses from Previous

Developers
DrKay
2012-11-10
2013-04-06
  • DrKay
    DrKay
    2012-11-10

    We need the ability to copy the ICD diagnoses from the previous fee sheet to the new one for hospital billing. The current method is laborious and redundant, requiring the biller to manually re-enter all the diagnoses associated with an encounter for each day of service. For hospitalized patients, the diagnoses are mostly the same, and often multiple, from day-to-day.

    This could also be helpful with outpatient billing.

    James L. Kay, D.O., FAAP

     
  • Kevin Yeh
    Kevin Yeh
    2012-11-11

    The ability to clone fee sheets and/or leverage other patient specific information (like the general problem list, or the encounter problem list) has been requested many times before, but still not implemented.

    Despite needs expressed by users, I suspect there are many reasons why developers have been reluctant to support these types of improvement. The code for the fee sheet is fairly complex, and the user interface is rather cluttered.  Since it is such a central piece of OpenEMR functionality, any issues resulting from modifications could be disastrous. Seemingly simple features are not so simple to implement, and thus we have not had any real innovation on the fee sheet.

    That said, I have some ideas on how to introduce new methods for choosing codes on the fee sheet in a well encapsulated module. There would only be a few new lines of code introduced in the current fee sheet itself (somewhere from 2-5). The interactions between the existing fee sheet and the new functionality would all be via AJAX, so none of the current features would change. 

    Here's what I believe I can accomplish.
    1. Allow review of historical fee sheets (not just the most recent)
    2. Selection of individual or all coded entries from previous fee sheets which can be copied to the current/active form
    3. Display of diagnosis codes from the encounter problem list and the patient's problem list which can be quickly copied into the fee sheet.

    Is my assessment that there are users (or vendors who want to provide this feature) out there that would be willing to pay for this correct?

     
  • MD Support
    MD Support
    2012-11-11

    This feature will help billers a lot.  For starters the fee sheet can have a single check box available when it is a new form that copies all fee sheet entries from prior encounter to the current encounter without status.  The biller can then edit the sheet as needed.
    On a related note, since we find the billers know the common codes rather well, the sheet should allow direct edit of the codes so daily CPT changes can be corrected without delete and add steps.

     
  • Kevin Yeh
    Kevin Yeh
    2012-11-13

    I envision more than just a simple check box.  My idea is to use some of the new CSS positioning tricks I've been learning to add an overlay which can present the diagnoses from previous fee sheets, the patient problem list and maybe also display the 10 most frequently used codes on the system. The frequently used list should simplify things for new patients.

    It'll be 2(two) mouse clicks to copy all the diagnoses from a previous fee sheet. The first one to bring up the review box, and the second to perform the copy. However all of the existing editing function will be retained, and the user will be able to see what is going to be copied before it happens.

    Direct edit of CPT codes is an interesting idea, but while require more thought on the best way to implement such a feature.  I'm hoping to focus on one issue at a  time.

    If folks are interested, I'll put together some screen mock-ups. 

     
  • Rod Roark
    Rod Roark
    2012-11-13

    It may be useful to rearrange the Fee Sheet into tabs to make it less cluttered.

    Yehster - not sure exactly what you mean, but I'd recommend striving for consistency!  The FS already supports drop-downs of selections for different categories, and if you're going to offer a different way of selecting codes to be added, then perhaps the existing groups should also use it.

    Dr. Kay - how is it that you are doing inpatient billing with OpenEMR?  I would not expect that to work very well.

    Rod
    www.sunsetsystems.com

     
  • Kevin Yeh
    Kevin Yeh
    2012-11-13

    It may be useful to rearrange the Fee Sheet into tabs to make it less cluttered….not sure exactly what you mean, but I'd recommend striving for consistency!

    Rod, my primary goal is usability/accessibility of my proposed new functionality (easy incorporation of multiple diagnoses from prior data). The current drop downs also only allow addition of one code at a time.  There needs to be a significant UI change to allow incorporating multiple diagnosis in a single operation.

    To keep the scope of this proposal manageable, I have a modularized implementation strategy. I anticipate only making minimal changes (a few new lines) to the current fee sheet code.  I am not going to change the existing groups.  This way there won't be much need to worry about breaking existing functionality, and I can focus my development and testing on
    "the new stuff," and be confident that it all works well.

     
  • Kevin Yeh
    Kevin Yeh
    2012-11-16

    New "Review Button" added:

    After clicking Review:

    Previous Diagnoses added:

    Anyway, there's still work to go in perfecting this, but I'm hoping these screenshots will generate some interest in funding for the project.
    -Kevin Yeh
    kevin.y@integralemr.com

     
  • Kevin Yeh
    Kevin Yeh
    2012-11-16

    Annoying that Sourceforge crops the right side of the images. If you want to see the full images, then right click and hit "View Image" but I think you get the idea. 

     
  • Robert Rambo
    Robert Rambo
    2012-11-16

    Yehster

    Nice work I like the add issues and the past encounter icds how much is that selling for?

     
  • Robert Rambo
    Robert Rambo
    2012-11-16

    Also this needs to be addressed add from and to

    https://lh6.googleusercontent.com/-S7uyMKAdVvU/UKZTuK8XGCI/AAAAAAAACLw/f81sGEm-yu4/s912/openemr%2520from%2520to.png
    
     
  • Robert Rambo
    Robert Rambo
    2012-11-16

     
  • has there been any update to this thread, or more importantly the implementation of a "copy this fee sheet" button?

     
  • Kevin Yeh
    Kevin Yeh
    2012-12-17

    Copy from previous is working fairly well.  You can take a look in this demo video:
    https://www.youtube.com/watch?v=8YnUkvsqVHU

    In order to keep producing valuable features like this I am looking to the OpenEMR community at large for support. Please consider making a financial contribution to my campaign.
    http://www.indiegogo.com/OpenEMR-FeeSheet

     
  • DrKay
    DrKay
    2012-12-22

    Rod- Sorry, I guess I forgot to click on the "monitor" link for this thread. I see newborns at the hospital for from 2-4 days each. They pretty much have the same diagnosis for each day. There is an E&M code for initial visit, and a different one for subsequent visits. Each day requires a new fee sheet in OpenEMR.

     
  • Kevin Yeh
    Kevin Yeh
    2012-12-22

    Ah… "Dropping babies" to check for Moro reflex. Fond memories from my week in the well baby nursery.
    What are the two E&M codes?  Also what diagnosis code(s) do you need?
    Am I right that the fee sheets are in fact identical for each newborn unless you find abnormalities?
    For something so routine, I would like to figure out how to implement a way to "rubber stamp" the fee sheet with a minimal click count. 

     
  • Kevin Yeh
    Kevin Yeh
    2012-12-22

    Ah… 99460 for the first day, 99462 on subsequent.

     
  • Kevin Yeh
    Kevin Yeh
    2012-12-22

    …and V20.2 as the justification
    Am I missing anything?

     
  • DrKay
    DrKay
    2012-12-23

    Here's what I have set up on my billing sheets. V30.00 if born in hospital delivered without cesarean section, V30.01 if born in hospital delivered by cesarean section, V30.1 if born before admission to the hospital, V30.2 if born outside hospital and not hospitalized; 765.29 if completed 37 or more weeks of gestation, 765.28 if completed 35-36 weeks of gestation, 765.27 if completed 33-34 weeks of gestation, 765.26 if completed 31-32 weeks of gestation, 765.25 if completed 29-30 weeks of gestation, 765.24 if completed 27-28 weeks of gestation, 765.23 if completed 25-26 weeks of gestation, 765.22 if completed 24 weeks of gestation, 765.21 if completed less than 24 weeks of gestation, 774.6 jaundice, 779.31 feeding problem in newborn. Supposedly we can use 99238 or 99239 for the date of discharge, but my payers reject these codes.

    Here's a good article on newborn billing: http://www.aafp.org/online/en/home/practicemgt/codingresources/newborncare.html

     
  • DrKay
    DrKay
    2012-12-23

    So often a newborn will develop jaundice on day 2 or 3, so 774.6 needs to be added. We might discover that they aren't nursing well on day 2 or 3, so add 779.31 on those dates.

     
  • Kevin Yeh
    Kevin Yeh
    2012-12-23

    That is really good info.
    Another valuable feature I might add is to provide an option for "most common diagnoses" to be procedure specific. 
    In other words, the diagnoses like these that you use with 99460 and 99462 specifically will be more prominent because they have been associated with each other before. This way something like the ICD-9 codes for asthma, which might be more prevalent in your practice as a whole won't show up in the context of newborns.

    The only reason I say "might" is because making sure that the queries to do this are fast enough might be tricky. 

    Dr. Kay, are you the one inputting this data for the fee sheet? Or does your biller do it?  If it's your biller, how do you communicate the relevant information?

    Anyway, I'm planning to be scarce for the next few days over the holidays.

     
  • DrKay
    DrKay
    2012-12-23

    I'm doing the hospital billing right now because my biller has been swamped with converting to OpenEMR (mostly because we are entering a bunch of data for each patient that is new to us because we didn't keep it in a computer system before, like all the parents' contact info, including home phones, cell phone, work, permission to contact by email, sms, etc., but there have been several billing glitches we have needed to work through as well that have put her behind). She may be doing these in the future. If so, I would communicate them to her by writing them on the hospital face sheet that I can print from the hospital EHR. You probably know this, but a face sheet is a sheet that contains the patient demographics and insurance information. I would hand-write the diagnoses, type of deliver, and any medical issues on the sheet, as well as the dates that I saw the newborn on this sheet.

     
  • DrKay
    DrKay
    2012-12-23

    We can also add an ICD-9 code for the weight of the newborn (in ranges like for the gestational age). I don't do this. I don't know if the health plans really care, or if they care if I enter a code for the gestational age for that matter.

     
  • Kevin Yeh
    Kevin Yeh
    2012-12-23

    Ideally it would be easier and more reliable for you to be able to accomplish the billing in OpenEMR directly, rather than needing to relay the information through a paper face sheet.
    Given how similar the billing is across all newborns, I think this is a realistic goal, but things often end up being more complicated than they first appear.
    I'd like to continue this discussion with you in more detail and possibly through a more efficient communication format after the holidays.