============================================================================= Run Date: MAY 19, 2015 Designation: OR*3*391 Package : OR - ORDER ENTRY/RESULTS REPORTING Priority: Mandatory Version : 3 SEQ #352 Status: Released Compliance Date: JUN 19, 2015 ============================================================================= Associated patches: (v)OR*3*361 <<= must be installed BEFORE `OR*3*391' Subject: ICD-10-CM REMEDIATION FOR ANTICOAG MGT Category: - Enhancement (Mandatory) - Other Description: ============ This patch extends the existing list of ICD-9-CM indications for care in support of Anticoagulation Management, to include a number of common diagnoses that were excluded from the original list. It also introduces a new set of indications for care, using the ICD-10-CM classification system, which will be presented to the user after ICD-10-CM implementation (currently scheduled for 10/01/2015) in lieu of the ICD-9-CM indications. In addition to the Automatic Primary Indication for Care configurable by Clinic for the original version of AMT, facilities will also be able to specify an Automatic Secondary Indication, using ICD-9-CM, along with Automatic Primary and Secondary ICD-10-CM Indications, which will be used for visits which occur after ICD-10-CM implementation. The following tables present the list of additional indications for care from which the user can select when the corresponding coding systems are active. Current (extended): ICD-9-CM Display Text Code ICD-9-CM Description ========================================================================== A Fib 427.31 Atrial Fibrillation A Flutter 427.32 Atrial Flutter Antiphospholipid Antibodies 286.9 Other and unspecified coagulation defects Antithrombin III Deficiency 286.9 Other and unspecified coagulation defects Apical Thrombus 429.79 Certain sequelae of myocardial in- farction, not elsewhere classified, other Arterial Thrombosis 444.9 Embolism and thrombosis of unspec- ified artery CAD (Coronary Art Dis) 414.00 Coronary atherosclerosis of un- specified type of vessel, native or graft CHF (Cong Heart Fail) 428.0 Congestive heart failure, unspec- ified CVA 437.9 Unspecified cerebrovascular disease Cardiomyopathy 425.4 Other primary cardiomyopathies Carotid Stenosis - Plaque 433.10 Occlusion and stenosis of carotid artery without mention of cerebral infarction Cerebrovascular Disease 436. Acute but ill-defined cerebrovasc disease Clotted Graft 996.74 Other complications due to other vascular device, implant, and graft DVT 453.89 Acute ven emb and thromb oth spec veins Enctr for Tx Drug Monitoring V58.83 Encounter for therapeutic drug monitoring Hypercoag State 289.81 Primary hypercoagulable state L/T (Current) Anticoag Use V58.61 Long-term (Current) use of anticoagulant LV Thrombus 429.79 Certain sequelae of myocardial in- farction, not elsewhere classified, other Mesenteric Thrombosis 557.0 Acute vascular insufficiency of intestine PAD (Peripheral Art Dis) 443.9 Peripheral vascular disease, unspecified PE 415.19 Other pulmonary embolism and infarction Prophylaxis S/P Ortho Surgery V54.89 Other orthopedic aftercare Recurrent DVT 453.79 Chronic venous embolism and throm- bosis of other specified veins Recurrent PE 416.2 Chronic pulmonary embolism TIA 435.9 Unspecified transient cerebral ischemia Valve-Mech V43.3 Heart valve replaced by other means Valve-Tissue V42.2 Heart valve replaced by transplant Future: ICD-10-CM Display Text Code ICD-10-CM Description ========================================================================== A Fib I48.91 Unspecified atrial fibrillation A Flutter I48.92 Unspecified atrial flutter Act Prot C Res D68.51 Activated protein C resistance Acute MI (within 4 weeks) I21.3 ST elevation (STEMI) myocardial infarction of unspecified site Antiphospholipid Synd D68.61 Antiphospholipid syndrome CVA (unspecified sequela) I69.30 Unspecified sequelae of cerebral infarction Cerebrovascular Disease I67.89 Other cerebrovascular disease DVT Bilat LE Unspec Veins I82.403 Acute embolism and thrombosis of unspecified deep veins of lower extremity, bilateral DVT LLE Unspecified Veins I82.402 Acute embolism and thrombosis of unspecified deep veins of left lower extremity DVT RLE Unspecified Veins I82.401 Acute embolism and thrombosis of unspecified deep veins of right lower extremity DVT Uspec veins, unspec LE I82.409 Acute embolism and thrombosis of unspecified deep veins of unspecified lower extremity DVT oth spec veins not in LE I82.890 Acute embolism and thrombosis of other specified veins Enctr for Tx Drug Monitoring Z51.81 Encounter for therapeutic drug level monitoring Hypercoag State D68.59 Other primary thrombophilia L/T (Current) Anticoag Tx Z79.01 Long term (current) use of anticoagulant Lupus Anticoag Synd D68.62 Lupus anticoagulant syndrome Old MI (> 4 wks, no curr symp) I25.2 Old myocardial infarction Oth Prim Thrombophilia D68.59 Other primary thrombophilia PE I26.99 Other pulm embol w/o acute cor pulmonale Prothrombin Gene Mut D68.52 Prothrombin gene mutation TIA G45.9 Transient cerebral ischemic attack, unspecified Valve-Mech Z95.2 Presence of prosthetic heart valve Valve-Tissue Z95.3 Presence of xenogenic heart valve The ICD-10-CM codes corresponding to the ICD-9-CM indications used since 2008 were identified using the General Equivalence Mappings, which are developed and maintained by The Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC). Note that the indication "Hypercoag State" (ICD-9-CM 289.81) may map to any of five ICD-10-CM indications (Activated protein C resistance, Antiphospholipid syndrome, Lupus anticoagulant syndrome, Other primary thrombophilia, or Prothrombin gene mutation), and so the list is slightly more specific. The remaining indications mapped more easily into ICD-10-CM in one-to-one fashion. This patch includes both client- and server-side components, as detailed below. The client-side changes involve making the application "ICD version-aware." That is, based on the date of service, the user will only be able to select diagnoses from the active ICD version (ICD-9-CM or ICD-10-CM) when they specify the indications for care. The client was also enhanced to use the same Lexicon Search dialog provided in the CPRS Encounter Form, should the user choose 'Other' when selecting the indications for care. Here again, only the appropriate ICD version will be presented, based on the date of service. ROUTINE: ======== ORAM - Modified the PATIENT subroutine to correct a problem with the visit matching algorithm that was observed for new Anticoagulation patients. If a patient who was not yet enrolled in the Anticoagulation flowsheet database had a visit scheduled for one of the Anticoagulation Clinic locations within the look-up interval, that visit was not being identified. ORAM1 - Modified the ACDATA subroutine to handle selection of SNOMED CT concepts with multiple mapped ICD-9-CM diagnoses (e.g., Transient cerebral ischemia due to atrial fibrillation (SNOMED CT 426814001) = 427.31/435.9). ORAM2 - Modified the RPT subroutine to assure that the Anticoagulation Report on the CPRS Reports tab displays indications in a manner consistent with the rest of AMT. ORAMSET - Modified the GET & INDICS subroutines to accept Visit Date as an argument, and return the appropriate Parameter values, given the ICD-10-CM Implementation date. - Introduced a new function $$GETCMPDT(CODESYS) that returns a compare date for the Coding System of interest, to be used in screening active codes during parameter set-up. ORAMX - Modified the PCESET subroutine to handle the case where a SNOMED CT concept is selected for the indication which has multiple mapped ICD-9-CM targets, and to allow an automatic secondary indication. - Split routine, moving the WRAP function to ORAMX1, to comply with the SACC routine size limit. ORAMX1 - Moved the WRAP function from ORAMX, and the RPT subroutine from ORAM2 in order to keep those routines within the SACC size limit. - Introduced a new function GETVSIT, which will assure that the CPRS Report for AMT uses includes all information stored in PCE for the Encounter generated for most recent flowsheet entry, including any diagnoses that were added via the CPRS Encounter form or any other data source. ORY391 - Post-install routine, which creates the package-level default values for the ORAM I10 INDICATIONS FOR CARE parameter. PARAMETER DEFINITION: ===================== ORAM AUTO PRIMARY INDICATION This parameter has been used by the Anticoagulation Management Tool (AMT) v1 to allow the facility to specify an Automatic Primary Indication for Care (as ICD-9- CM) for each clinic using the software. The current patch modifies the VALUE SCREEN CODE to assure the selection of an active ICD-9-CM code prior to ICD-10-CM implementation. ORAM AUTO SECONDARY INDICATION This is an Indication for care which will automatically be filed as the first Secondary Indication for each visit to the applicable Clinic. (e.g., if all visits to a non-licensed provider should be filed with V58.83 ENCTR THERAP DRUG MONITOR as the first secondary indication, you can specify that with this parameter, and the user will still be able to select additional secondary indication(s) from the list). ORAM I10 AUTO PRIM INDICATION This parameter will be used by AMT going forward to allow the facility to specify an Automatic Primary Indication for Care (as ICD-9-CM) for each clinic using the software. The current patch includes VALUE SCREEN CODE to assure the selection of an active ICD-10-CM code following ICD-10-CM implementation. ORAM I10 AUTO SEC INDICATION This is an Indication for care which will automatically be filed as the first Secondary Indication for each visit to the applicable Clinic. (e.g., if all visits to a non-licensed provider should be filed with Z51.81 Encounter for therapeutic drug level monitoring as the first secondary indication, you can specify that with this parameter, and the user will still be able to select additional secondary indication(s) from the list). ORAM INDICATIONS FOR CARE This parameter has been used by AMT v1 to provide a server-side mechanism to specify a list of Additional Indications for Care (as ICD-9-CM). The current patch modifies the VALUE SCREEN CODE to assure the selection of active ICD-9-CM codes prior to ICD-10-CM implementation. ORAM I10 INDICATIONS FOR CARE This parameter will be used by AMT going forward to provide a server-side mechanism to specify a list of Additional Indications for Care (as ICD-10-CM). The current patch includes VALUE SCREEN CODE to assure the selection of active ICD-10-CM codes following ICD-10-CM implementation. PARAMETER TEMPLATE: =================== ORAM CLINIC PARAMETERS This parameter template is modified to allow the user to specify the value of the new ORAM I10 AUTO PRIM INDICATION for each clinic configured to use AMT. ORAM SITE PARAMETERS This parameter template is modified to remove the DSS UNIT and DSS ID parameters, which have never been used by AMT and have caused significant confusion. REMOTE PROCEDURE: ================= ORAM1 ACDATA Modified the RPC to accept Date of Service as a parameter. ORAMSET GET Introduced a new parameter to allow the client to pass Visit Date/time in internal VA FileMan format and return a Boolean flag indicating whether ICD-10-CM is active as the 11th piece of the 2-node of the result array. Patient Safety Issues (PSIs): ============================= None RELATED CQ'S: ============ 18489 - AC:Start note not displaying secondary indications for new patient 21939 - OR*3*391 v1 Error "ORAM INDICATORS FOR CARE parameter is corrupt. Contact IRM" 21949 - OR*3*391 v2 CPRS Flowsheet on the Reports tab has incorrect label for displayed diagnosis 21996 - Exception error on Reports tab in CPRS for Anticoagulation Flowsheet 21998 - D/C note allows user to sign without entering clinical relevant reason for discharge 21999 - Error is not a valid floating point integer when entering too specific INR Goal value in AMT 22000 - Access violation occurs when outside lab data is copied or longer than expected 22001 - General validation needs to done for several data entry points 22002 - When invalid ICD code is entered no diagnosis code is filed with the encounter and user is unaware 22126 - AMT Clinic Parameter to enter Automatic Indication for Care for ICD-9 allows entry of ICD-10 code 22206 - M ERROR generating flow sheet for existing pt. ICD-10 remedia- tion AMT pkg. v5 22216 - ICD-10 remediation Invalid ICD-9 indication saves in Note before AMT gives user incomplete error 22223 - M ERROR when attempting to print AntiCoagulation Flowsheet on CPRS report tab RELATED Remedy Tickets: ====================== None TEST SITES: =========== Cleveland Minneapolis Denver SOFTWARE & DOCUMENTATION RETRIEVAL: =================================== To obtain the current client- and server-side software and documentation, use FTP to retrieve OR_30_391.zip and OR_30_391.KID from one of the following OI Field Offices' ANONYMOUS.SOFTWARE directories: OI Field Office FTP Address Directory --------------- ----------- --------- Albany ftp.domain.ext Hines ftp.domain.ext Salt Lake City ftp.domain.ext The software distribution includes these files: FILE NAME RETRIEVAL FORMAT SIZE --------- ---------------- ---- OR_30_391.ZIP BINARY 11923 OR_30_391.KID ASCII 316 Source code is also available, and may be optionally downloaded as: OR_30_391_SRC.ZIP BINARY 7735 ZIP FILE CONTENTS DESCRIPTION FILE VERSION ----------------- ----------- ------------ AMT_1_0_391_7.msi Windows Installer 1.0.391.7 Anticoag_help_file.chm Compiled HTML Help AntiCoagulate.exe Client 1.0.391.7 oramig.doc Install Guide MS Word R/W oramig.pdf Install Guide PDF Read Only oramtm.doc Technical Manual MS Word R/W oramtm.pdf Technical Manual PDF Read Only oramum.doc Users Manual MS Word R/W oramum.pdf Users Manual PDF Read Only GUI Client installation instructions are in the Anticoagulation Management Installation/Implementation Guide, which is included in the .ZIP file, and may also be found in the VistA Documentation Library: http://www.domain.ext/vdl. INSTALLATION INSTRUCTIONS: ========================== This patch can be loaded with users in the system but it is recommended that it be installed when user activity is low. Installation time will be less than 2 minutes. 1. From the Kernel Installation & Distribution System menu, select the Installation menu. 2. From this menu, choose to Load a Distribution and enter the location of the Host File OR_3_391.KID 3. From the same menu, you may select to use the following options: (when prompted for INSTALL NAME, enter OR*3.0*391) a. Verify Checksums in Transport Global - This option will allow you to ensure the integrity of the routines that are in the transport global. b. Print Transport Global - This option will allow you to view the components of the KIDS build. c. Compare Transport Global to Current System - This option will allow you to view all changes that will be made when this patch is installed. It compares all components of this patch (routines, DD's, templates, etc.). d. Backup a Transport Global - This option will create a backup message of any routines exported with this patch. It will not backup any other changes such as DD's or templates. 4. Use the Install Package(s) option and select the package OR*3.0*391. 5. When Prompted "Want KIDS to INHIBIT LOGONs during the install? NO//" respond NO. 6. When Prompted "Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO//" respond NO. POST-INSTALLATION INSTRUCTIONS: =============================== After successful installation of the OR*3.0*391, IT staff should confer with local CACs and AMT users to: 1. Set the appropriate values for the Automatic Primary and Secondary Indications for Care to be used in each Anticoagulation Clinic. To receive proper workload credit, these should be set as follows: Auto Primary Indic for Care (ICD-9-CM) V58.83 Auto Secondary Indic for Care (ICD-9-CM) V58.61 Auto Primary Indic for Care (ICD-10-CM) Z51.81 Auto Secondary Ind for Care (ICD-10-CM) Z79.01 This can be done using the ORAM ANTICOAGULATION CLINIC PARAMETERS VistA option, under the ORAM ANTICOAGULATION SETUP menu. 2. Deploy the new executable AntiCoagulate.exe and the corresponding help file, replacing the prior version, either on a network drive, or to each of the workstations accessed by the AMT users at your facility, as performance and ease of maintenance may require. Routine Information: ==================== The second line of each of these routines now looks like: ;;3.0;ORDER ENTRY/RESULTS REPORTING;**[Patch List]**;Dec 17, 1997;Build 11 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: ORAM Before: B75504293 After: B83839096 **307,330,391** Routine Name: ORAM1 Before:B166176086 After:B175474289 **307,339,351,361,391** Routine Name: ORAM2 Before:B144805795 After: B58023259 **307,339,354,361,391** Routine Name: ORAMSET Before: B43363006 After: B59301848 **307,361,391** Routine Name: ORAMX Before:B164083781 After:B169673089 **307,339,361,391** Routine Name: ORAMX1 Before: n/a After: B81414252 **391** Routine Name: ORY391 Before: n/a After: B58110854 **391** Routine list of preceding patches: 330, 361 ============================================================================= User Information: Entered By : Date Entered : FEB 25, 2014 Completed By: Date Completed: MAY 18, 2015 Released By : Date Released : MAY 19, 2015 ============================================================================= Packman Mail Message: ===================== No routines included