$TXT Created by ANZALDUA,CAROL K at CHLVSS.FO-ALBANY.MED.VA.GOV (KIDS) on Thursday, 03/22/07 at 16:06 ============================================================================= Run Date: MAY 10, 2007 Designation: LR*5.2*308 Package : LR - LAB SERVICE Priority: Mandatory Version : 5.2 SEQ #283 Status: Released Compliance Date: JUN 10, 2007 ============================================================================= Associated patches: (v)LR*5.2*248 <<= must be installed BEFORE `LR*5.2*308' (v)LR*5.2*259 <<= must be installed BEFORE `LR*5.2*308' (v)LR*5.2*274 <<= must be installed BEFORE `LR*5.2*308' (v)LR*5.2*291 <<= must be installed BEFORE `LR*5.2*308' (v)LR*5.2*349 <<= must be installed BEFORE `LR*5.2*308' (v)LR*5.2*359 <<= must be installed BEFORE `LR*5.2*308' Subject: ANATOMIC PATHOLOGY CPT CODING CORRECTIONS Category: - Routine - Enhancement (Mandatory) - Data Dictionary Description: ============ ===================== Blood Bank Review ================= EFFECT ON BLOOD BANK FUNCTIONAL REQUIREMENTS: Patch LR*5.2*308 does not contain any changes to the VISTA BLOOD BANK Software as defined by VHA DIRECTIVE 99-053 titled VISTA BLOOD BANK SOFTWARE VERSION 5.2. EFFECT ON BLOOD BANK FUNCTIONAL REQUIREMENTS: Patch LR*5.2*308 does not alter or modify any software design safeguards or safety critical elements functions. RISK ANALYSIS: Changes made by patch LR*5.2*308 have no effect on Blood Bank software functionality, therefore RISK is none. VALIDATION REQUIREMENTS BY OPTION: Because of the nature of the changes made, no specific validation requirements exist as a result of installation of this patch. ===================== Patch Description ================= Several updates have been identified as requiring immediate action after the installation of patch LR*5.2*274, AP CPT Coding & NLT Code Update. This patch LR*5.2*308 includes updates that have been identified in the NOIS's listed below. The following updates are included. 1. Currently: If a Current Procedural Terminology (CPT) code is not found or is marked inactive in the CPT file (#81), a general message, "Nothing Selected" displays, or no message at all displays. The CPT code is not selected and passed to PATIENT CARE ENCOUNTER (PCE). Update: If one or more CPT's are not found in the CPT file (#81), the following message displays and lists the CPT codes: "The following CPT Code(s) are not selected: Not found in #81: #####,#####,". For one or more CPTs that are marked inactive in the CPT file (#81), the following message displays and lists the CPT codes: "The following CPT Code(s) are not selected: CPT(s) inactive in #81: #####,#####". All CPTs that are inactive or not found in file #81 will not be passed to PCE. 2. Currently: CPTs marked inactive in the WKLD CODE file (#64) can be selected and are passed to PCE. Update: If a selected CPT is marked inactive in file (#64), a search is made for another active CPT linked to the same workload code. If another active CPT is found, the active CPT replaces the inactive CPT and is passed to PCE. The following message will display if an active replacement is found: "The following CPT Code(s) are not selected: Inactive in #64\Active Replacement Found: ##### \ #####; ##### \ #####". If no active replacement found, the selected CPT is not passed to PCE and is displayed in the following message: "The following CPT Code(s) are not selected: CPT(s) inactive in #64: #####,#####". 3. Currently: Inactive CPTs found in the WKLD CODE file (#64) can be entered and passed to PCE for non-AP accessions. When an inactive CPT is selected and passed to PCE, the entire order is marked invalid for workload and no workload is passed, and a mail message is generated at the site which states "No lab OOS location defined". Update: If a CPT is found inactive in file #64, a search will be made for another active replacement CPT linked to the same workload code. If another active CPT is found, the active CPT replaces the inactive CPT. If no active replacement CPT is found, the original CPT is not passed to PCE, and thus no misleading mail message is generated. 4. Currently: Any subsequent CPT codes entered on an accession will replace or overlay the quantity previously passed to PCE. Example: CPT 88302 with quantity of 2 entered on day 1; PCE shows quantity of 2. On day 2, CPT 88302 with quantity of 1 entered; PCE shows updated quantity of 1. It should show 3. Update: All subsequent CPT code quantities entered for an accession will be added to existing quantities stored in PCE. 5. Currently: If a selected CPT is not linked to a workload code in the WKLD CODE file (#64), the CPT is passed to PCE, and the message "Storing in LMIP". This message incorrectly identifies the CPT as having been stored in the WKLD CODE file (#64). Update: Selected CPT codes that are not linked to a workload code in the WKLD CODE file (#64) will not be passed to PCE, and the following message will display: "The following CPT Code(s) are not selected: Not linked to workload in #64: #####, #####". 6. Currently: If a selected CPT code is linked to multiple workload codes, the workload code with the lowest IEN is selected. This cannot be changed; however, the problem has been reduced by increasing the number of allowed ES Display Order numbers that can be assigned to a specific CPT-workload code combination. The limit has been increased from 100 to 1000. 7. Currently: When more than one accession is entered for a patient on the same date, at the same location, and the specimen collection date/time does not contain a unique time, then each accession for this patient will have the same encounter/visit number assigned when CPT codes are entered and passed to PCE. Update: Within Anatomic Pathology (AP) Login, the "Date/time Specimen taken:" prompt default has been changed from TODAY (date only) to NOW (date and time). This helps decrease the chance of having the same encounter number assigned to more than one accession entered on the same patient on the same date, at the same location. 8. A couple of minor cosmetic updates are included in this patch: a. The prompt "Releasing Pathologist:" has been changed to "Provider:" since the name entered at this prompt must be an active provider. b. The pathologist or cytotechnologist name, if entered on the accession, is included in the header information that displays at the time CPT coding is entered. The updates described above are displayed in the following screen format. This screen format is used in the menu options listed below it: Provider: PROVIDER, ONE// PRO PHYSICIAN Select CPT codes: 88302 TEST, PATIENT1 000-99-1234 DOB: Mar 05, 1955 Collection Date: Jan 06, 2005@11:52 Acc #: NSP 05 1 Loc: 5N Specimen: Tissue Specimens: TAIL Test(s); SURGICAL PATH REPORTING/ SURGICAL PATHOLOGY LOG-IN/ Pathologist: PHYSICIAN, ONE Selected CPT Codes (1) 88302 LEVEL II - SURGICAL PATHOLOGY, GROSS AND MICROSCOP Surgical Pathology Level II {88518.0000} Menu Options: Lab CPT Billing [LRCAPES] Verify/release reports, anat path [LRAPR], CPT Coding selection Provisional anatomic diagnoses [LRAPAUPAD] Autopsy protocol [LRAPAUDAP] Autopsy protocol & SNOMED coding [LRAPAUDAB] Autopsy protocol & ICD9CM coding [LRAPAUDAA] FS/Gross/Micro/Dx [LRAPDGM] FS/Gross/Micro/Dx/SNOMED Coding [LRAPDGS] FS/Gross/Micro/Dx/ICD9CM Coding [LRAPDGI] 9. A couple of general corrections are included in this patch. For certain $D statements which read, "'$DATA()#2", the modulo is incorrectly applied to the result of the "'$DATA()". Instead, the NOT operator "'" should be applied to the evaluation of "$DATA()#2" to correctly read, "'($DATA()#2)". The following statements have been corrected: a. In SETWKL+13^LRCAPES1, Q:'$D(^LAM(LRP,0))#2, has been changed to Q:'($D(^LAM(LRP,0))#2). b. In EN5+4^LRCAPPH1, Q:'$D(^LRO(69,LRCDT,1,LRSN,2,LRTST,0))#2, has been changed to Q:'($D(^LRO(69,LRCDT,1,LRSN,2,LRTST,0))#2). ====================== DATA DICTIONARY UPDATES ----------------------- The ES DISPLAY ORDER field (#26) in the WKLD CODE file (#64) has been modified. The allowed quantity of the ES Display Order numbers has been increased from 100 to 1000. 64,26 ES DISPLAY ORDER 10;1 NUMBER INPUT TRANSFORM: K:+X'=X!(X>1000)!(X<1)!(X?.E1"."1N.N) X I $D(X), '$D(DIU(0)),$D(^LAM("AK",X)) D EN^DDIOL("Already Exist on "_$P($G(^LAM($O(^LAM("AK",X,0)),0)),U),"","!?20") K X LAST EDITED: MAR 02, 2004 HELP-PROMPT: Type a Number between 1 and 1000, 0 Decimal Digits DESCRIPTION: This field is used to by the LAB CPT BILLING option to display those CPT codes defined by this NLT codes and will be referenced by this number. The number entered must be unique between 1-1000. ====================== This patch addresses the following New Service Request (NSR): ------------------------------------------------------------- There is no NSR associated with this patch. This patch addresses the following E3Rs: --------------------------------------- There are no E3Rs associated with this patch. This patch addresses the following NOISs / Remedy Tickets: --------------------------------------------------------- CPH-0103-41645 / HD0000000069980 FGH-0103-31657 / HD0000000069982 MIN-0103-41656 / HD0000000069981 BHS-0103-12034 / HD0000000069988 UNY-0103-11749 / HD0000000069985 WBP-0103-21809 / HD0000000069986 SAM-0603-21566 / HD0000000070159 JAC-1103-70158 / HD0000000070386 ALT-0304-20022 / HD0000000070580 SBY-0304-31852 / HD0000000070614 BIL-0304-31578 / HD0000000070606 WRJ-0404-10360 / HD0000000070654 HVH-0404-11404 / HD0000000070684 CPH-0804-41938 / HD0000000070965 MIN-1204-40394 / HD0000000071122 HEH-0304-41954 / HD0000000070618 Overview of NOIS / Remedy Tickets: =========================== CPH-0103-41645 / HD0000000069980 Problem: It would be nice if the user was warned that the CPT code they entered, is not entered in file 64 under "CODE", for a wkld file entry. The screen displays "Storing LMIP Workload", but it really doesn't. I see that there are other NOISs about "over-writing" the CPT codes instead of adding to them. That explains #5. The clerk didn't know that she should enter the multiple codes separated by commas, therefore she was continually overwriting her previous entry by entering one a a time. I was thinking that lab would have to be responsible for know what they put in by reviewing the code so if they were going to put in additional on the next day, if there was already a quant of 1 or 2 they would have to add that to the number that they are doing for the current entry... but then that screws up the lmip I believe.?? don't know.. that needs to go to development. Resolution: See Updates #4 and #5 for resolution of this problem. -------------------------------- FGH-0103-31657 / HD0000000069982 Problem: When inputting the CPT CODES, from the patch description it states ************************* The LAB CPT BILLING option can be used anytime after the accession has been created. If the accession has been purged, the option cannot be used. The LAB CPT BILLING option has two functions: and CPT billing can be done multiple times for the same accession. ************************* These are true statements but if a site originally put in multiple code of 88342 IMMUNOCYTOCHEMISTRY... so it would look like this ..88342,88342 two entries go in and the quantity goes down to PCE as 2. BUT if the next day they do ANOTHER 88342, and go to input that cpt code, when it is passed to PCE, it is overwriting the previous entry that was sent that had a quantity of 2, it now present as only have done 1. This is not adding to the previous work... it should be 3 Resolution: See Update #4 for resolution to this problem -------------------------------- MIN-0103-41656 / HD0000000069981 Problem: Also, I cannot figure out how to add multiples of the same CPT code AFTER I leave the option, and go back to that accesssion to add more. The quantity keeps appearing as 1. What if you go back at a later date and need to add more? Resolution: See Update #4 for resolution to this problem -------------------------------- BHS-0103-12034 / HD0000000069988 Problem: It appears that if a workload code has an inactivated CPT code linked to it and it is used in the new LAB CPT Billing option then the inactive as well as the active CPT codes are getting passed to PCE. This is different in CH-subscripted tests that pass CPT codes to PCE, the inactive codes don't pass. This issue didn't come up during the test phase of the patch because we never used any workload codes with inactivated CPT codes. It appears that the only way to get it to work for only the active code (for the AP work) is to delete the inactive code which we were told not to do because it screws up the CPT audit on a workload code. Resolution: See Update #1 for resolution to this problem -------------------------------- UNY-0103-11749 / HD0000000069985 Problem: I've been following the guidelines for the setup of file 64 with regards to patch LR*5.2*274 and I have a question on section 6 of attachment 1. I set up the NLT's in section 6a through 6f instead of the generic NLT's in section 6. All the NLT's in section 6b have the CPT code 88313 assigned. When I go into the option Lab CPT Billing, and type in 88313, it responds with "SPECIAL STAINS" (which is true) and the data is stored. When I look at the workload for the accession, however, it has stored the NLT for Amido Black Hemoglobin Stain wich was not correct, I wanted a Congo Red Stain. It appears that when I assigned the CPT 88313, the system took the first entry in file 64 that it came to with that CPT code and assigned that workload code to the accession. Resolution: See Update #1 for resolution to this problem -------------------------------- WBP-0103-21809 / HD0000000069986 Problem: PLUS this - When I was testing the options in the mirror account, the CPT code assocciated with the WKLD code for frozen section was a generic code(88399). I inactivated that CPT code and entered the CPT code (88329) that I wanted passed to PCE. I then tested the option. When I printed the log book the inactivated CPT code(88399) was listed and when I checked to see if it was also passed to PCE it was. See below. Resolution: See Updates #1 and #2 for resolution to this problem -------------------------------- SAM-0603-21566 / HD0000000070159 Problem: Some background: Starting 7/1/03, Lab at Salem will start CPT coding for AP (it is being done by coders currently). I am ready to edit the ES DISPLAY ORDER for the CYTO NLT codes. There are 12 NLT codes that my pathologist has selected for the pick list - 5 of the 12 have undesirable CPT codes already assigned. After patch LR*5.2*263 was installed, we are not supposed to deleted incorrect CPT codes, rather enter the inactive date and replacement codes to preserve the audit trail. However, the AP/PCE software does not "see" the inactive date and will pass incorrect codes on a routine basis. Resolution: See Update #2 for resolution to this problem -------------------------------- JAC-1103-70158 / HD0000000070386 Problem: We have a question concerning the pick list from patch 274. We have just implemented the electronic signature patch and will start using the pick list from 274. One case that we are dealing with has an active and an inactive code under the workload code. We have the pick list set up to choose the number, but in choosing the number, it lists both the active and inactive CPT codes as being assigned. We tried to see whether or not it passed to PCE, but it was an inpatient OR case, so they weren't there. Resolution: See Update #2 for resolution to this problem -------------------------------- ALT-0304-20022 / HD0000000070580 Problem: PATCH went in on sunday.. One problem reported today from lab is that the code 89399 is giving them problems....I see it is one that was inactivated..... Resolution: See Update #2 for resolution to this problem -------------------------------- SBY-0304-31852 / HD0000000070614 Problem: After reviewing the order and patient results the lab ADPAC and I were unable to find anything that needed to be to corrected. Where else should we be looking? Subj: NIGHTLY WKLD CODE CHECK REPORT Mar 19, 2004@00:04:06 [#19030346] 03/19/04@00:04 5 lines From: POSTMASTER In 'WASTE' basket. Page 1 ------------------------------------------------------------------------ Lab Order Number 895824 Not Processed - No DEFAULT LAB OOS LOCATION defined. =================== Listing of all offending codes: Resolution: See Update #3 for resolution to this problem -------------------------------- BIL-0304-31578 / HD0000000070606 Problem: New test was set up for BHCG. NLT code has been linked. CPT code associated with the NLT code has a release date in file 64, and is active in file 81. Another test for same pt, location, provider, accession area works fine, so problem seems to be related to this specific NLT/CPT. It appears that lab is sending the info, but a visit is not being created in PCE. I have tried deleting NLT from file 60 and relinking. Also tried removing CPT code from 64 and adding back. In addition to the current CPT code, this file 64 entry also has an old CPT code with an inactivation date, (NOIS: WRJ-0403-11668), but I haven't tried deleting the inactive code as it appears lab is sending info and I don't like the idea of deleting unless absolutely necessary. Is there a way to trace in PCE what was sent from lab and try to pin down why this code isn't passing. Resolution: See Update #3 for resolution to this problem. -------------------------------- WRJ-0404-10360 / HD0000000070654 Problem: We seem to be having a sporadic problem with "Visit Number(s)" not being generated on an order. This causes problems with CPT codes not being sent to PCE. Any ideas why this would happen? I did a test today and ordered the tests individually and the visits were generated fine, but as a group they appear not to generate the visit number. Please see Lab Order # 41579 for date 4/5/2004 below: Resolution: See Update #2 for resolution to this problem. -------------------------------- HVH-0404-11404 / HD0000000070684 Problem: How do I go about fixing the following errors from the NIGHTLY WKLD CODE CHECK REPORT ? Subj: NIGHTLY WKLD CODE CHECK REPORT Apr 18, 2004@00:12:30 [#945027] 04/18/04@00:12 29 lines From: POSTMASTER 2 of 2 responses read. In 'WKLD' basket. Page 1 -------------------------------------------------------------------------- Lab Order Number 339664 Not Processed - No DEFAULT LAB OOS LOCATION defined. =================== Lab Order Number 347067 Not Processed - No DEFAULT LAB OOS LOCATION defined. =================== Resolution: See Update #2 for resolution to this problem -------------------------------- CPH-0804-41938 / HD0000000070965 Problem: One of the labs in our VISN called me today & said that they had a patient that had 3 Cytology & 1 Surg path Accession numbers for samples all on the same day. After entering the CPT codes, (using the "ES" numbers), PCE showed only 1 LAB encounter with the CPTs for only the first case entered. I'm sure that I saw that this was already reported, but can't locate an E3R or NOIS on it. Has an E3R or NOIS been logged for this? Resolution: See Update #6 for resolution to this problem -------------------------------- MIN-1204-40394 / HD0000000071122 Problem: Received this mailman message, but I don't know where to look to correct the problem or what it really means, or where it comes from??? Subj: NIGHTLY WKLD CODE CHECK REPORT Dec 07, 2004@00:02:36 [#35287868] 12/07/04@00:02 5 lines From: POSTMASTER (MINNEAPOLIS VAMC) In 'IN' basket. Page 1 Lab Order Number 1079545 Not Processed - No DEFAULT LAB OOS LOCATION defined. Resolution: See Update #2 and #3 for resolution to this problem. ====================================== Test Sites: ========== Boston HCS - VMS/CACHE (large integrated site) Durham VAMC - VMS/CACHE (large site) Iowa City VAMC - VMS/CACHE (large integrated site) Long Beach VAMC - VMS/CACHE (large site) Software Retrieval ------------------ VistA Laboratory AP CPT Coding Corrections Patch LR*5.2*308 software is distributed by Packman. Documentation Retrieval ----------------------- VistA AP CPT Coding Corrections Patch LR*5.2*308 User Guide is available at the following Office of Information Field Offices (OIFOs) ANONYMOUS.SOFTWARE directories: OI Field Office FTP Address Directory --------------- ----------- --------- ALBANY ftp.fo-albany.med.va.gov [ANONYMOUS.SOFTWARE] HINES ftp.fo-hines.med.va.gov [ANONYMOUS.SOFTWARE] SALT LAKE CITY ftp.fo-slc.med.va.gov [ANONYMOUS.SOFTWARE] Documentation Retrieval Formats ------------------------------- VistA AP CPT Coding Corrections Patch LR*5.2*308 User Guide files are exported in the following retrieval formats: File Name Contents Retrieval Formats --------- -------- ----------------- LAB_52_308_UG.doc AP CPT Coding Corrections Patch LR*5.2*308 User Guide BINARY LAB_52_308_UG.pdf AP CPT Coding Corrections Patch LR*5.2*308 User Guide BINARY VistA Website Locations: ----------------------- VistA AP CPT Coding Corrections Patch LR*5.2*308 User Guide is accessible in MS Word (.doc) and Portable Document Format (.pdf) at the following VistA locations: Laboratory Version 5.2 Home Page -------------------------------- http://vista.med.va.gov/ClinicalSpecialties/lab/ VistA Documentation Library (VDL) --------------------------------- www.va.gov/vdl/ Routine Summary: ================ The following is a list of the routines included in this patch. The second line of each of these routines will look like: ;;5.2;LAB SERVICE;**[patch list]**;Sep 27 1994 CHECK^XTSUMBLD results: Routine Before Patch After Patch Patch List ------- ------------ ----------- ---------- LR308 N/A 3577348 **308** (Deleted by KIDS) LRAPLG1 5113296 5107203 **72,121,248,308** LRAPUTL 9752029 9713709 **259,308** LRCAPES 13104305 13495108 **274,259,349,308** LRCAPES1 8132160 13575476 **274,308** LRCAPPH1 13504461 14078305 **127,136,138,158,263,264,274,291, 359,308** Sites should use CHECK^XTSUMBLD to verify checksums. NOTE: LR308 will be deleted after successful patch installation. The following is a list of fields included in this patch: NOTE: This is a modified field. Field Name (Number) File Name (Number) ---------------------- ------------------- ES DISPLAY ORDER (#26) WORKLOAD CODE (#64) INSTALLATION INSTRUCTIONS ========================= This patch can be installed with users on the system. However, it is recommended that installation occur when there is no Anatomic Pathology activity or activity is at a minimum. This will prevent 'Cannot return to source routine' errors. The Anatomic Pathology menu [LRAP] will be disabled automatically by this patch and re-enabled after installation. Install Time - less than 5 minutes. 1. LOAD TRANSPORT GLOBAL --------------------------------------- Choose the PackMan message containing this patch and invoke the INSTALL/CHECK MESSAGE PackMan option. 2. START UP KIDS Start up the Kernel Installation and distribution System Menu [XPD MAIN]: Edits and Distribution ... Utilities ... Installation ... Select Kernel Installation & Distribution System Option: INStallation ---- 1 Load a Distribution 2 Verify Checksums in Transport Global 3 Print Transport Global 4 Compare Transport Global to Current System 5 Backup a Transport Global 6 Install Package(s) Restart Install of Package(s) Unload a Distribution DD DD, 2nd Line Comparison Select Installation Option: 3. Select Installation Option: ------------------------------- NOTE: The following are OPTIONAL - (When prompted for the INSTALL NAME, enter LR*5.2*308): a. 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. b. 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.). c. Verify Checksums in Transport Global - This option will allow you to ensure the integrity of the routines that are in the transport global. 4. Select Installation Option: Install Package(s) ------------------ **This is the step to start the installation of this KIDS patch: a. Choose the Install Package(s) option to start the patch install. b. When prompted 'Want KIDS to INHIBIT LOGONs during the install? YES//' answer NO c. When prompted, 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//', answer NO 5. Routine LR308 will be deleted by the software. Routine Information: ==================== The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: LR308 Before: n/a After: B10318611 **308** Routine Name: LRAPLG1 Before: B12986045 After: B12975824 **72,121,248,308** Routine Name: LRAPUTL Before: B65239334 After: B64931804 **259,308** Routine Name: LRCAPES Before: B75227462 After: B82507767 **274,259,349,308** Routine Name: LRCAPES1 Before: B25817305 After: B68838767 **274,308** Routine Name: LRCAPPH1 Before: B56348077 After: B60854861 **127,136,138,158,263,264,274, 291,359,308** ============================================================================= User Information: Entered By : LYON,KAREN Date Entered : JUL 23, 2003 Completed By: ELIJAH,VICKEY Date Completed: MAY 09, 2007 Released By : LECLAIR,RAY Date Released : MAY 10, 2007 ============================================================================= Packman Mail Message: ===================== $END TXT