============================================================================= Run Date: JAN 09, 2003 Designation: LR*5.2*274 Package : LR - LAB SERVICE Priority: Mandatory Version : 5.2 SEQ #224 Status: Released Compliance Date: FEB 09, 2003 ============================================================================= Subject: AP CPT Coding & NLT Code Update Category: - Data Dictionary - Routine - Enhancement (Mandatory) - Input Template - Print Template Description: ============ VISTA Laboratory Package patch LR*5.2*274 contains no changes to software controlled by VHA DIRECTIVE 99-053, titled VISTA BLOOD BANK SOFTWARE. ==================== Patch Description: (1) WKLD CODE (#64) file is updated with the latest released National Laboratory Test (NLT) codes. (2) This patch allows the user to manually encode CPT codes for a given accession. This method of CPT coding does not use the CPT codes associated by the mapping of LABORATORY TEST file (#60) entries to WKLD CODE file (#64). The user can select any appropriate CPT code(s) to identify the professional service(s) rendered during this particular tissue exam. The user can select from a pre-defined pick list or enter CPT codes individually separated by commas ",". The pick list can be defined by editing the ES DISPLAY ORDER field (#26) of the WKLD CODE file (#64). The number entered in the ES DISPLAY ORDER field controls the order of CPT codes in the pick list. The numerical order of the pick list uses the number entered in ES DISPLAY ORDER field for each WKLD CODE defined. (3) The NLT Mapped Code Search [LRCAP64S] option has been changed to correctly respond to the following prompt at the end of each page: "Enter RETURN to continue or '^' to exit:" ======================= New/Enhanced Options: 1. Edit or Print WKLD CODES [LR WKLD CODE EDIT PRINT] option has been enhanced to include the new field ES DISPLAY ORDER (#26) of WKLD CODE (#64) file. This option is used to print or edit fields in the WKLD CODE (#64) file. 2. The new option LAB CPT BILLING [LRCAPES] has been created to provide manual CPT billing and laboratory workload capture. The LAB CPT BILLING option has no security key restriction. The option has been added to the Verify/release menu, anat path [LRAPVR] option. 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: A. If the procedure was ordered on a patient from PATIENT (#2) file, from a location that has TYPE (#2) of CLINIC, MODULE or OTHER as defined in the HOSPITAL LOCATION (#44) file, the user identified CPT codes will be passed to the Laboratory PCE API. If the PCE API accepts the passed data, the PCE ENC # (30) field of the ACCESSION NUMBER SUB-FIELD (#68.02 of the DATE SUB-FIELD (68.01) of the ACCESSION (#68) file will be populated with the PCE visit number. CPT billing can be done multiple times for the same accession. B. The software will also capture the WKLD CODE(s) associated with the ES DISPLAY ORDER number. This data will be captured as laboratory workload. It will be reported based on the current LMIP workload reporting protocol. 3. Electronic Catalog Print [LA7S PRINT CATALOG] option [LA7S PRINT] template has been modified to display the LEDI HL7 (#.09) field of the TOPOGRAPHY FIELD (#61) file instead of the SNOMED CODE (#2) field. This is to assist LEDI collection sites with defining the LAB SHIPPING CONFIGURATION (#62.9) file. 4. Print log book [LRAPBK] option has been enhanced to display a list of CPT codes passed to PCE for outpatients. This option can also be used to provide a partial audit of CPT coding practices. ================= Required Patch List: LR*5.2*163 LR*5.2*264 LR*5.2*258 LR*5.2*266 ================= NOIS: SAM-1102-20599 BHS-0990-11616 ================= Files: There are no new files contained in this patch. However the following files will be updated with additional data. (1) WKLD CODE (#64) file will be updated with any missing National Laboratory Test (NLT) codes during the post installation phase. LAB NLT/CPT CODES (#64.81) contains a complete listing of NLT codes. WKLD CODE (#64) file is checked to determine if an NLT code should be added. If the new NLT code is successfully added to WKLD CODE (#64) file or the NLT code already exists, the entry in LAB NLT/CPT CODES (#64.81) file is deleted. (2) The TEST/PROCEDURE (#.01) field of the SPECIMEN # (#1) subfile of LAB ORDER ENTRY (#69) file, input screen has been changed to allow the entry of LABORATORY TEST (#60) that have the TYPE (#3) field set to OUPUT. This screen was changed in the software of an earlier released patch. The user should see no difference in software behavior. (3) The DSS TEST NUMBER (#.01) field of the RESULT (#8) subfile of LAR DSS LAR EXTRACT (#64.036) file has been increased from 50 to 300 to accommodate patch ECX*3*47 number of tests to be extract. Below is a listing of files exported by this patch, indicating if the imported file will contain additional data. FILE # NAME With Data ---------------------------------------------- 64 WKLD CODE NO 64.036 LAB DSS LAR EXTRACT NO 64.2 WKLD SUFFIX CODES YES 64.21 WKLD CODE LAB SECT YES 64.22 WKLD ITEM FOR COUNT YES 64.3 WKLD INSTRUMENT MANUFACTURER YES 64.81 LAB NLT/CPT CODES YES 68 ACCESSION NO Note: The LAB NLT/CPT CODES (#64.81) file is purged during the pre-installation phase. This file is only used to update THE WKLD CODE (#64) file and has no other purpose or function. This file will have no data after the post installation routine has successfully run to completion. ====================== New Fields: ES DISPLAY ORDER(#26) field has been added to the WKLD CODE (#64) file. This field is used by the LAB CPT BILLING option to display a pick list of those CPT codes defined by the NLT code. CPT codes can be selected by using this number. PCE ENC # (#30) of ACCESSION NUMBER SUB-FIELD (#1) of ACCESSION (#68) file has been added. This free text field contains a list of PCE Visit numbers generated for this accession. If there are multiple visit numbers for this accession they are separated by ';'. This field is only populated if professional service PCE workload is generated. This is usually the type of PCE workload generated by the Pathologist reporting anatomic pathology services. PCE workload is only generated for those hospital locations with the type of clinic, module or other. Note: No PCE workload is generated for inpatient locations. ========================= Modified Print Template: Electronic Catalog Print [LA7S PRINT CATALOG] option LA7S PRINT template has been changed to display the LEDI HL7 (#.09) field instead of SNOMED CODE (#2) in TOPOGRAPHY FIELD (#61) field. The LEDI HL7 field is required by LEDI collecting sites when defining tests to be sent to the Host laboratory and shipping manifest. The LEDI HL7 specimen must match the specimen the HOST laboratory requires. ========================== Input Template: Input Template [LR WKLD EDIT ALL] has been modified to allow editing of all user definable fields in the WKLD CODE (#64) file. Most notable is that the LOINC CODE (#4) field of the TIME ASPECT (#30) sub-file of the WKLD CODE (#64) file. This template is very useful to delete or correct LOINC CODE entry in the WKLD CODE (#64) file. Input Template [LR WKLD ES CPT] is designed to allow quick editing of the ES DISPLAY ORDER (#26) field and to edit all CODE (#18) sub-file entries. The CODE sub-file is where CPT CODE assignments are entered. ========================= Test Sites: Muskogee, OK Long Beach, CA Durham, NC Lake City, FL Central Texas Gainesville, FL Boston, HCS St. Louis, MO ========================= Routine Summary: The following is a list of the routine(s) included in this patch. The second line of each of these routine(s) will look like: ;;5.2;LAB SERVICE;**[patch list]**;Sep 27, 1994 CHECK^XTSUMBLD results Routine Before After Patch Name Patch Patch List LR274 N/A 6102494 274 (Deleted by KIDS) LR274PO N/A 9865530 274 (Deleted by KIDS) LR274POA N/A 4193520 274 (Deleted after install) LRAPBK 12411722 13558720 51,72,201,274 LRCAPES N/A 12983418 274 LRCAPES1 N/A 8132160 274 LRCAPFDS 9495229 9744247 105,119,127,163,274 LRCAPPH1 11010117 11352750 127,136,138,158,263,264,274 LRTT5P1 12439150 12768427 153,221,263,274 LRTT5R1 6009458 6020078 153,201,274 LRVER3A 10508599 10313641 1,5,42,100,121,153,190 221,254,263,266,274 =========================== Required Patches: LR*5.2*163 LR*5.2*201 LR*5.2*263 LR*5.2*264 LR*5.2*266 LR*5.2*258 ========================= Installation Instructions: The patch LR*5.2*274 KIDS build file named LR52_274.KID stored in the ASCII format can be obtained from the following Office of Information Field Offices(OIFOs) ANONYMOUS SOFTWARE directories OIFO FTP Address Directory Albany ftp.fo-albany.med.va.gov anonymous.software Hines ftp.fo-hines.med.va.gov anonymous.software Salt Lake ftp.fo-slc.med.va.gov anonymous.software All users may remain on the system. Note: It is still recommended that the patch be installed during off peak hours. No laboratory background jobs need to be stopped. No options need to be placed out of service. From the Kernel Installation & Distribution System (KIDS) menu 1. Use the 'Load a Distribution' option to load the LR52_274.KIDS file onto your system. 2. The patch has now been loaded into a Transport global on your system. You now need to use KIDS to install the Transport global. On the KIDS menu, under the 'Installation' menu, use the following options: Print Transport Global Compare Transport Global to Current System Verify Checksums in Transport Global Backup a Transport Global 3. Users may remain on the system, but installation should be done at off peak hours. 4. Installation time is less than 5 minutes during off peak hours and less than 15 minutes during peak hours. 5. Installation of this patch requires no additional memory space. 6. From the 'Installation Menu' of the KIDS menu, run the option 'Install Package(s)' Select the package 'LR*5.2*274' and proceed with the install. 7. When prompted 'Want KIDS to INHIBIT LOGONS during the install? YES//' respond NO. 8. When prompted 'Want to DISABLE scheduled Options, Menu Options, and Protocols? YES//' respond NO. ====================== Example of install: Select Installation Option: INSTAll Package(s) Select INSTALL NAME: LR*5.2*274 Loaded from Distribution 7/11/02@09:42:27 => LR*5.2*274 This Distribution was loaded on Jul 11, 2002@09:42:27 with header of LR*5.2*274 It consisted of the following Install(s): LR*5.2*274 Checking Install for Package LR*5.2*274 Will first run the Environment Check Routine, LR274 Sending install started alert to mail group G.LMI --- Environment Check is Ok --- Install Questions for LR*5.2*274 Incoming Files: 64 WKLD CODE Note: You already have the 'WKLD CODE' File. 64.036 LAB DSS LAR EXTRACT Note: You already have the 'LAB DSS LAR EXTRACT' File. 64.2 WKLD SUFFIX CODES (including data) Note: You already have the 'WKLD SUFFIX CODES' File. I will OVERWRITE your data with mine. 64.21 WKLD CODE LAB SECT (including data) Note: You already have the 'WKLD CODE LAB SECT' File. I will OVERWRITE your data with mine. 64.22 WKLD ITEM FOR COUNT (including data) Note: You already have the 'WKLD ITEM FOR COUNT' File. I will OVERWRITE your data with mine. 64.3 WKLD INSTRUMENT MANUFACTURER (including data) Note: You already have the 'WKLD INSTRUMENT MANUFACTURER' File. I will OVERWRITE your data with mine. 64.81 LAB NLT/CPT CODES (including data) Note: You already have the 'LAB NLT/CPT CODES' File. I will OVERWRITE your data with mine. 68 ACCESSION Note: You already have the 'ACCESSION' File. Want KIDS to Rebuild Menu Trees Upon Completion of Install? YES//NO Want KIDS to INHIBIT LOGONs during the install? YES// NO Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES// NO Enter the Device you want to print the Install messages. You can queue the install by enter a 'Q' at the device prompt. Enter a '^' to abort the install. DEVICE: HOME// TELNET TO ALPHAS --------------------------------------------------------- Install Started for LR*5.2*274 : Jul 11, 2002@09:57:20 Build Distribution Date: Jul 11, 2002 Installing Routines: Jul 11, 2002@09:57:20 Running Pre-Install Routine: PRE^LR274PO Installing Data Dictionaries: Jul 11, 2002@09:57:26 Installing Data: Jul 11, 2002@10:01:18 Installing PACKAGE COMPONENTS: Installing PRINT TEMPLATE Installing INPUT TEMPLATE Installing OPTION Jul 11, 2002@10:01:19 Running Post-Install Routine: POST^LR274PO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Building List Of Added WKLD CODEs List Of Added WKLD CODEs Complete Sending message to LMI Mail Group. Sending install completion alert to mail group G.LMI Updating Routine file... Updating KIDS files... LR*5.2*274 Installed. Jul 11, 2002@10:05:28 LR*5.2*274 Install Completed Installation of patch LR*5.2*274 started on Jul 11, 2002@09:56:20 Installation of patch LR*5.2*274 completed on Jul 11, 2002@10:05:27 LIM: Review description for LR*5.2*274 use KIDS Utilities Build File Print End of installation example. =============================================== Post Install instruction: The Laboratory Information Manager (LIM) should obtain from the Anatomic Pathology department, a list containing CPT codes for the procedures most frequently performed. The entries on this list need to be ranked by frequency (i.e. most frequently used procedure is #1, next frequently used procedure is #2, etc.) This list will provide a template for the display listing. Next, the LIM need to select a NLT code from the WKLD CODE (#64) file with the corresponding CPT code. Next, using the option Edit or Print WKLD CODES[LR WKLD CODE EDIT PRINT] option, edit the ES DISPLAY ORDER (#26) field by entering the sequence number from the frequency list and edit the CODE (#18) field multiple with the appropriate CPT Code(s). Editing of the WKLD CODE file can be done with the Edit or Print WKLD CODES [LR WKLD CODE EDIT PRINT] option. ================================================ User Information: The user performing the CPT coding for tissue exam using the LAB CPT BILLING [LRCAPES] option can enter the ES DISPLAY ORDER number (the sequence number from the frequency list) to select CPT codes. The user can enter double question marks '??' to see a list of CPT codes selectable by entering the ES DISPLAY ORDER numbers. If the appropriate code does not appear on the list, the user can enter the individual CPT code number(s) separated by commas. The coding software ensures that all CPT codes selected are active. If the user does not have the PROVIDER security key, a valid active provider must be entered. The user reviews the accessioned test(s) and the CPT codes selected. The user is prompted to accept or reject the information. After accepting the previous information the software will determine, using the TYPE (#2) field of the HOSPITAL LOCATION (#44) file, if the location entered is an outpatient location. Those locations with the type of clinic, module or other are considered to be out patient location. CPT coding is ONLY PASSED FOR OUT PATIENT LOCATION TYPES. If the specimen is assigned to a Patient as defined by an entry in the PATIENT (#2) file, the specified CPT codes are passed immediately to the Laboratory/PCE API. The date/time of the visit is set to specimen collection date/time. If the time is not specified, a default of 12:01 is used. The PCE API returns the visit number which is stored in the PCE ENC (#30) field of the ACCESSION NUMBER (#1) sub-file of the DATE (#.01) sub-file of the ACCESSION (#68) file. The software will also store the WKLD CODES associated with the CPT codes selected. These WKLD CODE are added to the Laboratory LMIP workload for that accession. This is done regardless of the location type. Example of File setup =============================================================== The example does not represent true clinical situation, it is used only for demonstration purposes. LRMENU Laboratory DHCP Menu Select Laboratory DHCP Menu Option: SUPervisor menu Select Supervisor menu Option: LAB LIaison menu Select Lab liaison menu Option: LIM workload menu Select LIM workload menu Option: EDIT 1 Edit ACC Area OOS Locations 2 Edit or Print WKLD CODES CHOOSE 1-2: 2 Edit or Print WKLD CODES Do you want to edit specific WKLD CODES/ALL fields? ? N// YES Select WKLD CODE PROCEDURE: 88551.0000 Surgical Pathology Level I 88551.0000 PROCEDURE: Surgical Pathology Level I// (No Editing) DESCRIPTION: No existing text Edit? NO// PRINT NAME: ^CODE Select CODE: CPT.88300 Searching for a active CPT code., (pointed-to by CODE) Searching for a active CPT code. 88300 SURGICAL PATH, GROSS ...OK? Yes// (Yes) RELEASE DATE: T-1 (JUN 24, 2001) INACTIVE DATE: REPLACEMENT CODE: CODE NOTES: No existing text Edit? NO// Select CODE: ^ES DISPLAY ORDER ES DISPLAY ORDER: // 1 Select OPTION NAME: LRMENU Laboratory DHCP Menu Select Laboratory DHCP Menu Option: Anatomic pathology ANATOMIC PATHOLOGY MENU Select Anatomic pathology Option: Verify/release menu, anat path Select Verify/release menu, anat path Option: ? RR Verify/release reports, anat path RS Supplementary report release, anat path LU List of unverified pathology reports CPT LAB CPT BILLING Example of CPT code capture. ============================================================= Select Verify/release menu, anat path Option: CPT LAB CPT BILLING Select Accession: SURG SURGICAL PATHOLOGY SURGICAL PATHOLOGY Accession Date: TODAY// (NOV 06, 2002) Number part of Accession: (1-999999): 3 BRADY,MOM 389-24-0000 DOB: May 02, 1955 Collection Date: Apr 17, 2002 Acc #: NSP 02 3 UID: PCE ENC # 314; Specimen: Tissue Specimens: VAGINAL CANAL Test(s); SURGICAL PATHOLOGY LOG-IN/ Releasing Pathologist PROVIDER: REV. GINSBURG,RONALD Ordering Location: : RED CLINIC Would you like to see PCE CPT Information? No// Select CPT codes: ?? List or range e.g., 1,3,5-7,88300. Select from the following or enter CPT separated by a comma 1 = 88300 LEVEL I - SURGICAL PATHOLOGY, GROSS EXAMINATION ONLY Surgical Pathology Level I { NLT = 88551.0000 } 2 = 88302 LEVEL II - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EX Surgical Pathology Level II { NLT = 88518.0000 } 3 = 88304 LEVEL III - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC E Surgical Pathology Level III { NLT = 88553.0000 } 4 = 88305 LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EX Surgical Pathology Level IV { NLT = 88555.0000 } 5 = 88307 LEVEL V - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXA Surgical Pathology Level V { NLT = 88557.0000 } 6 = 88309 LEVEL VI - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EX Surgical Pathology Level VI { NLT = 88559.0000 } 7 = 88329 PATHOLOGY CONSULTATION DURING SURGERY; Frozen Section Add Cut { NLT = 88360.0000 } Would you like to see PCE CPT Information? YES CPT: 88300 PATIENT NAME: BRADY,MOM VISIT: APR 17, 2002@12:01 PROVIDER NARRATIVE: SURGICAL PATH, GROSS QUANTITY: 1 ENCOUNTER PROVIDER: REV. GINSBURG,RONALD CPT: 88302 PATIENT NAME: BRADY,MOM VISIT: APR 17, 2002@12:01 PROVIDER NARRATIVE: TISSUE EXAM BY PATHOLOGIST QUANTITY: 1 ENCOUNTER PROVIDER: REV. GINSBURG,RONALD Select CPT codes: 1,2 BRADY,MOM 389-24-0000 DOB: May 02, 1955 Collection Date: Apr 17, 2002 Acc #: NSP 02 3 UID: PCE ENC # 314; Specimen: Tissue Specimens: VAGINAL CANAL Test(s); SURGICAL PATHOLOGY LOG-IN/ Selected CPT Codes (1) 88300 LEVEL I - SURGICAL PATHOLOGY, GROSS EXAMINATION ON Surgical Pathology Level I {88551.0000} (2) 88302 LEVEL II - SURGICAL PATHOLOGY, GROSS AND MICROSCOP Surgical Pathology Level II {88518.0000} Is this correct ? Yes// YES Sending PCE Workload Visit # 314 Storing LMIP Workload End of examples: ====================================== Routine Information: ==================== Routine Name: - LRCAPES Routine Checksum: Routine Name: - LRCAPFDS Routine Checksum: Routine Name: - LRCAPPH1 Routine Checksum: Routine Name: - LR274 Routine Checksum: Routine Name: - LR274PO Routine Checksum: Routine Name: - LR274POA Routine Checksum: Routine Name: - LRAPBK Routine Checksum: Routine Name: - LRCAPES1 Routine Checksum: Routine Name: - LRTT5P1 Routine Checksum: Routine Name: - LRTT5R1 Routine Checksum: Routine Name: - LRVER3A Routine Checksum: ============================================================================= User Information: Entered By : STALLING,FRANK Date Entered : MAY 17, 2001 Completed By: DIBENEDETTO,PETER Date Completed: JAN 08, 2003 Released By : BELSCHWINDER,MICHAEL Date Released : JAN 09, 2003 ============================================================================= Packman Mail Message: ===================== No routines included