New ICANotes Features: Nov. 1, 2010

1.  AIMS Monitor Modifications: 

The AIMS section can now be accessed using buttons on the PN2 or Finish Initial Screens.  When AIMS monitoring is set the face of the button will show when the next AIMS is due

The AIMS scale is by default set to normal or, if this is repeat AIMS, to the last AIMS findings.

Once the latest AIMS is completed it can be printed and/or copied into the latest progress note, in the MSE section.

You can be reminded when to do the next AIMS or set a repeat reminder.  The next AIMS can be set manually or you can go to the Reminder section of the program, which will be set to remind you to do an AIMS. All you have to do is set the next date and the subsequent interval.  The reminder will be sent to your internal messaging in-box. 

2.  Vital Signs Graphing:  Vital signs in the Vital Signs Log, can now be graphed.  Height and weight are graphed against a background of normal graphs for children and adolescents.

New Features as of 10-20-10

New Features in ICANotes:

As ICANotes prepare for certification, development is occurring rapidly, and you may be noticing new features. Here are some of them:

1. Diagnoses may now be categorized as Active, Inactive, Chronic or Resolved. Explanations of what these categories mean are contained in the ? above the column. Note that a Resolved problem is a cured problem and that problem will not be carried forward to subsequent notes.
2. There have been a number of changes to our Logs. First of all, more items are being logged. Diagnoses are now being logged, and the diagnoses log can be screened so that you can, for example, see just the active diagnoses. Test results and reports of adverse drug reactions are also being logged.
3. AIMS results are also being logged. In addition, when the AIMS is complete it will be copied into the MSE. Also, if you wish you can go right from the completed AIMS to the Reminder Screen where it can be set to remind you when to do subsequent AIMS.
4. The Reminder Screen has been enhanced so that you can now set recurrent reminders. For example, you can set Reminder to do an AIMS every three months until a certain date.
5. On the Preview Screen, after compiling your note, there is a new button called “Create a Clinical Summary.” The Clinical Summary contains the patient's latest diagnoses, medication orders, allergies and adverse drug reactions, and most recent lab results. This summary can be printed and given to the patient or (soon) sent to another clinician or sent to a medical repository like Google Health or Microsoft HealthVault. There, it can be accessed in an emergency or at any time by the patient.
6. If you order Clozaril you will see a new category of message. This message does not alert you to a potential adverse drug reaction or a dangerous interaction. Instead, it provides clinical information about how to monitor patients receiving Clozaril.

Other imminent changes include the logging and graphing of vital signs.

The ICANotes Team

Initial Psychiatric Exam: What You Need to Achieve a Higher Code

When doing an Initial Psychiatric Examination in a hospital setting, there are three possible E/M codes: 99221, 99222 and 99223.

In order to achieve the higher codes, 99222 and 99223, three conditions have to be met.

The first is that you have to do a Comprehensive History

In order to do a Comprehensive History, you must do, among other things,  a symptom review in at least two other systems (besides the psychiatry system.)  ICANotes makes it easy to do a symptom review in the Constitutional and Musculoskeletal systems. Then, if all the other systems (cardiovascular, pulmonary etc) are normal, a simple statement that "All other systems are normal" will suffice for the other systems. If all the other systems are not normal you can go to the Detailed ROS, record the abnormal history findings, and then use the "All other systems normal" button.

The second condition is that you have to do a Comprehensive Exam.

To do a Comprehensive Exam you must record at least 4 mental status elements (eg: mood, affect etc).  In addition, you must do an exam in two other systems.  ICANotes makes it easy for you to do a Constitutional Exam and a Musculoskeletal Exam. You may, if you wish, examine and record your exam findings in other systems by using the Physical Exam button on the MSE screen. 

The third condition is that you have indicated that the complexity of the case or the level of complexity of medical decision making is at least moderate or high. Typically, this is warrented if the patient is in a hospital. Complexity can be set using a button on the HPI screen. Definitions of what is meant by moderate or high complexity are found on the Show Me Coding screen.

If your History and your Exam are Comprehensive and your Complexity is moderate, you will code a 99222. If your complexity is high, a 99223.

Is this complicated? Yes, but don't blame ICANotes!  We are just following CMS rules.  And CMs rules when it comes to E/M coding.

Ira