Even More Stupid CCD Tricks

Here is another one that I just saw.

In addition to the usual missing codes, units, etc., it looks like  they tried to place the observation in the procedure reason. So I read this as we performed this unknown procedure from CPT-4 because we got a result for an improperly coded creatinine random urine test. I suspect that the procedure entry was used instead of the result observation entry, and that they really want to be reporting the urine test result. At least, that's what the narrative block seems to indicate.

<entry typeCode="DRIV">
                        <procedure classCode="PROC" moodCode="EVN">
                            <templateId root="2.16.840.1.113883.10.20.1.29"/>
                            <templateId root="2.16.840.1.113883.3.88.11.83.17"/>
                            <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19"/>
                            <id root="36e3e930-7b14-11db-9fe1-0800200c9a66"/>
                            <code code="0" codeSystem="2.16.840.1.113883.6.12" codeSystemName="CPT-4" displayName="UNK">
                                <originalText>
                                    <reference value="#proc5"/>
                                </originalText>
                            </code>
                            <text>
                                <reference/>
                            </text>
                            <statusCode code="completed"/>
                            <effectiveTime nullFlavor="UNK"/>
                            <entryRelationship typeCode="RSON">
                                <observation classCode="OBS" moodCode="EVN">
                                    <templateId root="2.16.840.1.113883.3.88.11.83.15.1"/>
                                    <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.13"/>
                                    <templateId root="2.16.840.1.113883.10.20.1.31"/>
                                    <id root="36e3e930-7b14-11db-9fe1-0800200c9a66"/>
                                    <code code="UNK" codeSystem="2.16.840.1.113883.5.83" displayName="MERCURY, RANDOM URINE"/>
                                    <text>
                                        <reference value="#Res5"/>
                                    </text>
                                    <statusCode code="completed"/>
                                    <effectiveTime nullFlavor="UNK"/>
                                    <value unit="UNK" value="4" xsi:type="PQ"/>
                                    <interpretationCode code="L" codeSystem="2.16.840.1.113883.5.83"/>
                                    <referenceRange>
                                        <observationRange>
                                            <value xsi:type="IVL_PQ">
                                                <low nullFlavor="UNK" unit="UNK"/>
                                                <high nullFlavor="UNK" unit="UNK"/>
                                            </value>
                                        </observationRange>
                                    </referenceRange>
                                </observation>
                            </entryRelationship>
                        </procedure>
                    </entry>

More Stupid CCD Tricks

I got this problem observation from another trading partner.

<observation classCode="OBS" moodCode="EVN">
    <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
    <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.5" assigningAuthorityName="IHE PCC"/>
    <id/>
    <code code="" displayName="" codeSystem="" codeSystemName=""/>
    <text>
        <reference value="#problem-93333"/>
    </text>
    <statusCode code="completed"/>
    <effectiveTime>
        <low value="20081119000000"/>
        <high nullFlavor="UNK"/>
    </effectiveTime>
    <value xsi:type="CD" nullFlavor="UNK">
        <translation code="466.0" codeSystem="2.16.840.1.113883.6.103" codeSystemName="ICD9CM"/>
    </value>
</observation>

The problem type needs to be specified in the Code element. This is the error from the validator.

Error: HITSP/C83 Conditions Problem Type SHALL be coded as specified in HITSP/C80 Section 2.2.3.1.2 Problem Type. The Problem Type code element SHALL contain a code attribute that identifies the SNOMED CT code for one of the following seven conditions: Finding (404684003), Symptom (418799008), Problem (55607006), Complaint (409586006), Condition (64572001), Diagnosis (282291009, Functional limitation (248536006). See HITSP/C83 Section 2.2.2.7.3, rule C83-[DE-7.02-1].

Error: HITSP/C83 Conditions Problem Type SHALL be coded as specified in HITSP/C80 Section 2.2.3.1.2 Problem Type. The code SHALL contain a codeSystem attribute that identifies the SNOMED CT codeSystem (2.16.840.1.113883.6.96). See HITSP/C83 Section 2.2.2.7.3, rule C154-[DE-7.02-1].

The Problem Type is to be taken from the Problem Type Value Set (Table 2-60).

Concept Code	Concept Name (SNOMED Fully Specified Name)	Definition	Usage Note
404684003	Clinical finding (finding)	Not Available	Finding
418799008	Finding reported by subject or history provider (finding)	Not Available	Symptom
55607006	Problem (finding)	Not Available	Problem
409586006	Complaint (finding)	Not Available	Complaint
64572001	Disease (disorder)	Not Available	Condition
282291009	Diagnosis interpretation (observable entity)	Not Available	Diagnosis
248536006	Finding of functional performance and activity (finding)	Not Available	Functional limitation

Then the value needs to be taken from the Problem Value set. This is constrained SNOMED-CT.

Element	Description
Identifier	2.16.840.1.113883.3.88.12.3221.7.4
Name	Problem Value Set
Source	Veterans Administration/Kaiser Permanente (VA/KP)
URL	http://evs.nci.nih.gov/ftp1/FDA/ProblemList/
Purpose	Problems and Diagnosis
Definition	See VA/KP Problem List Subset of SNOMED CT This describes the problem. Diagnosis/Problem List is broadly defined as a series of brief statements that catalog a patients medical, nursing, dental, social, preventative and psychiatric events and issues that are relevant to that patients healthcare (e.g., signs, symptoms, and defined conditions)
Version	20081203
Type	Extensional
Binding	Dynamic
Status	Active
Effective Date	Unknown
Expiration Date	N/A
Creation Date	Unknown
Revision Date	20090331
Code System Name	SNOMED CT
Code System Source	National Library of Medicine UMLS

What they are saying here is that patient has a problem, Acute Bronchitis. They coded it internally using ICD9. But, they don't know the SNOMED-CT code for this concept. They need to provide the SNOMED-CT code for this, which is 10509002.

I wonder if I am the only one that works with vendors that don't get it?

2011-2012 Hockey

I start playing hockey again this week.

Moosejaw will be playing on Monday nights, this year. The league has four teams and five goalies. They have a goalie schedule and rotation. I will not play every week. I will also play for each of the other teams, once. It will be confusing. We're playing at the Arctic Pond. We played there once before in a different league.

Here is the schedule:

http://www.allprosoftware.net/ARCTIC_45_TEAM/ls96.htm

I begin playing with the Wednesday drop-in group this week. I've played with this group of guys for many years. For a while, most of the best players would end up on one team. They beat me like a rented mule. I finally got fed up and played against them every week. When you are the first goalie on the ice, you get to pick the goal that you will play in. I got to the point where I was beating them regularly, and they asked why I never played for them. I told them that I wanted to face the tougher shots.

Last year, they started drafting teams each night, so I never knew who would be shooting at me.

It will be good to be back on the ice.