Inside Angle
From 3M Health Information Systems
Coding the problem list
The problem list is well known to the medical coding industry since codes based on the problem list are used for research and reimbursement. With the advent of the patient portal, more patients are becoming aware of the problem list too, including how their problems are coded. To better understand the problem list, let’s go back to its origin. In the 1950s, Dr. Lawrence Weed first developed a system used to organize patient data. He was dissatisfied with the illegible, handwritten notes providers wrote about patients, a practice he considered chaotic. To bring order to the process, Dr. Weed developed the Problem Oriented Medical Record, for which he is revered as an industry pioneer. From this development, the problem list emerged and is now used almost nationwide.
Dr. Lawrence Weed challenged the status quo. He challenged the notion that doctors could rely on memory and personal judgment instead of utilizing tools to adequately keep track of their patient’s problems across specialties. The problem list has evolved to a database of all the patient’s diagnoses and a tool providers use to keep track of and share patient information.
As patients become savvier in using technology, they are more actively involved in reviewing their problem list and identifying errors. Any incorrect code assigned from an improper diagnosis can cross over into the problem list and negatively affect the patient, including possible issues with insurance coverage, effort required to get an incorrect code corrected, and even legal issues—all stressful situations.
The problem list can be documented as Patient Active Problem List, which suggests a list of only those conditions in the patient record that affect the patient’s care. However, the problem list has become a list of every single diagnosis assigned to the patient whether it’s current, chronic, affects the patient’s care or not. As coders, we would not arbitrarily assign codes to these conditions. Clinicians need to manage the list to ensure that it’s complete, current and accurate. Until this happens, coders must continue to review the patient record to ensure diagnoses documented in the problem list meet reporting criteria.
Monica Sanchez is an outpatient coding analyst at 3M Health Information Systems.
7 thoughts on “Coding the problem list”
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Monica Sanchez
Coding Analyst
Monica Sanchez has been in the health information management industry for over 15 years. She supports 3M’s 360 Encompass Outpatient Auto-Suggest clients utilizing CAC and NLP. Monica is happy to…
The problem list, itself, is a problem, because (in the EMR’s I’m familiar with) the diagnoses are not entered by coding staff, but rather entered by clinical individuals, so they are not accurately coded. We know that clinical terminology does not match coding terminology. Our assigned codes are often vastly different. Since those “codes” are needed for other things, e.g. meaningful use, we need a solution for when the accounts are coded. Maybe we have a preliminary problem list, then a final, after we code them? I don’t have the solution, but it’s definitely worth addressing to avoid misinformation of patients, payers, and more.
I agree that this is worth addressing. Possibly come up with a few solutions and decide which one is most feasible.
We instruct our IP coding staff to use their “coder brain” to code diagnoses that meet the ‘Other Diagnoses’ definition from the Problem List. It is something we have to remind them of, but they do a pretty good job. Until medical schools wake up and train new physicians the importance of what and how they document even in the electronic environment, the Problem List will always be a “problem”.
Getting out of old habits and training the new physicians would be ideal. There have been some improvements but there’s nothing like clear, complete, concise and relevant documentation.
Yep, Jannifer is right-on. Our providers constantly have old, unspecified, or just flat-out wrong codes in the problem list, or they simply don’t feel like adding new ones if they know a patient has hypertension and they say so in the recent chart note without “clicking another box,” as two 40-year practice veterans like to say.
It’s a neverending battle to get them to code correctly. They like to say “that’s what we hired you for.”
Similar to Janice – we do not allow coding exclusively from the problem list. It can be an indicator of other things to look for. We have stripped out any reference to I10 codes. Our EHR has come a long way over the years (we predominately have the one that does not begin with “E”), but there is still room for opportunity from a coding perspective.
If the patient is taking medications from the diagnosis in problem list than those those diagnosis should also be reported along with Primary diagnosis…!!