Signing an e-Rx: a cautionary tale

Here's something that technology has unfortunately made way too easy. A nephrologist is settling back in to the office after a short vacation and absentmindedly okays an e-Rx without actually verifying it. He doesn't notice that the Rx was mistakenly entered into the computer at a lethally high dose.

The patient dies.

... The physician tried to explain it to the attorney. “The way that I pulled up the email, the actual prescription information didn't show… so I didn't actually see the text,” he explained.

“But by clicking on the signature box you were effectively signing off on the prescription,” said the attorney. “This is problematic to defend. [It] would likely be considered by a jury to be below the standard of care owed to your patient.”

After careful consideration, the case was settled out of court for an amount within Dr. P's insurance coverage.

Via MPR.

CMS clarifies rules on Virtual Credit Cards (Hint: you aren't required to accept them).

Does it pain you to pony up the 5% processing fee incurred when running virtual credit card payments from certain insurance providers? You'll be happy to know that health plans are required to use EFT on request.

According to AMA Wire:

“A health plan cannot require a provider to accept virtual credit card payments,” the CMS states. “A provider has the right to request that a health plan use the electronic funds transfer (EFT) transaction. If a provider makes the request, the health plan must comply.”

Additionally, the fees for EFT are limited:

"The new guidance on the CMS FAQ page states that the only fee that may apply to a HIPAA EFT transaction is the small charge (averaging 34 cents per transaction) applied by the provider’s bank."

Source: AMA Wire. "Physicians protected from health plan credit card fees." 2017 Oct 5 (via Univadis).

Ophthalmic ICD10 code changes for 2018

In contrast to 2017, optometry won't have to deal with too many new codes in FY 2018. About half the pertinent code changes don't actually change the code itself, but simply correct/change the spelling of the code descriptions. The following is a round up of the changes we've noticed.

The spelling of "entropion" was corrected in the trichiasis codes:

H02.051 Trichiasis without entropion right upper eyelid
H02.052 Trichiasis without entropion right lower eyelid
H02.053 Trichiasis without entropion right eye, unspecified eyelid
H02.054 Trichiasis without entropion left upper eyelid
H02.055 Trichiasis without entropion left lower eyelid
H02.056 Trichiasis without entropion left eye, unspecified eyelid
H02.059 Trichiasis without entropion unspecified eye, unspecified eyelid

Degenerative myopia was added:

H44.2A1 Degenerative myopia with choroidal neovascularization, right eye
H44.2A2 Degenerative myopia with choroidal neovascularization, left eye
H44.2A3 Degenerative myopia with choroidal neovascularization, bilateral eye
H44.2A9 Degenerative myopia with choroidal neovascularization, unspecified eye
H44.2B1 Degenerative myopia with macular hole, right eye
H44.2B2 Degenerative myopia with macular hole, left eye
H44.2B3 Degenerative myopia with macular hole, bilateral eye
H44.2B9 Degenerative myopia with macular hole, unspecified eye
H44.2C1 Degenerative myopia with retinal detachment, right eye
H44.2C2 Degenerative myopia with retinal detachment, left eye
H44.2C3 Degenerative myopia with retinal detachment, bilateral eye
H44.2C9 Degenerative myopia with retinal detachment, unspecified eye
H44.2D1 Degenerative myopia with foveoschisis, right eye
H44.2D2 Degenerative myopia with foveoschisis, left eye
H44.2D3 Degenerative myopia with foveoschisis, bilateral eye
H44.2D9 Degenerative myopia with foveoschisis, unspecified eye
H44.2E1 Degenerative myopia with other maculopathy, right eye
H44.2E2 Degenerative myopia with other maculopathy, left eye
H44.2E3 Degenerative myopia with other maculopathy, bilateral eye
H44.2E9 Degenerative myopia with other maculopathy, unspecified eye

More specificity was added to the blindness & low vision codes:

H54.0X33 Blindness right eye category 3, blindness left eye category 3
H54.0X34 Blindness right eye category 3, blindness left eye category 4
H54.0X35 Blindness right eye category 3, blindness left eye category 5
H54.0X43 Blindness right eye category 4, blindness left eye category 3
H54.0X44 Blindness right eye category 4, blindness left eye category 4
H54.0X45 Blindness right eye category 4, blindness left eye category 5
H54.0X53 Blindness right eye category 5, blindness left eye category 3
H54.0X54 Blindness right eye category 5, blindness left eye category 4
H54.0X55 Blindness right eye category 5, blindness left eye category 5
H54.10 Blindness, one eye, low vision other eye, unspecified eyes
H54.1131 Blindness right eye category 3, low vision left eye category 1
H54.1132 Blindness right eye category 3, low vision left eye category 2
H54.1141 Blindness right eye category 4, low vision left eye category 1
H54.1142 Blindness right eye category 4, low vision left eye category 2
H54.1151 Blindness right eye category 5, low vision left eye category 1
H54.1152 Blindness right eye category 5, low vision left eye category 2
H54.1213 Low vision right eye category 1, blindness left eye category 3
H54.1214 Low vision right eye category 1, blindness left eye category 4
H54.1215 Low vision right eye category 1, blindness left eye category 5
H54.1223 Low vision right eye category 2, blindness left eye category 3
H54.1224 Low vision right eye category 2, blindness left eye category 4
H54.1225 Low vision right eye category 2, blindness left eye category 5
H54.2X11 Low vision right eye category 1, low vision left eye category 1
H54.2X12 Low vision right eye category 1, low vision left eye category 2
H54.2X21 Low vision right eye category 2, low vision left eye category 1
H54.2X22 Low vision right eye category 2, low vision left eye category 2
H54.3 Unqualified visual loss, both eyes
H54.40 Blindness, one eye, unspecified eye
H54.413A Blindness right eye category 3, normal vision left eye
H54.414A Blindness right eye category 4, normal vision left eye
H54.415A Blindness right eye category 5, normal vision left eye
H54.42A3 Blindness left eye category 3, normal vision right eye
H54.42A4 Blindness left eye category 4, normal vision right eye
H54.42A5 Blindness left eye category 5, normal vision right eye
H54.50 Low vision, one eye, unspecified eye
H54.511A Low vision right eye category 1, normal vision left eye
H54.512A Low vision right eye category 2, normal vision left eye
H54.52A1 Low vision left eye category 1, normal vision right eye
H54.52A2 Low vision left eye category 2, normal vision right eye

Optic tract and visual cortex injuries now specify the "side" involved rather than the "eye" involved:

S04.031A Injury of optic tract and pathways, right side, initial encounter
S04.031D Injury of optic tract and pathways, right side, subsequent encounter
S04.031S Injury of optic tract and pathways, right side, sequela
S04.032A Injury of optic tract and pathways, left side, initial encounter
S04.032D Injury of optic tract and pathways, left side, subsequent encounter
S04.032S Injury of optic tract and pathways, left side, sequela
S04.039A Injury of optic tract and pathways, unspecified side, initial encounter
S04.039D Injury of optic tract and pathways, unspecified side, subsequent encounter
S04.039S Injury of optic tract and pathways, unspecified side, sequela
S04.041A Injury of visual cortex, right side, initial encounter
S04.041D Injury of visual cortex, right side, subsequent encounter
S04.041S Injury of visual cortex, right side, sequela
S04.042A Injury of visual cortex, left side, initial encounter
S04.042D Injury of visual cortex, left side, subsequent encounter
S04.042S Injury of visual cortex, left side, sequela
S04.049A Injury of visual cortex, unspecified side, initial encounter
S04.049D Injury of visual cortex, unspecified side, subsequent encounter
S04.049S Injury of visual cortex, unspecified side, sequela

And the winner of the most arbitrarily over-specified codes in 2018 is the addition of the ATV and dirt bike accident codes (hey, you never know when you might want to specify the cause of that corneal abrasion!). We're sure this makes the life insurance lobby feel all warm and fuzzy.

V86.05XA Driver of 3- or 4- wheeled all-terrain vehicle (ATV) injured in traffic accident, initial encounter
V86.05XD Driver of 3- or 4- wheeled all-terrain vehicle (ATV) injured in traffic accident, subsequent encounter
V86.05XS Driver of 3- or 4- wheeled all-terrain vehicle (ATV) injured in traffic accident, sequela
V86.06XA Driver of dirt bike or motor/cross bike injured in traffic accident, initial encounter
V86.06XD Driver of dirt bike or motor/cross bike injured in traffic accident, subsequent encounter
V86.06XS Driver of dirt bike or motor/cross bike injured in traffic accident, sequela

V86.15XA Passenger of 3- or 4- wheeled all-terrain vehicle (ATV) injured in traffic accident, initial encounter
V86.15XD Passenger of 3- or 4- wheeled all-terrain vehicle (ATV) injured in traffic accident, subsequent encounter
V86.15XS Passenger of 3- or 4- wheeled all-terrain vehicle (ATV) injured in traffic accident, sequela
V86.16XA Passenger of dirt bike or motor/cross bike injured in traffic accident, initial encounter
V86.16XD Passenger of dirt bike or motor/cross bike injured in traffic accident, subsequent encounter
V86.16XS Passenger of dirt bike or motor/cross bike injured in traffic accident, sequela

V86.25XA Person on outside of 3- or 4- wheeled all-terrain vehicle (ATV) injured in traffic accident, initial encounter
V86.25XD Person on outside of 3- or 4- wheeled all-terrain vehicle (ATV) injured in traffic accident, subsequent encounter
V86.25XS Person on outside of 3- or 4- wheeled all-terrain vehicle (ATV) injured in traffic accident, sequela
V86.26XA Person on outside of dirt bike or motor/cross bike injured in traffic accident, initial encounter
V86.26XD Person on outside of dirt bike or motor/cross bike injured in traffic accident, subsequent encounter
V86.26XS Person on outside of dirt bike or motor/cross bike injured in traffic accident, sequela

V86.35XA Unspecified occupant of 3- or 4- wheeled all-terrain vehicle (ATV) injured in traffic accident, initial encounter
V86.35XD Unspecified occupant of 3- or 4- wheeled all-terrain vehicle (ATV) injured in traffic accident, subsequent encounter
V86.35XS Unspecified occupant of 3- or 4- wheeled all-terrain vehicle (ATV) injured in traffic accident, sequela
V86.36XA Unspecified occupant of dirt bike or motor/cross bike injured in traffic accident, initial encounter
V86.36XD Unspecified occupant of dirt bike or motor/cross bike injured in traffic accident, subsequent encounter
V86.36XS Unspecified occupant of dirt bike or motor/cross bike injured in traffic accident, sequela

V86.45XA Person injured while boarding or alighting from a 3- or 4- wheeled all-terrain vehicle (ATV), initial encounter
V86.45XD Person injured while boarding or alighting from a 3- or 4- wheeled all-terrain vehicle (ATV), subsequent encounter
V86.45XS Person injured while boarding or alighting from a 3- or 4- wheeled all-terrain vehicle (ATV), sequela
V86.46XA Person injured while boarding or alighting from a dirt bike or motor/cross bike, initial encounter
V86.46XD Person injured while boarding or alighting from a dirt bike or motor/cross bike, subsequent encounter
V86.46XS Person injured while boarding or alighting from a dirt bike or motor/cross bike, sequela

V86.55XA Driver of 3- or 4- wheeled all-terrain vehicle (ATV) injured in nontraffic accident, initial encounter
V86.55XD Driver of 3- or 4- wheeled all-terrain vehicle (ATV) injured in nontraffic accident, subsequent encounter
V86.55XS Driver of 3- or 4- wheeled all-terrain vehicle (ATV) injured in nontraffic accident, sequela
V86.56XA Driver of dirt bike or motor/cross bike injured in nontraffic accident, initial encounter
V86.56XD Driver of dirt bike or motor/cross bike injured in nontraffic accident, subsequent encounter
V86.56XS Driver of dirt bike or motor/cross bike injured in nontraffic accident, sequela

V86.65XA Passenger of 3- or 4- wheeled all-terrain vehicle (ATV) injured in nontraffic accident, initial encounter
V86.65XD Passenger of 3- or 4- wheeled all-terrain vehicle (ATV) injured in nontraffic accident, subsequent encounter
V86.65XS Passenger of 3- or 4- wheeled all-terrain vehicle (ATV) injured in nontraffic accident, sequela
V86.66XA Passenger of dirt bike or motor/cross bike injured in nontraffic accident, initial encounter
V86.66XD Passenger of dirt bike or motor/cross bike injured in nontraffic accident, subsequent encounter
V86.66XS Passenger of dirt bike or motor/cross bike injured in nontraffic accident, sequela

V86.75XA Person on outside of 3- or 4- wheeled all-terrain vehicle (ATV) injured in nontraffic accident, initial encounter
V86.75XD Person on outside of 3- or 4- wheeled all-terrain vehicle (ATV) injured in nontraffic accident, subsequent encounter
V86.75XS Person on outside of 3- or 4- wheeled all-terrain vehicle (ATV) injured in nontraffic accident, sequela
V86.76XA Person on outside of dirt bike or motor/cross bike injured in nontraffic accident, initial encounter
V86.76XD Person on outside of dirt bike or motor/cross bike injured in nontraffic accident, subsequent encounter
V86.76XS Person on outside of dirt bike or motor/cross bike injured in nontraffic accident, sequela

V86.95XA Unspecified occupant of 3- or 4- wheeled all-terrain vehicle (ATV) injured in nontraffic accident, initial encounter
V86.95XD Unspecified occupant of 3- or 4- wheeled all-terrain vehicle (ATV) injured in nontraffic accident, subsequent encounter
V86.95XS Unspecified occupant of 3- or 4- wheeled all-terrain vehicle (ATV) injured in nontraffic accident, sequela
V86.96XA Unspecified occupant of dirt bike or motor/cross bike injured in nontraffic accident, initial encounter
V86.96XD Unspecified occupant of dirt bike or motor/cross bike injured in nontraffic accident, subsequent encounter
V86.96XS Unspecified occupant of dirt bike or motor/cross bike injured in nontraffic accident, sequela

A different kind of EHR

Imagine an EHR for eyecare professionals with rich editing capabilities similar to Evernote or OneNote. Multiple people could edit the same chart notes at the same time. You'd be able to view exam notes with embedded anterior or posterior segment images. It would have intuitive drawing capabilities so you could quickly sketch pathology and easily refer to your sketches from past exams. You'd be able to use your smartphone or tablet device to take pictures and embed them anywhere in the chart, as you do with other mainstream apps. You could compare test results, like Visual Fields and OCT, side-by-side, year-over-year. And you'd be able to easily compare exam notes across several patient encounters like you can with handwritten notes, except it would be quicker, richer, and easier-to-navigate.

In short, think about an EHR product that takes those things at which the paper chart excels, and enhances and augments them so that you can engage with your patients in new and powerful ways.

That's the EHR product we'd like to use. And that's what we're building for ourselves. And we'd like to share it with you.

We're making FlowChart EHR™, a different kind of ophthalmic software. One which we hope provides a truly meaningful interaction with technology rather than simply checking off meaningful use requirements (although it'll do that, too). We think we can become better doctors through the use of better technology. If that interests you, and you'd like to be among the first to hear about our exclusive upcoming free trial, then please sign up for our weekly email newsletter so we can stay in touch.

FlowChart EHR™

We're making FlowChart EHR™, a different kind of ophthalmic software. We think we can become better doctors through the use of better technology. Sign up for our weekly email newsletter to learn more and be among the first to hear about our exclusive upcoming free trial.