VPHIB Past Medical History List
Posted by , Last modified by on 16 August 2015 01:13 PM
Unlike VPHIB’s version 2; version 3 collects the patient’s past medical history (PMH). In addition, the patient’s PMH now uses ICD10 codes in the background to bring EMS in-line with other health care services. The attached document(s) below describes how the VPHIB program is managing the availability of values, collection of those values, and validation of those values associated with the patient’s PMH.
Value: Understanding that using a new defined list to choose your patient’s PMH will be a change for providers and likely be frustrating at first; we wanted to point out a couple benefits of the this new method. EMS agencies have really begun using “data” for creating reports and performing quality improvement. Using PMH in addition to provider’s impression can add a huge amount of information to your QI program. Using a standard for PMH also prepares us for integrating with other health records.
Our approach: PMH is ICD10 code based and we highly recommend that EMS agencies and EMS providers not focus on ICD10; instead focus on the data standard as released by the OEMS and secondarily by NEMSIS. If you are your agency’s VPHIB admin or billing officer then you do need some basic understanding of how ICD10 was used.
The ICD10 list VPHIB staffs use (attached) has 91,737 codes. These codes include diagnosis, symptoms, cause of death, reason for health care encounters, and more. This is a level of detail that is simply not needed for EMS and can only make documenting more difficult for your providers and using reporting tools more difficult to use and less effective.
Using one of VPHIB PMH’s for colon cancer; here is an example of our approach:
VPHIB Label: Cancer – Colon
VPHIB/ICD10 Code: C18.9
ICD10 Label: Malignant neoplasm of colon, unspecified
Number of Possible ICD10 Codes: >35
Note: In this instance, and most times ICD10 codes are utilized in VPHIB, we use the ICD10 code at the end of each disease’s list which is typically “unspecified” or “not elsewhere classified.” As shown above the ICD code we use is typically on the end of the list and somehow ends in “9.”
Another approach that could be used for colon cancer is to use the code C18 which is “Malignant neoplasm of colon.” This is completely acceptable and the reason OEMS chose not to use C18 is because at the top of each list of diseases is what is called a “header.” Colum D of the attached spreadsheet show all headers as a “0.”
ICD10 Codes that are considered headers are non-billable codes. VPHIB staffs understand PMH is not a billable item, but as the data standard grows we would like to avoid future issues that could arise. Since ICD10 codes are used in other areas it is believed it is a best practice to avoid the use of headers in the future.
There is a “guidance” worksheet that provides more information and instructions on how to use the attachment to see VPHIB's list of PMH values and the entire list of ICD10 codes used by staff to create this list.
You can always contact VPHIB support for further information.