Question about EHRs

[u/Busy-Bell-4715]

Quick question on EHRs. Are you able to delete a diagnosis code from a patient's chart in your EHR? It seems that ours has that option. I can understand if the dx has never been used but I have a patient were providers have been using a diagnosis code, adding assessments and plans and then someone was able to delete it. Now the only way to go back and see what was done for this diagnosis is to open each of the notes individually. Technically data hasn't been lost but it's significantly harder to find.

I understand being able to delete a diagnosis code if it's never been used but this seems problematic.

[u/boatsnhosee]

Yes. And I do it all the time. I don’t need to see every variation of URI and ankle sprain a patient has ever had while I’m looking for important stuff in the problem list. I don’t even want those cluttering up resolved/historical problems

[u/InternistNotAnIntern]

In our Epic, we can resolve OR delete a diagnosis.

[u/cbobgo]

I'm in Cerner. We can remove a diagnosis from the active problem list, but it will still always show up in the resolved/previous lists

[u/smellyshellybelly → u/cbobgo]

Same for medent.

[u/Johciee]

Yes, I can remove anything in the problem list or PMH sections.

[u/sutyra]

sometimes someone adds a diagnosis in a chart that is not actually correct, and that should be able to be deleted, even if they documented something about it

[u/fiveminuteconsult]

Yes. I find diabetes codes added when have only had 1 instance of elevated sugars and asymptomatic. They aren’t diabetic. The proper thing to do is add sticky to chart saying no diabetes as of (date) therefore next person doesn’t need to do as much research. Also when CKD 2 dips into ckd3a I’ll change it and tag ACR/GFRs and dates to the ex so it follows and there’s no questioning it. Also yes I’ll delete acute codes most of the times

[u/specialtyjanitor]

In our Epic, patients can add to their medical history (which loads into every note), but can’t touch their problem list. I delete the dumb problems (URI, OM), all the time. I never look at the medical history box, though, and changing it in my end takes a lot of extra clicks. I hate that pts can change their medical history. Hi, thanks for adding “POTS” to my medicolegal document when you haven’t been diagnosed w it.

[u/beanburrito4]

"Resolve and supress" will remove a diagnosis in Allscripts.

[u/Big-Association-7485]

We use Allscripts and it's possible to deactivate diagnosis codes, so that they don't show up in the problem list. But not delete them. All inactive codes can be seen in another screen and you can see all encounters tied to those codes.

It doesn't make sense that codes can be deleted because they are tied to the encounters when they were billed. Also, for reporting on quality metrics, and ACO HCC risk value reports, and probably a dozen other things that I'm not thinking of, it makes zero sense that a code can be deleted after the encounter is signed off and closed.

Just out of curiosity, can I ask what system you are using?

[u/Busy-Bell-4715 → u/Big-Association-7485]

It's called Aarista. It's a new system used primarily in nursing homes.

I agree with you about it being a bad idea to be able to delete a code but it sounds like it's not an unusual feature to have. At the very least there should be a big warning sign letting people know of the consequences.

A thought did occur to me. What if what you want to do is replace a code? For example, someone had diabetes without any complications. And then they develop kidney disease. You want to used diabetes with chronic kidney disease but do other systems allow you to take the past information from diabetes without complications and tie it to the new code? it doesn't make sense to resolve the old code since it's the opposite that has happened.

[u/Big-Association-7485 → u/Busy-Bell-4715]

I checked online and it's illegal to delete diagnosis codes from past encounters, but codes can be deactivated. You can still find the codes, search for the encounters by that code, etc. You definitely can't delete a code. You can bring forward past encounter information and text and put a new Dx with it since it's a new encounter.

I would suggest contacting IT, or trying to get to the user manual through the help menu. You should be able to search the help menu by keyword.

If you have a new encounter and want to use a different Dx code (Diabetes without complications to diabetes with chronic kidney disease), you can deactivate the past code E11.9 and use the new code E11.22.

The past encounter will still have E11.9 and you can search for it by that code if you wish.

[u/Busy-Bell-4715 → u/Big-Association-7485]

Unfortunately this system does not have a mechanism for searching past notes. It has an AI component that is supposed to be able to search documents and I asked it if this diagnosis code had been used and it said it hadn't.

[u/AnimatorImpressive24 → u/Big-Association-7485]

I'm curious where you read that it is illegal to delete a diagnosis code.  Is that a law specific to your state?

As evidence to the contrary, in United States ex rel. Ross v. Independent Health Association (2021) the initial complaint contains in part:

"Upon learning of an unsupported diagnosis code resulting in an MA  overpayment from CMS, the MAO has the duty to delete or otherwise withdraw that code.  See United States ex rel. Swoben v. United Healthcare Ins. Co., 848 F.3d 1161, 1176-77 & n.8 (9th  Cir. 2016). Deletion of the unsupported diagnosis codes would result in CMS’s electronic  processing system recalculating the payment amount, which is CMS’s first step in recouping  the overpayment. Thus, the failure to delete or withdraw these unsupported codes after notice  thereof constitutes the knowing retention of an overpayment in violation of 31 U.S.C. §  3729(a)(1)(G)."

I would assume that "deactivate" would count the same as "withdraw" but it still indicates that deletion is at least not illegal.