CERNER MILLENNIUM Diagnoses and Problems In this demonstration we’ll review the distinction between diagnoses and problems, and how to record both. This has been prepared for Millennium code level 2015.01.15 & mPage 6.0. Subsequent updates may display cosmetic & functional changes. Use the keyboard or mouse to advance.

Diagnoses vs Problems Diagnosis: AKA Billing Diagnosis—What you’re seeing the patient for today. Your charges are based upon this. These are ICD 10 codes. Problem: AKA Chronic Problems or Problem List—Problems that need to be recorded as part of the medical history, even though you may not be addressing them today. These are SNOMED codes.

There are two places you can record diagnoses & problems There are two places you can record diagnoses & problems. One is on the Table of Contents. The other is on the workflow tabs, or mPages. We’ll start with the Table of Contents.

Billing Diagnoses are at the top. The Problem List is at the bottom. Unfortunately, Cerner misuses the term “Problem” in parentheses on the diagnosis list at the top. Please disregard the word “problem” on the top list.

To add a billing diagnosis, click in the search box & start to type To add a billing diagnosis, click in the search box & start to type. Select your desired match as it appears. If you know it, you can also search for the ICD 10 code.

If you didn’t see your desired billing diagnosis using the above method, click +Add.

Type at least part of your diagnosis, then click the search binoculars.

Select your desired diagnosis. Note that you have options here to search by “contains” vs “starts with” vs “exact match” or by ICD 10 code.

Add details as desired. When done click OK Add details as desired. When done click OK. (You could also click OK & Add New to add this diagnosis, then search for another diagnosis.)

The billing diagnosis is added.

You use the same approach to search for problems, either through the search box here, or via the +Add button.

If there are no chronic problems, you should select the No Chronic Problems button.

You can update details or resolve a problem You can update details or resolve a problem. Select a problem, then click Modify.

You can add comments, specify age or date of onset, & add other details. In this example, we’ll change the Status to Resolved.

When done click OK.

You can set the Problems Display to only display Active problems, & the resolved problem won’t appear.

You can convert a diagnosis into a problem You can convert a diagnosis into a problem. For example, if you first diagnose hypertension today, you could click Convert to add it to the Problem List as well.

It works the other way around as well It works the other way around as well. If hypertension were on the Problem List & you were addressing it today, you could click Convert to add it to today’s Billing Diagnoses.

Now let’s look at the Problem List as displayed on workflow mPages, which uses some different terminology. You have a search box, which has a dropdown list in front of it. Here, This Visit means Billing Diagnosis (ICD 10), while Chronic means Problem List. And you can your selection to both the Billing Diagnoses & Problem List at the same time.

Begin to type your search, then click on your choice.

Your choice is added. Also notice there are two buttons here: This Visit & Chronic. In this case the Chronic button is selected, since we searched for Add new as Chronic.

Similar to the Convert button we saw before, you can also click the This Visit button to add this to the Billing Diagnoses for today. You can also Resolve a chronic problem from here.

If you don’t find your desired search result searching this way, you can click the Problem List heading to take you to the full Table of Contents search previously demonstrated.

It doesn’t matter which method you choose It doesn’t matter which method you choose. Just remember: Billing Diagnosis = This Visit = Diagnosis = ICD 10 Problem List = Problems = Chronic

You or your staff may enter Problem List items as you’re taking the patient’s medical history. You may well come back & add Billing Diagnoses after you’ve evaluated the patient. Make sure to populate both lists before generating your visit note, so they will be included in your note.