DOHC NG Support

How to Document ABI Information

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In this Quick Reference Guide, users will learn how to properly document ABI information during visits.

This Guide assumes that the user has a basic understanding as to how to access the Intake MG template.

Visit Type

After accessing the Intake MG template:

  1. Select the Wound Care Visit Type.
  2. Click OK
  3. Free text the Reason for Visit in the Other field.
  4. Click Add

HPI Template

In the Reason for Visit HPI template:

  1. Free text ABI performed in the Comments field.
  2. Click Save & Close.

Accessing Assessment Template

Select the Assessments option from the Navigation MG bar.

Selecting Diagnosis

To select the diagnosis, click the blue pill button labeled Problem.

In the IMO ProblemIT Search window:

  1. Free text the Z13.6 diagnosis code in the search field.
  2. Click Search.
  3. Click the blue button with plus(+) sign to choose the Encounter for screening for cardiovascular disorders option.

From the Diagnosis Status Mstr window:

  1. Select the Routine status option.
  2. Click OK
Documenting the Office Procedure

To Document Office Services:

  1. Click the Office Procedures tab.
  2. Select desired Diagnosis.
  3. Click the Office Service Code field.
  4. Locate and Select the 93922 procedure code from the Service Item Mstr list.
  5. Click OK.
  6. Select the Performed check box.
  7. Ensure that the Provider and Location fields are all green.
  8. Click the Place Order button.

Mix matched Provider and Location information can lead to billing and chart errors.

By clicking the Performed check box. The status of the procedure will automatically be changed to Completed and the procedure code will automatically be submitted for billing.

Conclusion

It is important to note that during a visit where the patient is being seen by the provider. There is no need to Generate a Document or Submit a Code for a Nurse Visit when documenting the ABI information.

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