Add an Existing Diagnosis to the Current Encounter

NextGen Behavioral Health Suite Help 5.5

Add Diagnostic Details

In the Assessment/Diagnosis panel, confirm the assessment selected displays in the Description details and ICD Code field. If not, select the assessment in the grid to fill in the details. Add Status, Severity, Differential Dx, and Impression. To enter specifiers in the Specifiers field, do one of the following: Select in the field and enter free text. Select the My Phrases link and select a phrase from the list. If applicable, select Present on Admission and then select a description from the list. To indicate the diagnosis is chronic, add the diagnosis to the client’s clinical problems list, and/or add the assessment to my tracked problems, select the respective checkbox. Select Add To Grid. The information displays in the grid. To add psychosocial stressors, select the Psychosocial Stressors link. To add referrals, select the Referrals link. To reorder the diagnoses, select Sort. To update a diagnosis, select the diagnosis in the grid, modify the details, and select Update. Parent t

NextGen Behavioral Health Suite Help 5.5

Add an Admitting Diagnosis

Practices that use institutional billing must enter an Admitting Diagnosis. If your practice has institutional billing enabled on the BH Foundation Configuration template for the encounter program, select the admitting diagnosis for this encounter. From the Assessment/Diagnosis panel, select Admitting Diagnosis. The NG Get Current Diagnoses list opens. Select a diagnosis from the client’s current diagnosis list. Select OK. The Admitting Diagnosis and ICD Code fields fill in with the diagnosis details. Select Present on Admission and select a description from the list. Parent topic: Behavioral Health Assessment and Diagnosis

NextGen® Adaptive Content Engine Help Enterprise 8

Complete the Diagnoses Section for Transfer/Discharge

In the Behavioral Health Diagnoses section, select any of the available links: Diagnosis Code Lookup Add Common Assessment Mandated Care Coordination In the required Diagnostic description field, click to launch the diagnosis search window. Selecting a description value automatically populates the ICD Code field or vice versa. In the Status field, click to select a value from the list. If appropriate, enter a Severity. If needed, enter a Differential dx, and/or Impression. To enter Specifiers, click one of the following: In the field to manually enter any required values The My Phrases link. For more information about My Phrases, go to NextGen Healthcare Success Community, and download the Getting Started User Guide for NextGen® Adaptive Content Engine. For chronic conditions, select the option to Mark diagnosis as chronic. Select the options to add the assessment to the Clinical problems, My tracked problems, and/or My favorites where applicable. Click Add To Grid. In the Physical Hea

NextGen® Adaptive Content Engine Help Enterprise 8

Document an Assessment

To add or edit a diagnosis on the Add or Update Assessment template, use one of the following sections: Billing Diagnosis History Clinical Problems My Favorites The new or revised diagnosis appears in the list of diagnoses in the Today's Assessment grid. If a working assessment does not exist, the diagnosis information appears in the ICD description and ICD Code fields. If your practice required a status when you selected the diagnosis, it appears in the Status field. If a working assessment exists, it remains selected in the Today's Assessment grid, and the ICD description, ICD code, and status for the working assessment are retained. To change the working assessment, select the diagnosis being addressed for this encounter in the Today's Assessment grid. The selected diagnosis becomes the new working assessment that carries forward to the other templates that share the assessment. To change the ICD code, click the ICD Code field and search for and select the correct code for the diagn

NextGen® Adaptive Content Engine Help Enterprise 8

Adding a Tracked Diagnosis from the Patient's Problem List to the ICD Billing List

You can add a diagnosis from a patient's problem list to ICD billing list for that patient. A chronic or tracked condition diagnosis from the patient's problem list can be added to the ICD billing list. This causes the diagnosis to be associated with an ICD billing code, and enables it to be associated with a care guideline. Open NextGen® Enterprise EHR. Select the Care Guidelines link on any of the main template. The Care Guidelines template opens. Select Add/Update in the Care Guidelines panel. The Activate Care Guidelines template opens. Expand the Problem List panel, do the following: Select the Show chronic check box to display chronic problems only. Select the Show my tracked problems check box to display only those diagnoses that have been assigned to the patient’s tracked problems list. Select the No active problem check box, to indicate that the patient currently does not have an active problem. Problem List Note: To open the Problems module, select Add or Edit. To reload the

NextGen® Adaptive Content Engine Help Enterprise 8

Enter Assessment and Diagnosis Details

Expand the Assessment/Diagnosis panel. If enabled, click the DSM IV link in the upper, right corner to launch the BH – DSM IV template. Note: The display of the link is set up on the Behavioral Health section of the Practice Configuration system template. In the Behavioral Health Diagnoses section, select any of the available links. In the Diagnostic description required field, click to launch the diagnosis search window. Selecting a description value automatically populates the ICD Code field or vice versa. Add Status, Severity, Differential DX, and Impression. The out-of-the-box Severity picklist does not include Extreme or Persistent. These values can be added to the list in File Maintenance. Enter any required Specifiers by doing one of the following actions: Click the field to type a value. Click the My Phrases link to create a new sentence or part of a sentence. For more information about My Phrases, go to NextGen Healthcare Success Community and download the latest Getting Start

Add an Existing Diagnosis to the Current Encounter

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Add Diagnostic Details

Add an Admitting Diagnosis

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Adding a Tracked Diagnosis from the Patient's Problem List to the ICD Billing List

Enter Assessment and Diagnosis Details

Add Diagnostic Details

Add an Admitting Diagnosis

Complete the Diagnoses Section for Transfer/Discharge

Document an Assessment

Adding a Tracked Diagnosis from the Patient's Problem List to the ICD Billing List

Enter Assessment and Diagnosis Details

Add an Existing Diagnosis to the Current Encounter