Diagnosis
Diagnosis Best Practices
Ensure Valid Diagnosis Codes and Qualifiers
✅ Quality Checks - Ensure Valid Diagnosis Codes and Qualifiers: The NCPDP SCRIPT Standard allows for the transmission of a diagnosis code under the ICD-9 or ICD-10 format in the optional Diagnosis composite within the Medication Prescribed segment.
Include an (ICD-10) diagnosis code in every transaction. Ensure the first occurrence of the diagnosis element aligns to the primary diagnosis. If a secondary diagnosis is needed, a second occurrence of the diagnosis element may be sent. Transmit the diagnosis code without the decimal and include the appropriate qualifier code in the Primary.Qualifier or Secondary.Qualifier fields. Note that "ICD-10" is not a valid qualifier value. To increase interoperability and improve data quality, it is important to adhere to the standard(s) to ensure that all parties are able to send, receive and interpret the information in a meaningful way.
Example:
- Drug Description: Divalproex sodium 500 mg extended-release oral tablet Directions: Take 1 tablet by mouth one time daily Quantity: 30 tablets Diagnosis Code: G43.111 (Migraine with Aura, intractable, with migrainosus)
<Diagnosis>
<ClinicalInformationQualifier>1</ClinicalInformationQualifier>
<Qualifier>ABF</Qualifier>
<Value>G43111</Value>
<Description>Migraine with Aura, intractable, with migrainosus</Description>
<EffectiveDate>
<Date>2024-04-29</Date>
</EffectiveDate>
<ExpirationDate>
<Date>2025-04-29</Date>
</ExpirationDate>
</Diagnosis>Clinical Relevance/Rationale:
The inclusion of diagnosis information in its designated field can help healthcare providers validate the prescription’s purpose. This can improve patient counseling and help providers identify opportunities to optimize patient care.
Best Practices - For Technology Partners:
- Develop practical workflows that require all transactions to be associated with a diagnosis code prior to transmission.
- When receiving diagnosis code(s), ensure the application displays this information in a meaningful manner.
- Enable clinical-decision support tools to screen for potential drug-disease interactions and to allow for better dose alerts based on diagnosis.
- Ensure the diagnosis code is included in any subsequent transaction referencing the original NewRx (RxRenewal Request, RxChange Request, etc.)
Best Practices - For Prescribers:
- Associate the pertinent diagnosis with the medication, which may not be the same as the primary visit diagnosis.
- Diagnoses can be included in the Medication segment to communicate diagnoses directly related to the prescription. Diagnoses can also be in the included Patient segment which is used to communicate current diagnoses not directly related to the medication but may be important to the healthcare professional involved in the patient’s care.