Multiple Sclerosis Centers of Excellence
Add These National Quality Indicators In Your Multiple Sclerosis Clinical Notes
Rebecca Spain, MD, MSPH, FAAN and Heidi Maloni, PhD, APRN, BC-ANP, CNRN, MSCN
In an effort to improve MS care to all Veterans regardless of their geographic location, clinical notes for patients with definite MS will be reviewed annually for THESE QUALITY INDICATORS:
- Diagnosis of MS in the progress note AND coded in the encounter: ICD10: G35
- MS Subtype in the progress note AND coded in the encounter:
- Relapsing remitting MS (SNOMED 426373005)
- Secondary progressive MS (SNOMED 425500002)
- Primary progressive MS (SNOMED428700003)
- Discussion of disease-modifying therapy (DMT) in the progress note. This should include which drugs, dates taken, reasons for switching, intolerances, rationales for never taking DMT or for ending use, etc.
Quality indicators improve communication among the care team for the Veteran with MS, and help us track Veterans with MS nationally.
Some tips: Add the current level of activity to MS subtypes (e.g. clinical and/or radiographic relapses) and if there is any progression (e.g. relapse-independent worsening of MS disability).
Not every Veteran fits neatly into MS subtypes. If the diagnosis of MS is still uncertain or undergoing a work-up, make that clear in your text and ensure the encounter is not coded for “multiple sclerosis”. In those situations, code for what can be definitely diagnosed (e.g. “clinically isolated syndrome”, “optic neuritis”, “white matter abnormalities on brain MRI”, “syncope”, etc.).
The MS Centers of Excellence (MSCoE) are here to help. Our video shows how to add MS diagnosis and subtype codes to the encounter Problem Lists in CPRS and examples of MS clinical notes containing the quality indicators. MSCoE is adding these quality indicators to MS note templates coming soon to CPRS and Cerner.
Questions? Contact MSCentersofExcellence@va.gov.