The flowsheet in In Touch EMR is a list of all the procedures and exercises that were performed during the visit and the associated CPT code to charge for each procedure or exercise. 

Flowsheet Tab 

1. Add New - This is to create a new Flowsheet
2. Template Builder - This is to create new Flowsheet templates 
3. Preview -  When this button is clicked, you will see a pop-up for the Flowsheet preview. In this pop-up, you will see a summary of all the previous flowsheet that was created for the patient.  
   
   1. Generate Flowsheet - Once clicked, this will add the flowsheet area on the Patient Dashboard.
   2. PDF button - This will open a new tab showing the PDF with the list of all the previous flowsheets.  
   3. Previous Flowsheet List - This shows all the information that was on the previous flowsheets. 
       
4. Treatment Time - This will only appear if the Flowsheet Time Verification feature has been turned on. When it is turned on, it automatically populates the treatment time base on the total duration entered on the current flowsheet for all the exercise and procedures. To review how to turn the features on and off for users, click here
5. Scheduled Time  -  This will only appear if the Flowsheet Time Verification feature has been turned on. When it is turned on, it automatically populates the scheduled time base on the Scheduled start and end time for the appointment. The user has the ability to edit the Scheduled End and Start time on the Subjective. To review on how to make these changes in the Subjective Section, click here.  
6. Edit - This icon is only available to the current flowsheet. All other flowsheets in the list without this icon are previous flowsheets. Once clicked, it will open the Flowsheet page, allowing the users to make changes to the current flowsheet.  
7. Copy  - This allows the users to duplicate the flowsheet. This feature makes it easy to not have to type all the information again from the previous flowsheet and since it will show all the previous exercises and procedures from the previous visits, it will help clinicians to determine their next course of action for the patient. 
8. Delete - Only the current flowsheet will have this button. 
9. Preview  - This will show what information is in the flowsheet in a pop-up. Line item in Black font are confirmed/used. Line item in Red font were unused.
10. Expand - The system will not provide all the previous flowsheet in one view to make it easy for the user to load the page. But if users want to review the previous flowsheets that are not listed, they can click on the expand button. 

 

Creating a Flowsheet Template 

There are 2 ways to create a Flowsheet Template, under new template pop-up, the user can tick the box on the "Save as Template" option. This will save the current Flowsheet as a template for future use. 

 

Or the user can create templates from the Template Builder button. 

Template Builder button 

From the Flowsheet Tab, click on the Template Builder Icon 

 

A pop-up for template builder will appear.  It will have a drop-down that will list all Flowsheet templates. The first option is New Template, this is what needs to be clicked to start creating a new template. 

 

A pop-up will appear that will require the user to start entering the exercise or procedures to be added to the flowsheet template

1. List of all Exercises and Procedures - Users can add as many line items in their list of exercise and procedures. It will appear like so
   1. Edit - Allows users to edit this line item. Once clicked, fonts for the line item will turn to red and the boxes will allow users to type. The action icon will change to a check or x mark. . The check mark is to save the changes and the X mark is not to save any changes. 
   2. Populate Icon  - Once clicked this will send all the information on that line item down to the editing section. This is used in instances when you want to create another line item that is similar to the one already saved above,  it minimizes all the typing needed.
   3. Up and Down Sequencing  - This allows users to reorder the sequencing of exercises/ procedure lines. Once clicked, a pop-up will appear that the users can type which line number to change the sequence to. Users should click Reorder once done. 
   4. Delete
       
2. Flowsheet Template Title  - This will help distinguish one template from another when it is on the template list. 
3. Exercise/Modality Description - This is what will appear on the documentation as what was performed. 
4. Reps and Sets -
5. Duration  - This is how long the exercise or procedure was performed. Be advised that the computation of the unit for billing will be base on the length of time indicated on the duration. 
6. Charge As - This will be the CPT code. Users can enter the CPT code on the text box provided and the system will provide the proper description for that CPT code

 

But if the user does not know the specific CPT code and needs to look for one, click on the CPT selector. This will provide a pop-up box for the CPT Code Selector.

 

It has 3 tabs

• Customized - allows users to create their own codes. Be advised that customized code is not accepted by payers and will cause your claim to be rejected. Only use customized codes for self-pay or within clinic transactions. Click add custom CPT

Enter all the components for this new customized CPT code and save. 

• Favorites - This will be the list of CPT codes that the user has indicated as most commonly used or favorites. To add a CPT code to the favorites list, click the star button next to the CPT code from the Global list. This makes it easier for users to find their most commonly used codes. 

• Global - This houses all the CPT codes provided by CMS.

Users can click on the Add button to choose the CPT that they want to use for the exercise/ procedure that they want to add. 

7. Modifiers - The system automatically add the necessary modifiers but if the user would like to add one, this is the area to do so. 

8.  Treatment Precautions -  to add notes about precautions

9. Supporting Documentation  - This area is for the clinician to justify the meaningful use of exercise and procedure 

It is highly recommended that the input field for supporting documentation in the flowsheet be made mandatory for all clinicians at all times. Turn on the Mandate Supporting Documentation on Flowsheet feature to ensure that the users will enter supporting documentation whenever they are working on their flowsheet. To review how to turn the features on and off for users, click here

Comprehensive notes from the clinician in this field enable auditors and payers to verify that the clinician is meeting or exceeding medical necessity for that visit. The flowsheet reveals not only what the clinician is doing and what the clinician is billing out, but also why it is being done. In the absence of supporting documentation, payments for services may be withheld or recouped by payers.

Every time that the patient is seen, it is important to enter supporting documentation to justify the ongoing medical need for therapy services. The question "Why are you continuing to see the patient?" has to be answered conclusively with every flowsheet. Meeting medical necessity is an ongoing process. Please note that supporting documentation may be distinct and unique from the subjective and objective entries in your day-to-day documentation. Therefore, we strongly recommend that supporting documentation be entered by all clinicians at all times.

10. Add Component button - Once clicked, this will add the entered exercise/procedure to the list above. 

11. Save Template 

 

Managing Templates 

To manage templates, click the template builder button.

Choose the template you want to manage from the drop-down list of templates.

 

 

Information that is on that template will appear on the pop-up. The buttons that were available during the creation of the template will again show. 

But it will also provide additional options

1. Update Template - this is to save all the changes that were made on the template 
2. Duplicate Template - This will copy all the information in this template and create a new copy. 
3. Delete Template 
4. Share Template - This will allow users to share their Flowsheet templates to other users within the clinic. Once clicked, it will show a pop up with the list of other users to choose from. Click the user name to copy the template to and click on the Share Template button. Multi-Select is an option by pressing the ctrl button from the keyboard and click on the name of the succeeding users. It will be highlighted in blue once it is selected. 

The notification that the flowsheet has been successfully shared will appear on the upper left corner of the screen. 

5. Hide Template - To remove the template from the list. 

 

How to use Flowsheet Templates 

When creating a Flowsheet click on the Add New button. 

 

The New Flowsheet pop-up box will appear. If users will not be using a template, there's an ability to add exercise/procedures one by one by filling out the highlighted fields below 

Each time the user clicks on Add component, it will add the exercise/procedure as one line item. The user can add as many line items as they wish. 

For users that want to use the template, click on the Display Templates button. 

This will show a drop-down list of all the templates that are available for the user. Click on the template to select it. It will be highlighted in blue once selected. 

It will also show the information inside the template. All the line items for exercises and procedures that are saved under the template. 

The user will have the ability to delete, change the order, or edit each line item. To edit, just click on the box and it will become editable. 

If the Flowsheet Confirm Propagation feature is turned on, only flowsheet components that are 'CONFIRMED' (in an active flowsheet) will be added to the claim review tab to be billed and will be a part of the documentation.  A red button icon in the action column will be available to indicate if the line item is pending or NOT confirmed. Once clicked, it will turn into green  indicating that the user CONFIRMED the line item and wishes to add it on the documentation and billing. 

This makes it easy to use the Flowsheet template by not having to retype all the work and inform the system which of the list of exercise/procedures were performed during the visit.  

The system will ONLY propagate 'CONFIRMED'  line items to claim review. The pre-selected 'PENDING' items will continue to appear on the flowsheet preview pop up, and also when the 'duplicate button' is clicked. These 'PENDING' items will appear in red for immediate user reference. This will enable the users to choose flowsheet templates and selectively propagate certain component, while being able to track what was done in previous components, using the duplicate or preview options.

Please note that the 'PENDING' components will not appear on the flowsheet preview PDF or the generated flowsheet PDFs since they are considered as 'not selected / not done' by the clinician.

In addition, the user will be able to save time by clicking on a 'CONFIRM ALL' button to automatically change all 'PENDING' components to a 'CONFIRMED' status with one click. The user will also have the additional option of being able to (in active flowsheets) automatically revert one or more 'CONFIRMED' components, with a single click, back to 'PENDING'. Remember to save the flowsheet and then proceed to claim review.

To review how to turn the features on and off for users, click here

If the Flowsheet Confirm Propagation feature is turned off,  the confirmation buttons will not be available. All the line items in the template will be automatically part of the documentation unless the user deletes it. 

Make sure to click on Save Flowsheet once done with all the changes. 

 

By default, all the line items in the Flowsheet will appear on the claim review for billing. But if you turn the Flowsheet Zero Propagation feature on, the system will not propagate zero value CPT codes from the flowsheet to claim review. A zero value CPT code is defined as any CPT code with no duration. This is ideal for treatment scenarios in which flowsheet line items need to be documented, but not billed out.  Such flowsheet line items must be designated with zero duration. 

Note - if a flowsheet component has a zero value for the CPT code itself ('null' CPT code), then that flowsheet row will not propagate to the claim review tab. 

To review how to turn the features on and off for users, click here

 

CPT codes are required when creating/adding every line item for each exercise/procedure. This is for compliance purposes.  The user is, therefore, is telling the system what was done, and how the procedure/exercise was billed out. But when you turn the Flowsheet CPT Non Mandatory feature on, CPT codes on individual flowsheet components are no longer mandatory. This means that the selection of the CPT code, when creating/adding flowsheet components or line items is no longer required. In such cases, the flowsheet will save, but since there is no CPT code assigned to some components, the corresponding components will NOT have a CPT line item on claim review, even if the flowsheet component is 'confirmed'. The user is responsible for appropriate billing since this can create mismatches between what is documented and what is billed, so please use with extreme caution.   To review how to turn the features on and off for users, click here

 

The Flowsheet Pre-populate All feature is turned on, it will add a component on the New Flowsheet pop-up screen to Prepopulate Flowsheet.  This gives the user the ability to search through the entire list of flowsheet components associated with all flowsheet templates. For example, if there are 20 flowsheet templates and each template has 20 flowsheet components, then the search function will allow searching through that entire list of all 400 components.

Please note that the search function (which is not case sensitive) will allow searching through the title of the individual flowsheet components, and not the description or any other part of the flowsheet components. Therefore, use descriptive titles for all your flowsheet components, such as Hip exercises, Lumbar mobilization and so on.

To review how to turn the features on and off for users, click here

 

Generally, all documents PDF only includes the Subjective, Objective, Assessment and Plan of Care but if the user wishes to include the Flowsheet in the document PDF, there's a capability to do so. When the Flowsheet Association feature is turned on, the user will be asked to select a designated document type (initial evaluation, progress note, daily note, re-evaluation and / or discharge). One or more documents can be selected. Once selected, the flowsheet preview (associated with the same date of service) will also appear on the PDF of the selected document type(s). This applies to that particular user.

To review how to turn the features on and off for users, click here

 

Supporting Documentation Standalone feature allows the 'supporting documentation' component on the flowsheet will display as a separate row with full width, as opposed to a column on the right-hand side of the PDF document. This is ideal when the 'supporting documentation' component of the flowsheet is long and detailed. We recommend that clinicians enable this, and have long and detailed 'supporting documentation' components to facilitate compliance with payer guidelines.

To review how to turn the features on and off for users, click here