The Omaha System and ABC Codes

With the development of electronic health records, coding schemes are available to clinicians to describe patient care. An example of this is the Omaha System. The Omaha System is used to document client needs, describe practitioner interventions, and measure client outcomes.

Users include nurses, physicians, occupational therapists, physical therapists, registered dietitians, recreational therapists, speech and language pathologists, and social workers. When multidisciplinary health teams use the Omaha System accurately and consistently, they have an effective basis for documentation, communication, coordination of care, and outcome measurement. 

The Omaha System consists of three components:

•   Problem Classification Scheme-Organize assessment (needs and strengths) for individuals, families, and communities 
• Intervention Scheme - Organize multidisciplinary practitioners’ care plans and the services they deliver
•  Problem Rating Scale for Outcomes- Evaluate individual, family, or community change over time

Domains and Problems of the Problem Classification Scheme

Environmental Domain: Material resources and physical surroundings both inside and outside the living area, neighborhood, and broader community. Some examples are:

Income
Residence
Neighborhood/workplace safety

Psychosocial Domain: Patterns of behavior, emotion, communication, relationships, and development.Some examples are:

Social contact
Role change
Interpersonal relationship
Spirituality
Growth and development

Physiological Domain: Functions and processes that maintain life. Some examples are:

Hearing
Vision
Speech and language
Cognition
Pain
Respiration

Health-related Behaviors Domain: Patterns of activity that maintain or promote wellness, promote recovery, and decrease the risk of disease.

Nutrition
Sleep and rest patterns
Physical activity
Personal care
Medication regimen

Categories of the Intervention Scheme: 

Teaching, Guidance, and Counseling: Activities designed to provide information and materials, encourage action and responsibility for self-care and coping, and assist the individual/family/community to make decisions and solve problems.

Treatments and Procedures: Technical activities such as wound care or and medication prescriptions that are designed to prevent, decrease, or alleviate signs and symptoms of the individual/family/community.

Case Management: Activities such as coordination, advocacy, and referral that facilitate service delivery, improve communication among health and human service providers, promote assertiveness, and guide the individual/family/community toward use of appropriate resources.

Surveillance: Activities such as detection, measurement, critical analysis, and monitoring intended to identify the individual/family/community status in relation to a given condition or phenomenon. 

Concepts and Ratings of the Problem Rating Scale for Outcomes:

Concepts	1	2	3	4	5
Knowledge:Ability of the client to remember and interpret information	No knowledge	Minimal knowledge	Basic knowledge	Adequate knowledge	Superior knowledge
Behavior:Observable responses, actions, or activities of the client fitting the occasion or purpose	Not appropriate behavior	Rarely appropriate behavior	Inconsistently appropriate behavior	Usually appropriate behavior	Consistently appropriate behavior
Status:Condition of the client in relation to objective and subjective defining characteristics	Extreme signs/ symptoms	Severe signs/ symptoms	Moderate signs/ symptoms	Minimal signs/ symptoms	No signs/ symptoms

A full description of the components is available online here

The Omaha System model incorporates the circular, dynamic, interactive nature of the problem-solving process; the practitioner-client relationship; and concepts of critical thinking, clinical decision making, and quality improvement.

ABC (Alternative Billing Codes) Code Structure

ABC codes provide a more detailed description of health care services to assure appropriate reimbursement. ABC codes were originally developed to process claims addressing conventional, complimentary, and alternative health care services not routinely included in traditional medical billing codes.

Here is a link to the ABC code structure website 

Each ABC code consists of a set of five alphabetic characters that are used to identify services. These five characters are organized in a hierarchical structure which groups similar products, remedies, and supplies together. The five character code is then followed by a two character code that identifies the type of practitioner who provided the service reflected in the code. The ABC code is recognized by the American Nurses Association (ANA) and is already integrated with other coding systems including the Current Procedural Terminology (CPT) and the Healthcare Common Procedure Coding System (HCPCSII).

This is an example of an ABC code below- For other ABC Code structure examples see website

REFERENCES:

ABC Code Set. (2015). “Find-A-Code.” Retreived January 30, 2015 from http://www.findacode.com/abc-codes-set.html

Garvin, J. H., Martin, K. S., Stassen, D., & Bowles, K. H. (2008). Omaha system: Coded data that describe patient care. Journal of AHIMA, 79(3), 44-49.