Healthcare Documentation: Is Integrity Important?

For the past year, I have served on the National Leadership Board of the Association for Healthcare Documentation Integrity (AHDI). AHDI may not be familiar to you, but it may ring a bell when I tell you that they were formerly the American Association for Medical Transcription (AAMT). AAMT became AHDI about six years ago when the association broadened its mission and vision beyond traditional healthcare documentation roles. Now AHDI’s focus is on the integrity of healthcare documentation, regardless of where it originates or is ultimately stored.

I think AHDI was smart to include the word “integrity” in its new name because it reminds us that the documentation accompanying patient care must adhere to standards of consistency, accuracy, and completeness. Integrity is important in all aspects of healthcare delivery, from the patient/caregiver relationship through coding and reimbursement practices.

Dust Off that Code of Conduct and Give Ethics Center Stage

Have you had one of those re-energizing moments where you want to take something you heard and act upon it right away? That was my experience at the recent Health Care Compliance Association (HCCA) Annual Institute in late April. Participating in a discussion with a room full of compliance and ethics professionals on the topic of business ethics, I found myself wanting to bring ethics more to the forefront of my daily interactions at work.

I read last year’s Wall Street Journal article, “Why We Lie,” to learn an important point: People are less apt to cheat or lie when given reminders of the right things to do at the time they are making a decision. Although we think our ethics training is fabulous, it appears to have less impact on the decisions that good people make every day to do the right thing (or not). The author, a professor of Behavior Economics at Duke University, goes on to describe the contagious nature of cheating, where others may follow the lead of the cheater.

Nomenclature vs. Classification – Part 3

Previously on Imelda’s World: You invented SNOFOO to standardize the nomenclature of footwear, so your servants can talk about your (by now 15,000) pairs of shoes unambiguously via their EFRs. You invented the ICF-9 classification to assign each pair to one of 256 mutually exclusive and exhaustive cubbyholes. When that became too restrictive for your growing collection, you got 2048 new cubbyholes and invented a new and better classification, ICF-10. Because people were using the cubbyhole number as a shorthand for a partial description of the types of shoes found in a cubbyhole, you invented the CHEMs to help them go back and forth between the two classifications.

Now you are wondering whether the CHEMs were such a good idea. People (other than cubbyholers) seem to think that ICF-10 is just a simple expansion of ICF-9. Now that you have eight times as many cubbyholes, they think you just took each of the original 256 and neatly subdivided the shoes in each cubbyhole, distributing them in the new, roomier structure. How many times, you wonder, do you have to explain to them that, while this is very often true, you also took into account changes in shoe fashion, not to mention changes in your own opinions about the best way to organize? Some categories disappear, some are severely reduced, new categories are introduced, and some whole chapters in the ICF-9 book are completely reorganized (for example, maternity shoes).

Nomenclature vs. Classification – Part 2

You did such a good job playing the role of Imelda in Part 1 (nomenclature), are you ready to resume for Part 2 (classification)?

Good. Let’s get started. You’ve more or less solved the problem of talking about your 10,000 pairs of shoes (admirers send new ones every day), but the big headache now is how to find them when you want them.

Then, for your birthday, your husband, Ferdie, adds a new room to the palace with 256 big bins, or “cubbyholes,” as your servants prefer to call them. So you and they get right to work. You soon realize that no single attribute sorts the shoes into 256 neat categories. Color, for example: the “black” cubbyhole would be overflowing onto the floor while the “puce with lime heels” would have only one pair in it. After nine tries, you finally get a scheme that works well enough, so you have it written down as Imelda’s Classification of Footwear (ICF-9). Copies are distributed to the full-time shoe servants—“cubbyholers” they call themselves—and pretty soon they are forming groups like the Cubbyholers of Imelda Meeting Annually (CHIMA) to promote “correct cubbyholing.”

Nomenclature vs. Classification – Part 1

When our esteemed Medical Director is about to make a pronouncement about something outside his vast area of expertise, he usually starts by saying, “I’m just a country doctor, but …”

Well, I’m just a country computer programmer, but I think we should discuss the difference between a nomenclature and a classification. “Nomenclature” is the “N” in SNOMED. “Classification” is the “C” in ICD-9 or -10.

Why am I wandering into such dangerous waters, swarming with medical informaticists and other academic denizens capable of biting my head off, or at least splitting all my hairs? Because many people, in their desire to have an easy ICD-9 to ICD-10 transition, are setting their expectations of the GEMs too high. This manifests itself as requests for otherworldly extensions to software that I helped write. And though I’d do almost anything to keep my customers satisfied, I’m not a magician.

What No Map Can Tell You about ICD-10: Coronary Angioplasty and MS-DRGs, Part 2

Last time I exhausted my blog space and myself and probably a few readers describing in principle how the differences in the language of ICD-9 and ICD-10 impact the MS-DRG assignment of angioplasty procedures. In this blog, it’s time to get off the soapbox and play in the sandbox. Here is a sample set of procedure scenarios we can mess around with to show how they will be coded and reimbursed in the past, the future, and in the fun house mirror view you sometimes get from mapping.

First, a quick review of the differences in angioplasty coding between ICD-9 and ICD-10, and the MS-DRGs assigned for coronary artery procedures.

A New Team: Utilization Review and Coding for Medical Necessity?

On March 21, I told you about the new regulation from CMS – 1455R, which is an exciting opportunity for hospitals to recoup some dollars otherwise lost on denied inpatient stays.  Specifically, CMS says,

The hospital may submit a Part B inpatient claim for payment for the Part B services to the extent the services furnished were reasonable and necessary,  that would have been payable to the hospital had the beneficiary originally been treated as an outpatient rather than admitted as an inpatient, except when those services specifically require an outpatient status.

The hospital could re-code the reasonable and necessary services that were furnished as Part B services, and bill them on a Part B inpatient claim. This proposed policy would only apply to denials of claims for inpatient admissions that are not reasonable and necessary, and would not apply to any other circumstances in which there is no payment under Part A, such as when a beneficiary exhausts Part A benefits for hospital services or is not entitled to Part A.

What No Map Can Tell You about ICD-10: Coronary Angioplasty and MS-DRGs, Part 1

Everyone on the planet knows what a coronary angioplasty is, since it makes the news every time someone in public office gets their coronaries reamed out.  Angioplasties happen—a lot—and when they do happen, because of significant differences in the language of procedure coding between ICD-9 and ICD-10, even the best map cannot predict actual financial impact. You may have heard me once or twice say, “of course the differences between ICD-9 and ICD-10 are significant, otherwise there would be no point in switching.”* Here is a classic case of that sentence at work in the real world.

The crux of the difference is in how the coronary arteries themselves are classified. In ICD-9, the axis of classification is the number of distinct coronary vessels treated—the left anterior descending, the right main, the obtuse marginal, and so forth. In ICD-10, the axis of classification for coronary artery procedures is the total number of sites treated, regardless which coronary artery it is.

Susan White and Lisa Knowles Hit Home Run at AHIMA ICD-10/ CAC Summit

While the Baltimore Orioles played the Toronto Blue Jays at Camden Yards last week, I was across the street listening to industry leaders speaking at the annual AHIMA ICD-10 and Computer Assisted Coding (CAC) Summit. One presentation which stood out was titled, “The Role of Technology and the HIM Professional in Ensuring Data Integrity,” co-presented by Susan White, PhD, Clinical Associate Professor at Ohio State University, and Lisa Knowles-Ward, RHIT, Director of Coding at the Cleveland Clinic. They reported the results of research recently completed by the AHIMA Foundation and the Cleveland Clinic. This research was funded by 3M and examined how CAC technology in the hands of the AHIMA-credentialed coder can improve data integrity.

HIMagine That! Queries in ICD-10

Sue:    So Donna, read anything good lately?

Donna:    Well, I did come across something that got me thinking. Did you see there is a new AHIMA Practice Brief, “Guidelines for Achieving a Compliant Query Practice”?

Sue:    I sure did. What about it?

Donna:    Well, it reminded me it might be time to think about ICD-10 queries. What do you think? Is too early to start querying for ICD-10 documentation specificity?

Sue:    I think that adapting queries should be done as part of your ICD-10 Implementation timeline. If you are going to start dual coding in October 2013, then the queries should be compatible with the ICD-10 language.