Alphabet Soup: Acronyms and E&M Coding

As healthcare professionals, we have a lot of acronyms to keep straight, don’t we? Feels like alphabet soup in my head some days. I’m reminded of a scene in the movie, Good Morning Vietnam, where Robin Williams’ character has an entire conversation using acronyms, making fun of the military jargon. We could do the same in healthcare, especially in E&M coding.

Today, let’s think a bit about HPI, not to be confused with PHI. If you have a translator in your head the way I do, these two don’t even sound the same, but for those outside the realm of coding, these acronyms can get confusing. PHI is Protected Health Information. HPI, or History of Present Illness, is the portion of the E&M (Evaluation and Management) visit during which the patient describes why they are seeing the physician. Continue reading

OPPS Proposed Rule for 2015

July 4th has come and gone, but we can still look for fireworks in next year’s OPPS proposed rule, which is now available on the CMS website.

CMS plans to continue expanding the packaging they began in 2014 by implementing comprehensive APCs and packaging of ancillary services.

Continue reading

Risk Adjustment and Socioeconomic Status – The NQF Task Force Report

I was fortunate to serve on the NQF Task Force on Risk Adjustment for Socioeconomic Status or other Sociodemographic Factors (SDF)i. This report generated more comments than any other NQF Task Force Report – ever. Of the 700 comments received in reaction to the draft report, the vast majority (more than 98%) were in favor. CMS was one of a very small number of institutions opposed to the initial report. While the final report contains significant modifications to the initial report, much of the spirit and substance remains. Continue reading

The Real Impact of DRGs: Meaningful Data that Changed Hospital Management

A recent blog by François de Brantes, executive director of HCI3, titled “Letting the Facts Get in the Way of So-called Truths,” is highly critical of the DRG based Medicare inpatient prospective payment system (PPS). He urges readers to discover the facts about DRGs, a system he describes as endorsed by “agents of the status quo” that produces “meaningless comparisons” of patient data, with hospitals “being hurt more than helped by false truths.” As a member of the research team that developed Diagnosis Related Groups in the late 1970s, I want to respond to his assertions. Mr. de Brantes’ blog is rife with errors and distortions of fact; any valid points are lost in a barrage of misinformation. Continue reading

Oh What a Tangled Web We Weave…The Impact of CDI and Coding Part II

I previously discussed how selection of principal diagnosis may impact quality. This ripple effect (like a pebble on a pond) may occur when one works in a silo, ignoring other departments such as quality. If only the ripple effect was the lone “offender” in which CDI and coding may impact quality outcomes. Consider a spider web: intricately designed and seeming impervious. However, as strands get broken, the web collapses.

In review, CDI professionals and coders are tasked with obtaining and capturing a complete picture of the patient’s encounter for appropriate reimbursement, accurate reflection of severity of illness (SOI) and risk of mortality (ROM) and outcomes of care. Historical models of CDI programs and coding processes focused predominately on the first two tasks, without acknowledgement of how this may affect quality outcomes (potentially fracturing the spider web). Continue reading

The Patient’s Side of Telemedicine

Last week, I had the opportunity to visit Good Samaritan Clinic in central Honduras. The clinic supports the primary care needs of 90,000 people within the municipality. Access to specialists is few and far between so Good Samaritan recently implemented telemedicine technology (computer, camera, imaging, and internet) to connect with specialists in the US. Access to these specialists is made available at no cost through the “Global Partnership for TeleHealth (GPT).”

Telemedicine is often defined as “the use of information and communications technology to deliver healthcare, particularly in settings where access to medical services is insufficient.” Better overall patient care and improved outcomes are cornerstones of telemedicine. As a result, many hospitals and health systems are deploying telemedicine as a way for rural patients to have access to healthcare services that they would not be able to obtain otherwise. Continue reading

Taking a Closer Look at the June ICD-10 Coding Challenge

Blog by Julia Palmer

A patient presented to outpatient surgery for laser treatment of scars from third-degree burns. The patient had a large scar on her neck, one on her chest, and a third one on her abdomen. Laser treatment of the skin of each area was performed successfully.

The codes for last month’s scenario are as follows:
L90.5 Scar conditions and fibrosis of skin
T21.32XS Sequela of third degree burn of abdomen
T21.31XS Sequela of third degree burn of chest
T20.37XS Sequela of third degree burn of neck Continue reading

Medical Homes: It’s not “Do they work?” but “How do they work?”

Earlier this year, The Journal of the American Medical Association (JAMA) published a widely publicized but limited article on medical homes in Pennsylvania that found little improvements in quality and no improvements in costs or utilization associated with medical homes. The authors concluded medical homes may generally “need further refinement” — a phrase that was taken by many in the press to mean that medical homes “don’t work.”

Subsequently, there has been much debate and little clarity around the promise of medical homes. Continue reading

Report from AMDIS: Top CMIO Issues

Last week we attended the 2014 Physician-Computer Connection Symposium sponsored by AMDIS, the Association of Medical Directors of Information Systems. It was our first time attending the event, held this year in Ojai, California. The conference is geared toward the needs and concerns of Chief Medical Information/Informatics Officers (CMIOs), and we learned a great deal about the issues that are top of mind for today’s CMIOs. This is a relatively new role within hospitals, health systems, and corporations. In the past, the CMIO was primarily seen as a liaison or bridge between providers and IT; more recently, however, the role has transformed into a leadership position that plays a key role in IT decision making, managing people, and even managing its own budget. Continue reading

CQI and Performance Evaluation: The Debrief

Continuous quality improvement is well known to us and integral to the culture of 3M. We often think of this as process improvement, employing Six Sigma and Lean methodologies. There is a distinctly human aspect to evaluation of individual and critical team performance because of opportunities for personal growth and refinements to team dynamics, respectively. Tremendous value is achieved when individuals bring absolute honesty and integrity to the process. Continue reading