Toss Those Pebbles Carefully…The Ripple Effect of CDI and Coding on Quality Outcomes

I have never been able to skip a stone, but I do enjoy watching the ripples expand until they disappear. Or do they?

Clinical documentation improvement (CDI) has been around for quite a while and the function has changed throughout the years. Initially, the focus was on appropriate financial reimbursement for resources provided to patients. As quality of care became more transparent, the scope expanded into accurate reflection of severity of illness and risk of mortality. Today, the role of clinical documentation has grown far beyond these two functions. Continue reading

ICD-10 Coders Climb Mountains

The small nation of Papua New Guinea was an early adopter of ICD-10, inspired by its neighbor Australia. In the remote provinces of New Guinea, an ICD-10 codebook is considered a precious object. One codebook is granted to each village and entrusted to the care of the village coder, who is held in the highest esteem by the people. The account that follows gives us yet another example of the quiet heroism of the ICD-10 coder.*

There were two warring tribes deep in the hinterlands of Papua New Guinea, one that lived in the valley and the other high in the mountains. One day, the mountain people invaded the valley, and as part of their plundering of the people, they kidnapped an ICD-10 book from one of the villages and took the codebook with them back up into the mountains. Continue reading

HIMagine That! Highlights from the AHIMA Clinical Coding Meeting

Donna: Hey, Sue – what were your takeaways from the AHIMA Clinical Coding meeting held in New Orleans?

Sue: I really enjoyed the presentation by Dr. Jon Elion. He offered great clinical perspective on some of the diseases that can cause the most difficult documentation and coding conundrums – you know, like malnutrition, encephalopathy, CHF, malignant hypertension . . .

Donna: So interesting! He noted that there is no specific code for hypertensive urgency. If this is documented and there is no current or impending organ failure, one should not query for malignant hypertension in this scenario – instead, it is just reported as unspecified hypertension.

Sue: Which presentation piqued your interest? Continue reading

Why Are We Complaining about ICD 10? The Cost of Non-Compliance (Again)

In my May blog, I talked about the cost of non-compliance versus the cost of implementing ICD-10. My hypothesis: human nature is the real cost driver in health care – not code set changes. A recently released study by OIG revealed that physicians increased the billing of all E/M (Evaluation and Management) services from 2001 to 2010 (the years studied). The higher the level of E/M codes assigned, the greater the reimbursement. CMS found that E/M services are 50 percent more likely to be paid in error than other Part B services. Why? Because they are coded to a higher level which results in more money paid to the provider – physician and non physician alike. CMS identified the root cause of the overpayments – no surprise here, coding error and poor documentation. Continue reading

Quality Reviews: Delivering Constructive Feedback

To many healthcare documentation specialists (HDS), the QA process can feel like being scored for an academic grade. This is because a medical transcriptionist’s performance review, and sometimes even their compensation, is affected by her quality scores. But as I have discussed in previous posts, quality in documentation is a team sport in which the dictator, HDS, QA reviewer, and final authenticator(s) are all expected to contribute their best efforts to the document. Although it is important to ensure that each individual is doing her part to generate complete and accurate documentation, quality reviews should be treated as an opportunity to provide education and feedback toward continuous quality improvement. Continue reading

Three Reasons Not to Model Health Care after Trader Joe’s

The AHIP conference in Seattle this month includes three consumer retail executives on the agenda. In leading up to the event, the media cited one of the speakers, the former president of Trader Joe’s, and suggested that health care should take some cues from the retail grocer.

Stop right there. Health care should not imitate the business model of Trader Joe’s, known for its folksy story-telling and unique selection of private label foodstuffs. The healthcare market is significantly different from grocery stores in ways that make it difficult to be consumer friendly: Continue reading

Health Equity: Data and Analytics Are The Great Equalizer

Those in public health believe that everyone is entitled to breathe the same clean air, drink the same safe water, and eat the same uncontaminated food. Public health protects and promotes health for everyone — regardless of race, sex, age, socioeconomic status, whether among rural or urban dwellers, whether the employed or unemployed. The basis for charting progress has been measuring and monitoring health indicators using epidemiologic tools and methodologies that account for variations in the population, such as identifying risk factors for certain conditions and geographic considerations.

But what about equity in access to health care, health information and health security? Continue reading

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

Blog by Julia Palmer and Sue Belley

The results are in for the final ICD-10 Coding Contest! While the contest ends this week, participants have been loud and clear about how much they learn from the ICD-10 scenarios and feedback: “Let’s keep this going!” Sign up to be notified each month about new ICD-10 scenarios and commentary from 3M experts.

Contest Scenario:

Identical twin baby girls, who shared the same amniotic sac and placenta and were holding each others hand at delivery, were delivered just in time for Mother’s Day via low cervical cesarean section at 33 weeks and 2 days.

What diagnosis and procedure codes should be reported for the mom? Continue reading

ICD-10 Helps Grieving Souls Heal: “Johnnie and the Corridor of Flame”

This moving story of a mother’s journey beyond grief is offered to our readers with the kind permission of Angina Mae Hurt.*

Johnnie was a born daredevil. From the moment he could crawl it was a constant struggle to keep him from launching himself from the highest place he could find. If I left the room for a moment I would return to find him perched on the sofa, the bookcase, or the recliner, with a big grin on his face. I swore his first words would be, “Look, Mom!” But instead it was a perfectly eloquent statement of his life’s goal: “Wheee!!!”

His uncle took him water-skiing for the first time when he was eight years old. Johnnie was up on his first try. On his second try, of course, he had to try slalom, and though it took some practice, he soon mastered that, and anything else his uncle had to teach him. From then on, water-skiing was all Johnnie ever wanted to do. “Mom—it’s just like flying!” Continue reading

E&M Coding: Handling Two Sets of Guidelines

Evaluation and Management (E&M) coding has a lot of ins and outs. It’s the most commonly billed service, so as 3M’s first blogger in the realm of Professional coding, I think E&M coding is the best place to start this blog series. The first thing a coder or provider needs to decide is which set of guidelines to use. On the facility side of things, there aren’t any CMS guidelines to follow, but on the professional side, we have two sets: the 1995 guidelines and the 1997 guidelines. Why do we have two sets? Well, that’s a good question. Way back in the dark ages, when I was a production coder, we had one set, the 1995 guidelines. They had their problems, primarily for the specialists.   The exam of the 1995 guidelines was body part and/or organ system based. This meant that a specialist had to do a head to toe exam of a patient to qualify for the higher levels of care. For many providers, this wasn’t an issue, but for some it was. A head to toe exam isn’t really necessary for a complex ophthalmology patient. But, we all knew the body parts (arms, legs, head, neck, etc) and organ systems. We also knew how to total them up to select the level of exam documented. In short, that’s the good and bad of the 1995 exam. Continue reading