Strengthen Coding Skills & Prepare For Future
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This document is a presentation about strengthening coding skills and preparing for the future. It examines current coding challenges, discusses diagnoses that are difficult for coders like pneumonia and heart failure, and provides tips for coding best practices, productivity, and continuing education. The objectives are to learn why coding validation audits are important and increase knowledge through coding education.
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Strengthen Coding Skills & Prepare For Future
- 1. Strengthen Your Coding Skills & Prepare For The Future hrgpros.com Presented by: Laura Legg RHIT, CCS, CDIP, AHIMA approved ICD- 10 CM/PCS Trainer HRG Executive Director of Revenue Integrity and Compliance CODER CONFIDENCE
- 2. Disclaimer This PowerPoint presentation is an education tool to provide basic information for coding. The information is the sole view of the author and was put together based on experience, research and expertise in the coding profession. It is not intended to be an exhaustive review and should not be considered a substitution for Coding Guidelines. The presenter does not accept any responsibility or liability with regard to errors, omissions misinterpretations or misuse by the audience. hrgpros.com
- 3. Objectives hrgpros.com EXAMINE LEARN INCREASE current world of coding why coding validation audits are essential knowledge through coding education diagnoses challenging coders the most
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- 5. Anatomy - Coder hrgpros.com CDI specialist charge specialist denial specialist anatomy & physiology specialist
- 6. Essential Successful Coder Qualities hrgpros.com cope well with high levels of ongoing disruptive change sustain good health and energy under constant pressure bounce back easily from set-back overcome adversity
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- 13. Pneumonia • bacterial, viral, fungal lung infection • distinct from aspiration pneumonitis • signs & symptoms (fever, cough, hypoxia, infiltrate, leukocytosis) By James Heilman, MD - Own work, CC BY-SA 3.0 hrgpros.com Examples “66 y.o. with 3 days of cough, fever, left sided chest pain. CXR RML infiltrate. Rx azithromycin, RTC 3d. Dx: pneumonia.” J18.9 pneumonia, unspec. Organism. No set criteria but pretty clear. “33 y.o. in for appy, also with fever, CXR with hazy density RML. WBC 8.2. Will treat for pneumonia with ciprofloxacin x 10 days. F/U PCP PRN.” R91.8 NOS finding lung field and query.
- 14. Acute Renal Failure hrgpros.com RIFLE criteria Risk – Cr 1.5 x increase Injury – Cr 2 x increase Failure – Cr 3 x increase Loss – complete failure 4 weeks ESRD – complete failure 3 months • AKI – acute kidney injury • insufficiency = failure/injury • lab finding • discrete criteria – KDIGO (defines) RIFLE (stages) KDIGO Kidney Disease - Improving Global Outcomes •normal creatinine max – 1.2 female, 1.5 male •increase Cr by >0.3 within 48 hours •increase in Cr to >1.5 x baseline in 7 days •urine output <0.5 ml/kg/h for 6 hours •coder can validate
- 15. Acute Respiratory Failure • discrete criteria + clinical presentation • hypoxemic/hypercarbic • acute/chronic • complicates other pulmonary conditions (COPD, pneumonia, fibrotic lung disease) hrgpros.com Hypoxemic Type 1 pO2 <60 (SaO2 91%) P/F ratio if on oxygen Hypercarbic Type 2 pCO2 >50 COPD + pO2 70 = COPD J44.9 COPD + pO2 59 + dyspnea = Add respiratory failure J96.90 COPD + CRF + pO2 drop >10 + RR 22 = Make acute respiratory failure J96.21
- 16. Heart Failure • insufficient cardiac output for systemic needs • diastolic (HFpEF) • systolic (HFrEF) • acute • chronic By Kjetil Lenes - Own work, CC BY- SA 3.0 hrgpros.com • decreased ejection fraction (systolic) • decreased end-diastolic volume (diastolic) • = decreased stroke volume • stroke volume X rate = cardiac output
- 17. Heart Failure (cont.) Measured • EF <40% • EDV < 100mL By James Heilman, MD - Own work, CC BY-SA 3.0 hrgpros.com Subjective • pitting extremity edema • pulmonary edema • dyspnea on exertion • increased dose of diuretics “75 y.o. male with new-onset atrial fibrillation. Short of breath walking more than 20’. Initiated rate-control beta blockers and furosemide 40mg BID. Echo shows no left atrial thrombus, EF 40%.” Dx: new onset persistent atrial fibrillation. Fixated on atrial fibrillation? Missing the heart failure? Consider query.
- 18. Sepsis Definitions hrgpros.com • Coding Clinic, Fourth Quarter 2003 Page: 79 to 81 • “Sepsis is defined as SIRS due to infection.” • “…use of the terms sepsis or SIRS indicates that the patient's infection has advanced to the point of a systemic infection so the systemic infection should be sequenced before the localized infection.”
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- 25. Coding Validation Audits Conduct a baseline inpatient coding audit that encompasses each inpatient coder and a broad range of surgical procedures. Focus education on the baseline audit and the ICD-10 procedure coding system as knowledge needs have increased and coders are concerned about accuracy. Continue to monitor coding quality and productivity to ensure that the AHIMA recommended accuracy rate of 95% is reached Initiate a formal query process with diagnosis-specific queries, query policy and engage physician leadership to assist in working through issues with the medical staff. hrgpros.com
- 26. Auditing = Coding Education Opportunity hrgpros.com Individual Coder Results
- 27. Additional Coding Education Tips hrgpros.com
- 29. CONTINUE TO GROW YOUR KNOWLEDGE hrgpros.com • define your objective • make an action plan to achieve it • create a realistic timeline for completion - use small measurable steps When you take deliberate measures toward a goal you’ll have the fortitude to think-and do-big!
- 30. Look To The Future hrgpros.com
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- 35. TAMPER Criteria Ensure that at least one element of TAMPER is documented for each coded condition: hrgpros.com documentation can be found in any section of the patient record
- 38. Questions? Laura Legg, RHIT, CCD, CDIP Executive Director of Revenue Integrity & Compliance llegg@hrgpros.com hrgpros.com
- 40. hrgpros.com Laura Legg, RHIT, CCS, CDIP, AHIMA Approved ICD-10 CM/PCS Trainer HRG Executive Director of Revenue Integrity & Compliance Visit us online for more information on HRG’s CDI program and Laura’s upcoming speaking engagements! hrgpros.com/cdi 800.695.8171 YourPartner@hrgpros.com @hrgpros #WeAreHRG
Editor's Notes
- Hello everyone. Thank you for joining me for the webinar today. Coder confidence is so important in the ever changing and challenging world of coding. My name is laura Legg. I am the Executive Director of Revenue Integrity for Healthcare Resource Group. I have been in HIM for over 30 years but most of that time has been spent in coding. No matter where my career takes me I never get too far from my first love which is coding. Today we are going to talk about some of the things that allowed me to become a confident coder. The tools, education and attitude that allow all coders to be successful in this new world of ICD 10 and payer auditing.
- I am not a legal expert. The first authority for coding is always the official coding guidelines and the AHA coding clinic. What I am sharing with you today is taken from those guidelines and also from my personal experience. It is important to say that There is no substitute for those guidelines so please use them daily and do not depend on the opinions of others.
- Our objectives today include looking at the world of coding today and how much it has changed. We are going to spend some time going over some of the diagnosis that challenge coders the most. Learn the best way to become a confident coder.
- This is my definition of a confident coder. Confidence is defined as the state of feeling certain about the truth of something: -a feeling of self-assurance arising from one&apos;s appreciation of one&apos;s own abilities or qualities: It is important to be confident in your knowledge of the Official Coding Guidelines as well as the knowledge of your facility’s coding policies and procedures.
- I am sure you have heard the saying “Wear a lot of hats” Well that is a good definition for a coder today. These days coders are called upon to know more, recall it faster and be able to teach it to others. Departments often turn to coders for expertise in documentation, Charge master questions, and to make decisions regarding payor denials. ICD-10 specificity has given coders the opportunity to dig deeper into anatomy and physiology.
- Change to a new way of working and living under when an old way is no longer possible ex: ICD-9-CM to ICD-10-CM&PCS It is something you do not something you have
- What diagnoses challenge coders most?
- Pneumonia 9,501 million Pneumonia refers to lung infection with inflammatory exudation into the alveolar air spaces or infiltrate. Usually confirmed by chest x-ray. Pneumonia may be diagnosed on clinical grounds alone even when x-ray is negative. To avoid confusion the provider must make a specific reference to the clinical basis of the diagnosis also noting the absence of radiographic findings. A full course of antibiotic treatment lasting a total of 7-14 days would be expected to validate a diagnosis of pneumonia. Infiltrates may not appear to be present if the patient is dehydrated. C-reactive protein tests or CRP tests are a clinical validation of bacterial pneumonia. CXR is still the standard considered by Recovery auditors.
- ARF is an rapid loss of kidney function. Many causes: Low circulating blood volume,, exposure to medications or toxins and prostate enlargement. Clinical indicators: Decreased urine production Elevated BUN and creatinine May lead to metabolic acidosis, high potassium levels and changes in body fluid balance American Society of Nephrology defines ARF as: Abrupt reduction in kidney function (48 hours) Increase in serum creatinine Reduction in urine output When baseline for creatinine is unknown The lowest S creatinine obtained during hospitalization is usually greater than or equal to baseline. This should be used to diagnosis and stag AKI This criteria cannot be used for code assignment without physician verification.
- Respiratory failure, insufficiency, arrest (adult) 7,077 million ARF is defined as abnormal arterial oxygenation and/or carbon dioxide accumulation. Common causes include: pneumonia, asthma exacerbation, heart failure, pulmonary embolism COPD exacerbation and cardiac arrest. Types of respiratory failure include Type 1 or hypoxic Most common, usually acute rarely chronic Airspace flooding Type 11 or hypercapnic Acute or chronic Due to increased airway resistance COPD, Asthma suffocation Due to reduced breathing effort Drug effects/overdose, morbid obesity Due to decreased lung area
- Congestive heart failure 10,218 million Physiology of heart failure often unknown to coders Heart failure is defined as impairment of diastolic filing or of systolic ejection of blood that results from functional or structural abnormalities of the heart Decreased blood flow to the kidneys causes retention of water and sodium which accumulates in the lungs, abdominal organs and lower extremities (edema) Symptoms include SOB, orthropnea, easy fatiquabiliy
- Systolic heart failure occurs when the left ventricle no longer has the ability to contract hard enough to push the blood into circulation Diastolic heart failure occurs when the left ventricle does not relax therefore, the chamber does not fill with blood appropriately. Both right and left heart failure cause edema and jugular vein distention, left heart failure also causes SOB, malaise and fatigue. As the heart grows weaker the symptoms progress. Fluid build up causes weight gain, frequent urination and cough indicative of pulmonary edema. Diagnostic criteria for systolic heart failure EF below normal &lt;55% EF &lt; 40% is indicative of heart failure whether previously diagnosed or not Most common cause is ischemic heart disease e.g. coronary artery disease Diagnostic criteria for diastolic heart failure Heart failure with normal or elevated ejection fraction Echo may also show diastolic dysfunction parameters Most common cause is ESRD or hypertension
- Sepsis, a life-threatening illness when an infection spreads through the body, was the most expensive condition treated in U.S. hospitals in 2013. Sepsis accounted for $23.7 billion (6.2%) of the total costs
- sepsis-related organ failure assessment (SOFA) score AHA CODING CLINIC New clinical consensus definitions for sepsis and septic shock were included in the 2016 sepsis diagnostic guidelines developed by a joint task force of the Society of Critical Care Medicine and European Society of Intensive Care Medicine and published in the Journal of the American Medical Association (JAMA). -Coders are questioning whether ICD-10-CM codes for sepsis may be assigned based on the new clinical criteria. Coders should never assign a code for sepsis based on clinical definition or criteria or clinical signs alone. Code assignment should be based strictly on physician documentation (regardless of the clinical criteria the physician used to arrive at that diagnosis). Refer to the Official Guidelines for Coding and Reporting when assigning codes for sepsis, severe sepsis, and septic shock. The coding guidelines are based on the classification as it exists today. Therefore, continue to code sepsis, severe sepsis and septic shock using the most current version of the ICD-10-CM classification and the ICD-10-CM Official Guidelines for Coding and Reporting, not clinical criteria.
- Inpatient coders are dependent on the quality of the discharge summary
- Charting these achievements can boost your confidence because success is a success. And the more of them you have the more favorably youre likely to view yourself.
- In the code proposals, type 1 would be included in I21.0-I21.4, which are the ST elevation myocardial infarctions (STEMI) with the specificity of the involved wall and non-ST elevation myocardial infarction (NSTEMI). A new code would be added for MI NOS (I21.9). Type 2 would be assigned a new code of I21.A1. MI types 3-5 would be assigned to the proposed new code of I21.A9. Please note that demand ischemia will remain at I24.8 unless specified as “with myocardial infarction.” If that documentation is provided, the new code of I21.A1 would be assigned, as it is now a type 2 MI.
- The proposal for heart failure classifications is based on those used by the ACC as well as the American Heart Association. The entities use stages of A, B, C, and D. The New York Hospital Association classifications have not been included in this proposal.