Tuesday, May 19, 2020

OHIMA Membership Benefits 101: Member Resources & Discounts

by Donna Edmondson, BS, RHIA & Jenny Evans, MSHI, RHIA, CCS

Each life has been affected by this pandemic and now, more than ever, we need to feel this sense of community.

Did you know that as a member of OHIMA and AHIMA, you are entitled to the following benefits?

  • You automatically receive a State Association Membership at no extra cost when you become an AHIMA member
    • On the website you have access to:
      • Mission and Vision Statement of OHIMA 
      • Events and Education 
      • Member-only resources such as scholarship opportunities 
      • HIM related blog and other relevant HIM resources 
      • HIM Career Link 
      • Links to Ohio Regional Associations
  • What does a membership get you? 
    • Access to 4 free CEUs just by renewing your membership
    • Discounts on products and seminars for both OHIMA and AHIMA
    • Students and New members have a discounted membership fee
    • Access to Engage Communities, HIM Library, and current responses to global HIM topics
    • Career Assist and HIM Career Map
  • Eligible for a new graduate or established professional scholarship
  • Network with other HIM professionals and continue life-long learning

OHIMA and AHIMA are here for you and continuing to improve Health Information Management!

Get involved today!
Complete the Volunteer Form on the Call for Volunteers page by 5/31/20!

About the Authors

Donna Edmondson, BS, RHIA is the Director of Government Audits & HIM at UC Health-West Chester Hospital. Jenny Evans, MSHI, RHIA, CCS is Instructor and Clinical Coordinator for the Master of Science Health Informatics Program at The University of Findlay. Both serve as Project Leaders for the Membership Engagement strategy on the OHIMA FY19-20 Board of Directors. 

Monday, May 11, 2020

Privacy and Security Considerations for LGBTQ Patient

by Alonzo Blackwell, RHIA

For years, the US’s LGBTQ community has raised concerns about the privacy and security of sensitive personal identifying data collected throughout their healthcare visits. There are laws that address privacy and security in some fashion for this patient population. The laws provide a floor for managing protected health information (PHI) and personally identifiable information. Collection of this information is no different than when healthcare organizations started collecting HIV information. Consideration can be given to additional protections if it is determined that operationally, it is appropriate within the individual healthcare organization.

The HIPAA Privacy Rule states:

  • SO/GI or history of transition-related procedures may constitute PHI. 
  • Hospitals and other covered entities should provide training to physicians, employees and contractors to ensure compliance. 
  • A covered entity must have in place and apply appropriate sanctions against members of its workforce who violate the entity’s policies and procedures and the HIPAA Privacy Rule. 
  • Hospitals may use or disclose a patient’s PHI to a family member, other relative, close friend or any other person the patient identifies. 
  • The law respects the patient’s wishes on matters of privacy and confidentiality.

The Office of Civil Rights (OCR) has explicitly stated that this prohibition extends to claims of discrimination based on gender identity. It prohibits the denial of healthcare or health coverage based on an individual’s sex, including discrimination based on pregnancy, gender identity and sex stereotyping. Section 1557 of the Patient Protection and Affordable Care Act of 2010 builds on prior federal civil rights laws to prohibit sex discrimination in health care. The final rule also requires covered health programs and activities to treat individuals consistent with their gender identity.

The Joint Commission standard R1.01.01.01, EP 29 also protects LBGTQ individuals. EP 29 prohibits hospital discrimination based on age, race ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex sexual orientation and gender identity or expression.

In 2016, Federal Rule 45 CFR 170 under the HITECH  Act provided the following as a guideline to “improve health care quality, safety and efficiency through the promotion of health IT and electronic health information exchange.” It particularly refers to “reducing health disparities” by:

  • Ensuring that each patient’s health information is secure and protected, in accordance with applicable law 
  • Improving health care quality, reducing medical errors, reducing health disparities and advancing the delivery of patient-centered medical care. 
  • Reducing healthcare costs resulting from inefficiency, medical errors, inappropriate care, duplicative care, and incomplete information 
  • Providing appropriate information to help guide medical decisions at the time and place of care.

Some organizations have discussed placing additional security on patient records that contain sensitive sexual orientation and gender identity-similar to “break the glass” technology or protections that are currently used with behavioral health records and substance use disorder records today. There are no clear industry guidelines or standards.

Another area of concern is that some are calling “special security access” for the LGBTQ population. For example, a patient has undergone reassignment surgery. Questions have arisen about going to the extent of masking or placing increased EHR security on prereassignment surgery or clinical records such as Male to Female (MTF) or Female to Male (FTM). This practice is not recommended as it would change the clinical picture of the patient and would not allow the caregiver to have a comprehensive, historical patient story. Many questions remain unanswered and HIM professionals , in particular are being challenged to answer these questions as the need for privacy is balanced with the expectations for high quality care provision and data usage and reporting.

Some of the larger EHR vendors have been working on the creation of LGBTQ modules where patient identity and preferred name can be captured and displayed in the patient header.

In summary, special consideration should be given for addressing SO/GI data in the following areas privacy/security, population health, physician engagement and patient/consumer engagement. HIM professionals have a unique opportunity to assist in the design , implementation and execution of technology and operational processes that ensure LGBTQ patients can receive quality, inclusive and safe health care. HIM can also ensure data is sound and available to foster population health that is managed safely, securely and privately-- an expectation of all healthcare consumers.


About the Author

Alonzo Blackwell, RHIA is an Area Manager at MRO. He serves as a 1st-year Director on the OHIMA FY 2019-20 Board of Directors, overseeing the Privacy & Security strategy and Student & New Graduate Committee.   

Wednesday, May 6, 2020

Coding Coronavirus

The coronavirus is in the news every day.  With the World Health Organization (WHO) declaring it a pandemic, in this issue of “In the kNOW” we’ll take a look at the guidance provided to help coding professionals appropriately code for this condition.

First, let’s look at some background on this disease.  This version of the coronavirus appears to have originated in Wuhan, China.  While there are many different strains of the coronavirus, the origin of this one seems to be from bats.  Initial transmission of the disease was animal to human but has since evolved to human to human.  This makes containment of the disease much more difficult in today’s world.  Ease of transportation and length of incubation (14 days) means that there is possibility of exposure without the ability to determine how or when the exposure took place. 

Symptoms of someone infected with the coronavirus vary widely.  The symptoms may be mild to the point of not being noticeable to severe which can lead to death.  They include shortness of breath, fever and cough. 
The WHO developed a temporary ICD-10 emergency code (U07.1) for the new coronavirus which has since been named the 2019 novel coronavirus (COVID-19).  In the United States, the National Center for Health Statistics (NCHS), which is part of the Centers for Disease Control and Prevention (CDC), made an unprecedented decision to implement a new code for COVID-19 effective April 1, 2020. 
U07.1 is the code that has been implemented for ICD-10-CM.  It was felt that there was an immediate need to capture the specificity afforded by initiating the new code now rather than waiting until fall.  It is important to recognize that the new code (U07.1) is NOT retroactive.  It can only be assigned for discharges or dates of service on or after 4/1/2020.  It is also worth noting that this code and the guidance supplied apply to all patient types, inpatient and outpatient.  U07.1 should be assigned for confirmed cases of COVID-19 which means that physician documentation that the patient has COVID-19 is sufficient.  Coding professionals are also instructed that presumptive positive cases should be coded as confirmed.  Presumptive positive is a term that is used when a state or local test has returned positive but it hasn’t been confirmed by the CDC.  Confirmation testing by the CDC is no longer being conducted.
U07.1 will be assigned first with the manifestations listed additionally.  This is a sequencing directive according to the “Use additional code” note in the Tabular List.  This differs from the interim guidance that is listed below when coding for the virus with dates prior to 4/1/2020. 
The primary MS-DRGs that will be obtained when U07.1 is assigned as a principal diagnosis are MS-DRGs 177-179 which are Respiratory infections and inflammations with MCC, CC, or neither. 
The following Official Coding Guidelines supplement was issued providing direction on appropriate coding. 
Exposure to COVID-19
When exposure to COVID-19 is a possibility but is ruled out, assign code Z03.818 Encounter for observation for suspected exposure to other biological agents ruled out.
When exposure to a confirmed case of COVID-19 occurs, assign code Z20.828 Contact with and (suspected) exposure to other viral communicable diseases.
Bear in mind, that the following coding guidance applies to coding cases prior to 4/1/2020.  It is noteworthy that B97.29 is not specific to COVID-19.  There are over 30 different strains of coronavirus, and this code would apply to all.  It has been recommended that facility-specific guidelines be implemented to use B97.29 only for COVID-19 cases so that data can be captured accurately.  
Coding pneumonia due to COVID-19
                J12.89 Other viral pneumonia
                B97.29 Other coronavirus as the cause of diseases classified elsewhere
Acute Bronchitis due to COVID-19
                J20.8 Acute bronchitis due to other specified organisms
                B97.29 Other coronavirus as the cause of diseases classified elsewhere
                                If the bronchitis is not otherwise specified assign J40 with B97.29 when due to COVID-19
Lower respiratory infection due to COVID-19
                J22 Unspecified acute lower respiratory infection
                B97.29 Other coronavirus as the cause of diseases classified elsewhere
If the respiratory infection is not otherwise specified assign J98.8 with B97.29 when due to COVID-19
ARDS due to COVID-19
                J80 Acute respiratory distress syndrome
                B97.29 Other coronavirus as the cause of diseases classified elsewhere
Signs and symptoms
                For the signs and symptoms without a definitive diagnosis of COVID-19, assign the appropriate sign or symptom code only.  For example, R05 for cough.
A few additional points.  First, provider documentation of uncertain terms in conjunction with COVID-19 like “possible”, “suspected”, or “probable”, mean we do not assign B97.29 even for inpatients.  Instead, the signs or symptoms should be coded.  This follows the same advice we have for coding for Zika virus.  Second, when coding for COVID-19, because the site has generally been respiratory, it would not be appropriate to assign code B34.2 Coronavirus infection, unspecified.  Third, in order to capture positive cases, it is recommended that facility-specific guidelines be initiated to hold the coding of cases until the results have been returned with this recommendation specific only to COVID-19 cases.  Be aware that physicians do not have to go back in their documentation to link a respiratory condition and a positive COVID-19 test.  If there is a positive test result, coders may assign U07.1.  This advice is specific to COVID-19 code assignment only and does not apply to the coding of other laboratory tests.
Further, new guidance states that when a patient has signs or symptoms that are indicative of COVID-19 and the provider suspects the patient may have it, then Z20.828 can be assigned even if it not specifically stated that the patient has been exposed.      
There are three codes for laboratory testing for coronavirus:
                CPT Code
-  87635 Infectious agent detection by nucleic acid (DNA or  RNA);severe acute respiratory syndrome coronavirus  2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique
HCPCS Level II Codes
-  U0001 Used when billing to CDC testing labs
-  U0002 Used when billing to non-CDC testing labs
Coding professionals can reference the CDC/NCHS and American Hospital Association websites for additional information and to find the Official Coding Guidelines supplement and FAQ that address this topic.  This information was current as of 4/28/2020 with the possibility that future changes or revisions will be made.  Coding professionals are urged to monitor official coding sites for updated information on a regular basis.
Now you are In the kNOW!!

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.

Wednesday, April 29, 2020

The Coding and Counting COVID-19 Patients

There is so much information out there about COVID-19.  It can be confusing because so much of what we are told on a day-to-day basis about COVID-19 conflicts: Stay at home. We need to prevent the spread of this virus. Don’t stay at home.  We need to develop immunity. Wear a mask. Don’t wear a mask. Etc. Etc. Etc.

I cannot provide expert advice on the vast majority of this information. I do not have a medical degree and expertise regarding how to best treat COVID-19 patients. Nor do I know the best course of action regarding when the stay-at-home orders should be lifted and the economy re-opened.

I am an expert in the arena of Health Information Management (also known as H.I.M.), and H.I.M.is important to COVID-19 because H.I.M. is the department/profession that houses medical coding.  Coding assigns diagnosis codes to the medical records of patients, which in turn generates data on the number of COVID-19 cases in the United States.  And with that data, the government, health officials and others make important decisions on our path forward. In the future, this data will be very important in research and the retrospective evaluation of COVID-19.

Because I am a Health Information Management professional, I want to clear up a few questions about how diagnosis codes are assigned to patients. I have heard conspiracy theories and questions about the counting of COVID-19 patients. Some say that the numbers are being padded. I have heard doctors are saying they are being “pressured” to add COVID-19 to the diagnosis list. These questions and concerns cannot be addressed until one understands how diagnosis coding works.  And many people – including doctors – do not understand how and when a diagnosis code is assigned to a patient’s medical chart.

First, a patient either has COVID-19 or he doesn’t. There are now COVID-19 tests that say “positive” (patient has COVID-19) or “negative” (patient does not have COVID-19). There have been questions about how accurate these laboratory tests are for COVID-19 – but that is another conversation and outside my area of expertise. If the laboratory test comes back positive, this means the patient has COVID-19 and this means that COVID-19 should be listed among the patient’s diagnoses in the medical documentation by the doctor.  And in turn, the diagnosis code of U07.1 (COVID-19) will be listed in the patient’s medical record and on the encounter. Think of “encounter” as an encounter with the health system – whether it is an inpatient stay in a hospital, a visit to the Emergency Room, appointment with family doctor, etc.

COVID-19 should never be excluded from a patient’s medical record if the patient has it.  Regardless of if the patient came to the hospital for another reason; even if he died of something else; even if the patient had other medical issues going on at that time which worsened his case of COVID-19.

everything that is abnormal with a patient should be listed in medical documentation. Because the medical professionals taking care of the patient need ALL the information in order to treat the patient effectively.  And should the patient return to the hospital again for the same or another reason, there needs to be continuity of care with that patient. This is how all medical documentation and coding works and has worked for a very long time. It is not different with coding for COVID-19. We will get to the how and in what order diagnosis codes are listed later on. But to wrap up my point, there is no “pressuring” to entice doctors to add COVID-19 to a patient chart. The patient either has COVID-19 or he doesn’t. Sure, if someone is pressuring doctors to add COVID-19 to a patient chart when the patient doesn’t have COVID-19, then that is a problem. But the vast majority of doctors would not deem it acceptable to enter false information into the medical chart. They could lose their medical license. Therefore, I can only assume that when a doctor says he is being “pressured” into adding COVID-19 to the diagnosis list – the patient(s) in question do actually have COVID-19 – but the doctor thinks that it is unimportant to the visit and/or he doesn’t think the patient should be “counted” as a COVID-19 patient for whatever reason. And therefore, he doesn’t want to add COVID-19 to the diagnosis list. But that isn’t his call.  That is not how medical documentation and coding works. The patient has COVID-19 or he doesn’t. It isn’t an “opinion” – unless there is some suspicion that the laboratory test is inaccurate. It is important to know how many patients do actually have COVID-19 – whether it contributes to the death rate or survival rate. Accurate data is important. And further, it is important to have the COVID-19 diagnosis in the patient’s medical record to ensure the safety of the patient’s caregivers – in the healthcare system and at home – so that they take the necessary precautions to protect themselves and others.

Now, onto how and in what order the diagnosis codes are listed. The “principal diagnosis” is always the reason that the patient was being seen or was admitted into the hospital. And the principal diagnosis does not change – regardless of what happens after the patient is admitted. For example, if a patient goes to the hospital because of a hip fracture, but then develops COVID-19 symptoms while at the hospital and a test confirms the he does have COVID-19 – the hip fracture is the principal diagnosis and COVID-19 will be among the other diagnoses listed (even if the COVID-19 actually causes the death of that patient or lengthens the hospital stay of the patient). Another example, a patient goes to Emergency Room with shortness of breath and cough, tests are run and confirm that these symptoms are because of COVID-19. The principal diagnosis will be listed as COVID-19 even if the patient falls off the hospital bed and breaks his hip while in the Emergency Room.

The reason for death is another matter. In order to determine the reason a patient actually died, one would need to look at the death certificate. The death certificate will list the “cause of death” (i.e. what diagnosis actually killed the patient) – regardless of the principal diagnosis or other diagnoses the patient may have had at the time of death. Now, there may be some room for discussion regarding how the “reason for death” is evaluated and determined, but that is not within the realm of Health Information Management nor coding.  A medical examiner who does autopsies for a living would have to chime in how the “reason for death” is assigned when there might be “co-morbidities.” A patient has co-morbidities when he has more than one chronic disease or conditions at the same time. And from current data, we know that co-morbidities can worsen or complicate a case of COVID-19.

Now, do we need to look at data from different directions? For example, how many patients died with a diagnosis of COVID-19 and had no other diagnoses? How many patients died with a diagnosis of COVID-19 and had other diagnoses (co-morbidities)?  How many patients have a principal diagnosis of COVID-19 (i.e. they entered the hospital because of COVID-19)? Yes, absolutely. But hopefully, I can at least clear up any questions on how and when a diagnosis of COVID-19 is assigned to a patient’s medical record.

About the Author

Since 2011, Lauren Manson, RHIA has been the Executive Director of the Ohio Health Information Management Association (OHIMA). Before taking on her role with OHIMA, Lauren worked in the H.I.M. department at The Ohio State University Medical Center and then spent several years implementing Electronic Medical Records throughout the United States. She graduated with honors from The Ohio State University in 2008 with a major in Health Information Management and Systems and a minor in Business. 


Monday, April 27, 2020

Our Journey Down the Yellow Brick Road to the OHIMA 2020 Virtual Conference: COVID-19, Virtual Events, Cancellation Costs, Oh My!

by Lauren Manson, RHIA

Envision. You are the Executive Director and only full-time employee of the Ohio Health Information Management Association. You are rapidly going down the Yellow Brick Road towards the “Wizard of Oz” themed OHIMA 40th Annual Meeting & Trade Show. There is an expected attendance of over 900 attendees and 75 exhibiting companies at the conference in Columbus, Ohio. You have donned your ruby red slippers and are fighting off the flying monkeys that always seem to swoop around during this time. Things are moving along well. You’ve made this journey many times before.

A munchkin tells you that the Wicked Witch of the West Coast (whose name is COVID-19 in this story) is hanging out in California. But she seems to be keeping her distance. The Good Witch of the Midwest – Glinda, uh, I mean Dr. Acton – has been giving daily updates that the Wicked Witch may be in Ohio already but has not been sighted flying on her broom just yet. The Wicked Witch really wants those ruby red slippers that you are wearing so they expect her to make an appearance at some point, but no one knows when and where that might be.

You have taken all the necessary precautions.  Setting up hand sanitizer stations along the Yellow Brick Road; declaring the Annual Meeting & Trade Show to be a “handshake free” conference; keeping updated on the Good Witch’s press conferences. One week prior to the conference, things are moving forward with caution. You are getting closer and closer to Oz. But THEN … the Wicked Witch of the West Coast shows up in Ohio. The Wizard of Oz – er, Governor Mike DeWine – declares a state of emergency for the state of Ohio. Events are being cancelled. There are all kinds of data and recommendations flying about – kind of like those flying monkeys. Employers are not allowing their employees to travel – even within Ohio and even to Oz. There are concerns about mass gatherings. Glinda and the Wizard – uh, Dr. Acton and Governor DeWine – are making recommendations to stay home. It seems like we aren’t in Kansas, er Ohio, anymore!

The OHIMA Board of Directors has an emergency Board Meeting via conference call 5 days before the Annual Meeting & Trade Show is supposed to take place and makes the very, very difficult decision to cancel the in-person portion of the conference.  But members still need CEUs - oh my!  It is decided that the educational sessions will be offered as a Virtual Conference instead. OHIMA has never done a virtual conference before – it’s a horse of a different color – but it’s still a horse!  Making a horse change colors is no easy feat in this story.

You, Dorothy, calls upon her trusty friends – the Scarecrow, Tin Man and the Lion i.e. OHIMA part-time staff, Board of Directors and speakers – to help record the Annual Meeting presentations in a three-day period.  The only way to get 30+ hours of presentations coordinated and recorded is to host them on the date/time that they were supposed to take place during the in-person conference. After many long nights and the support of many munchkins, the OHIMA Virtual Conference is up and running!  One week after the in-person conference was supposed to take place. Dorothy is quite tired.  And her ruby red slippers are a bit scuffed. But she couldn’t have done with without her trusty travel companions – the Lion, Scarecrow, and Tin Man

Oz has been saved!  And the journey down the Yellow Brick Road will have to wait until next year… Mark your calendars for February 22-24, 2021 for the OHIMA 2021 Annual Meeting & Trade Show!  There’s No Place Like H.I.M.