Healthcare – Technology – HIM

So, on my lunch breaks, I pull up You Tube videos on topics such as the future of healthcare and healthcare technology. (Feel free to insert nerd face emoji here – I take no offense.)  I find it both fascinating and encouraging that we WILL be in control of our own health and wellness.  It’s just a matter of time.

How is this possible you ask?  Through technology such as wearables, smart devices, and geo-typing,

Wearables which are currently in the form of wrist bands collecting our heart rate, calories burned and steps taken that day will advance towards smart clothing and adhesive bandages. The more data that can be obtained the better predictions can be made and preventative actions taken.  This data will be obtained through monitoring our excretions (yes, I am going there) – by analyzing data gathered from our number 1’s, number 2’s, sweat, and saliva, physicians will be able to see what we’ve been up to the other 99% of the time we are not in front of them.  This data will then be synced to our EHR. Epic (of course!) and Apple (of course!) have already partnered up to develop a tool for just this topic.

Some of this future awesomeness is already here with devices such as smart infusion machines monitoring the rate fluids are being delivered, programmable insulin and pain pumps, and robotic pharmacy dispensaries. The future tech on the horizon is bandages with sensors monitoring the moisture of the wound thereby alerting the healthcare professional it’s time for a change. Breath sensors that can detect illness, even certain types of cancer, before it occurs.  Hand-held breast exam devices will allow women all over the world access to early breast cancer detection.  There are devices that are being developed to track the rate of impact on the head in sports to assist with early detection of concussions.

Geo-typing or geonomics are being used to analyze why each of us respond differently to diet plans and fitness routines; thereby, in a sense, allowing a prescription of exactly what we need to eat and do to achieve optimal health.  As the saying goes – your genes load the gun and your lifestyle pulls the trigger.

So let’s stop here a moment and consider what we’ve just read.  With all of this data being collected when we are healthy; a personalized baseline can be achieved. Then when things go awry we can proactively take action to correct the situation.  Thereby, making it less likely for us to grace the doors of a healthcare facility.  This will save time and money – a win, win for everyone! I like knowing I’ll be the one driving the bus when it comes to my health and wellness.

So here’s where the plug for HIMer’s comes in because among all this amazingness are HIMer’s!  This is BIG DATA!  We have a seat at the table through data analytics and informatics, we just have to pull the chair out and sit down.

I can honestly say at this point in my career, I have seen our profession move up from the basement dungeons of hospitals with no sunlight to the beauty of the home office.  The future is so exciting and we’ve come a long way, baby!!

 

About the Author

Dee Mandley, RHIT, CDIP, CCS, CCS-P is the president and owner of D.Mandley and Associates, LLC.  She currently serves as as the OHIMA 2017-18 Board President.   

Hysterectomy Coding in ICD-10-PCS

Hysterectomy coding in ICD-10-PCS will be the focus of this “In the kNOW” segment.  When ICD-10-PCS codes were first adopted, we were trained that to code a total hysterectomy appropriately would require two codes: one for the resection of the uterus, and one for the resection of the cervix.  This followed the PCS guideline B3.2a which tells us that when the same root operation is performed on different body parts that have their own body part character we would code multiple procedures, thereby capturing each body part. 

Index:
Hysterectomy
    Total
       See Resection, Cervix 0UTC
       See Resection, Uterus 0UT9

So a laparoscopic total hysterectomy would have been coded as:

0 Medical and Surgical
U Female Reproductive
T Resection
9 Uterus
4 Percutaneous Endoscopic
Z No Device
Z No Qualifier

0 Medical and Surgical
U Female Reproductive
T Resection
C Cervix
4 Percutaneous Endoscopic
Z No Device
Z No Qualifier


Now fast-forward to the 2018 PCS updates and we see that there has been a change to this advice.  A new qualifier was added to the female reproductive table for resection.  This is the character “L” for supracervical.  This allows us to capture those hysterectomies when the physician has left the patient’s cervix in place, and only removes the uterus.  For example, if we were to code a laparoscopic supracervical hysterectomy our code assignment would be 0UT94ZL.

Index:
Hysterectomy
       Supracervical, see Resection, Uterus 0UT9
       Total, see Resection, Uterus 0UT9

0 Medical and Surgical
U Female Reproductive
T Resection
9 Uterus
4 Percutaneous Endoscopic
Z No Device
L Supracervical

If the procedure was a total hysterectomy performed laparoscopically, then the code would be 0UT94ZZ only.

0 Medical and Surgical
U Female Reproductive
T Resection
9 Uterus
4 Percutaneous Endoscopic
Z No Device
Z No Qualifier

Notice the Index change listing Total hysterectomy and only indicating Resection, Uterus as opposed to the previous index entry which referenced both uterus and cervix.  This change was addressed in the 4th Quarter 2017 Coding Clinic as well.

So, when coding total hysterectomy procedures for 2018 discharges, be sure to use only one ICD-10-PCS code.

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.