Christmas Catastrophes

by Dianna Foley, RHIA, CHPS, CCS 

Christmas for the Klutz family began like every other holiday-with a trip to the local ER.  A cascade of catastrophes had all the Klutz children packed into the car for the trip.  The calamities began with little Dana, who was so excited for Christmas morning, that while she was running to go downstairs, tripped over the carpet at the top of the steps, and went sprawling down them.  The clamor of the fall and his sister’s subsequent wailing roused Raymond, who was in his bedroom, from sleep.  Upon realizing it was Christmas morning, he started jumping on the bed in joy, tumbled off, hitting his chin on the nightstand.  Peter, who was in the shower, slipped in his hurry to see what all the commotion was about and struck his forehead on the faucet.  Egon, who was on the stepladder in the living room putting the Elf on a Shelf on an upper branch of the Christmas tree, was so startled by the hubbub that he lost his balance, and fell straight into the tree.  Janine, who was walking Peter to the car, slipped on the icy front porch steps hitting the back of her head on the cement sidewalk.

The ER staff, who knew the children by name, took each one to a bed and began examinations.  It turned out that little Dana had a broken nose.  Raymond had a nondisplaced, left mandibular body fracture.  A contusion of the forehead was the final diagnosis for Peter.  Egon suffered from multiple abrasions to the cheeks, nose, forehead, and chin.  Janine’s scalp laceration needed two sutures. 

Once all the children had been treated and discharged, the Klutz family returned to their lovely single-family home.  The children were sequestered to the couch (an action their parents hoped would prevent any further ER visits), and gifts were opened with no further injuries…at least for this day!


Click HERE for the answers.

HIM Careers Word Search

HIM professionals have so many options when it comes to career choice!  Find some of those options in the Word Search below.  Click HERE to print the word search.  Click HERE for the answers.

 

Hospital Operating Income Falls for Two-Thirds of Health Systems

by Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, CCDS, C-CDI, C-CDAM


Hospital systems continue to face significant economic operational challenges with strong headwinds for a number of reasons. Some key takeaway points:

1) Decreasing reimbursement from government payers while expenses continue to outpace revenue. Hospital expenses increased three percentage points faster than hospital revenue from 2015 to 2017.

2) Hospital revenue growth slowed during the period because demand went down for key hospital services, like surgery and inpatient admissions, Navigant explained. More services are being performed in the outpatient setting migrating away from more costly inpatient setting.

3) Continued reduction in Medicare updates from ACA and the sequester- as a result hospital losses in treating Medicare patients rose from $20.1 billion in 2010 to $48.8 billion in 2016, according to American Hospital Association analyses,”

Word to the wise for CDI with less inpatient admissions, we must capitalize upon the value proposition we bring to the table, focusing on the return we bring to the organization in light of the expenses in running a program. This requires partnering with case management, utilization review and our physician advisors to improve the communication of patient care beyond present models with focus upon gross patient revenue versus net patient revenue. Aside from reimbursement, we must not forget our duty to the patient given that quality of care directly correlates with quality of documentation and communication.With expenses continuing to increase trailing revenue increases and more services moving to the outpatient setting, the creation of a perfect storm where CDI must rethink its current model and develop a strategic initiative to drive CDI operational excellence and value should be a top priority. Business as usual is simply not an option, there is just no substitute for a CDI cultural change moving ahead, recognizing that operating in a silo is counterproductive and counter-intuitive approach to affecting positive improvement in documentation quality.

About the Author

Glenn Krauss is a longtime Revenue Cycle Professional with progressive hands one experience in all facets of the revenue cycle. He possesses a high energy level and passion for clinical documentation improvement initiatives that drive physician engagement in truly wanting to learn and acquire best practice standards of clinical documentation supporting communication of patient care.  He is the creator and founder of Core-CDI.com.

Coding Influenza

It’s that time of year again, when the public is reminded to get their flu shots.  That makes it a good time to review the coding of influenza in this segment of “In the kNOW”.

Let’s start by looking at the ICD-10-PCS procedure for a flu shot.  Last year, a revision was made in table 3E0 that gave facilities the ability to track flu shots.  This code begins in the Administration Section of PCS.  So let’s look at how the rest of the ICD-10-PCS would be built.

Section    - Administration
Body System - Physiological Systems and Anatomical Regions
Root Operation - Introduction
Body System/Region - Subcutaneous tissue
Approach - Percutaneous
Substance - Serum, Toxoid and Vaccine
Qualifier - Influenza Vaccine

This provides organizations with a method of tracking flu shots administered in an inpatient setting.

Now, when we look at the ICD-10-CM coding of influenza there are a variety of codes that could be reported based on the type of influenza (A, B), if known, and the manifestations that the patient is exhibiting.  Manifestations can include pneumonia, myocarditis, otitis media, encephalopathy, gastrointestinal problems such as enteritis, or other respiratory conditions like laryngitis or pharyngitis. 

It is vital to note that Influenza A is NOT the same as Novel Influenza A (H1N1 or H5N1) which is swine or bird flu.  Influenza A would take you to category J10, while the Novel Influenza A to category J09.

Assignment of Influenza A (J10.1) as the principal diagnosis without any other manifestations will take you to MS-DRG 195 Simple Pneumonia and Pleurisy without MCC with a weight of 0.6868.  Should there be an MCC to code, the MS-DRG would shift to 193 with a weight of 1.3167.  Interestingly, if the Novel Influenza A (J09.X2) is coded, it will be housed in the same MS-DRG as Influenza A.   However, notice the difference if either type of influenza is accompanied with other manifestations which would lead to MS-DRG 866 Viral Illness without MCC with a relative weight of 0.8204, of if an MCC is present, lead to MS-DRG 865 with a weight of 1.3822.

There is also a difference in MS-DRG assignment for unidentified influenza cases coded as J11.1.  Those that do not have an MCC are assigned to MS-DRG 153 Otitis Media and URI with a relative weight of 0.7118, while those with an MCC assigned will shift to MS-DRG 152 with a weight of 1.0421.

Coding Clinic has also weighed in on the topic of influenza and how it is to be assigned when it occurs with other conditions.  For example, in the 3rd Qtr. 2016 Coding Clinic, a question was asked about the appropriate coding of sepsis when it is due to Influenza B.  The codes that were determined to be correct were A41.89 and J10.1.  

Additional advice from the same issue of Coding Clinic, addressed the conditions of sepsis resulting from influenza with pneumonia.  Here, because the type of influenza was not specified, the codes would be A41.89 for the sepsis, and J11.00 for the influenza.  

Another example comes from the 4th Qtr. 2017 Coding Clinic, where the question was asked about the proper code assignment when a patient had both an acute exacerbation of COPD and a bacterial pneumonia on top of Influenza A.  Here it was determined that four codes were necessary.  J10.08 for the identified influenza with pneumonia; J44.0 for the COPD with acute lower respiratory infection; J15.9 for the bacterial pneumonia; and J44.1 for the acute exacerbation of COPD.  Bear in mind, that for this situation, sequencing of the principal diagnosis would be based on the circumstances of the admission with additional consideration given to the note change that accompanied J44.0 last year. That note changed from “Use an additional code” to identify the infection, meaning that the pneumonia would be sequenced secondarily, to a “Code also” to identify the infection which allows for sequencing of the pneumonia first if appropriate.      

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.

Thanksgiving Trials and Tribulations

by Dianna Foley, RHIA, CHPS, CCS 

It’s Thanksgiving at the Klutz family home, a beautifully restored single-family home with a large backyard.  Today began with Mrs. Klutz silently hoping to avoid any trips to the ER, after the seemingly countless number of trips that were made there on Halloween. 

The family all piled into the car to head downtown for the Thanksgiving Day Parade in which Egon would be playing the tuba with the high school band.  All was well, until Egon, unfortunately, stepped in a hole in the middle of Main Street (the business street of town), severely twisting his left ankle.  Mr. Klutz took Egon, Mrs. Klutz grabbed the tuba, and the other four children proceeded to the car (making their own mini-parade) for the first ER trip of the day.  X-rays revealed the good news being that no bones were broken; the ankle was just badly sprained.  The doctor recommended ice and elevation of the leg along with rest. 
 
Mr. Klutz got Egon situated on the couch with his leg propped up on the coffee table, and then went to play a game of touch football with Peter along with a few other neighborhood boys and their dads in the community park at the end of the street.  Mrs. Klutz took Janine and little Dana to the kitchen to begin preparing their Thanksgiving dinner. 

Things were going smoothly until Mrs. Klutz heard the back door slam and saw Mr. Klutz burst into the kitchen.  He said that Raymond had fallen out the oak tree that he’d been climbing in the backyard, quick to add that he seemed okay, just a little hobbling, but thought it best to take him to the ER to be checked out.  Mr. Klutz’s sudden entrance startled Janine who had been lifting a large, cast iron pot of peeled potatoes to put on the stove, but instead dropped it on her right foot.  With tears welling in her eyes, Mr. Klutz hurried her to the car as well, and off to the ER he went with Janine and Peter.  Another round of x-rays concluded that Janine had a broken second metatarsal, while Raymond had a left distal tibial fracture.  An ortho boot was provided to Janine, and a splint for Raymond.  Mr. Klutz returned home with both children and placed them on the couch next to Egon.            

Mrs. Klutz was still working on dinner so Mr. Klutz went to get Peter who was still playing football.  He was just in time to see Peter get tackled at the knees and go down in a slump.  (Touch football had evolved in Mr. Klutz’s absence.)  He helped his son to the car, informed Mrs. Klutz of yet another ER visit and drove off.  Peter’s x-rays showed a lateral dislocation of his right patella which the ER physician successfully manipulated back into place.  Upon his return home, Peter’s siblings made room for him on the couch, adding yet another leg to the coffee table.

Both Klutz parents kept a watchful eye on little Dana, fearful that she would somehow hurt herself, too.  But as the late afternoon wore on, little Dana remained uninjured.  Until, that is, she went to get herself a drink of water in the bathroom and dropped the glass on the tile where it shattered.  Frightened she ran (in her bare feet) over the glass to find her mother who promptly took her to the ER to have the embedded glass and small lacerations on her left foot tended. 

That evening, the Klutz couch was full of children all with legs propped on the coffee table.  Mr. and Mrs. Klutz sighed and gave thanks that another day of ER visits was over…..for now!


Click HERE for the answers.

Making the Connection – HIM and Healthcare Analytics

 As a statistician that entered the healthcare industry early in my career, I learned the value of a deep understanding of the context of the data available in the healthcare industry.  As a fresh PhD, I had a number of advanced statistical methods in my toolbox and was eager to start applying them to this newfound rich data source.  I caught on very quickly that the HIM professionals in the office knew the answers to my data integrity and interpretation questions.

In my current position as the administrator of analytics for a large academic medical center, I have a staff of eighteen analytics professions – seven of them are HIM professionals with RHIAs and CHDA credentials.  These analysts provide enterprise-wide dashboards and scorecards, custom analytics for process improvement efforts, data validation for publicly reported quality measures and predictive models.

Why hire HIM professionals for these positions?  The HIM profession requires a deep understanding of healthcare data collection, use and protection – and they are some of the best critical thinkers in the industry.  Making connections between disparate data elements and transforming them into end products that may be used to make critical business and clinical decisions are skills that differentiate between a successful analytics team and a report production team that fills orders from customers.

Healthcare analytics is 75% data preparation and 25% true analytics.  The data preparation portion includes scoping with the end users including senior leadership, administrators and front line clinicians.  HIM professionals are able to translate the needs of the end users to available data and deepen the users’ understanding of the strengths and weaknesses of the data elements.  Traditional IT professionals and data scientists are able to complete complex queries and design intricate analyses, but these are all for naught if the link between the data, analytics and clinical operations is not maintained.  This is where the knowledge and experience that HIM professionals bring to the table are most valuable.

Healthcare news headlines include the words analytics, machine learning, and predictive modelling every day.  These techniques sound very daunting, but the level of analytics understanding required for an HIM professional to make a real difference in their organization and professional career are actually achievable by seeking out some of the many free on-line courses and workshops.  Preparing and passing the Certified Health Data Analyst (CHDA) credential will demonstrate a higher level of understanding of these techniques and allow advancement in this fast moving area of HIM. 

About the Author 

Susan White, PhD, RHIA, CHDA is an Administrator of Analytics at The James Cancer Hospital.  She is also a Associate Professor in the Health Information Management and Systems Division at The Ohio State University.  Dr. White frequently presents at both national and state level association meetings.  She has also served on the OHIMA and AHIMA Board of Directors.

Newly Elected Officer Experiences

by Clarice Warner, RHIA, CCS-P, CPC, CHC

As a newly elected OHIMA board member, I have been balancing my professional, personal,
and volunteer pursuits. Some days everything is in perfect harmony and then there are days
when it all falls apart. But the optimist in me knows this too shall pass and tomorrow is another
day to get it right.

As I’ve been getting oriented to the new position, I’ve had the opportunity to experience two
adventures that I would like to share.

The first was my visit to the AHIMA corporate office. During the 2018 Component State
Association (CSA) Leadership Symposium meeting in Chicago, we were offered the opportunity
to tour the AHIMA office. Initially I was hesitant, I thought about how much earlier I would have
to wake up and that I would miss my morning walk. I convinced myself it was worth it and off I
went.

I love quotes and sayings and as you enter the lobby, you are greeted by Grace Whiting Myers’
quote from the presidents address at the first annual session in Chicago 1929. In her quote,
she answers the question, “What does one gain by belonging to the large association?”

While the office was very modern, there were historical elements and artifacts throughout.

 There was even a spot to showcase awards and achievements.

There were lots of open space for meeting and collaboration. One of my favorite areas was the
Employee Brag Board. The brag board was a place where staff posted pictures of children,
grandchildren, nieces, nephews, and even fur children.

It felt really good to be in the space where AHIMA makes decisions for the organization. The

place where the day-to-day activities that benefit the membership happens. Let me just say, if
you are ever in Chicago, I would encourage you to visit the office - you’ll be glad you did!

The second experience I want to share was the House of Delegates meeting in Miami, Florida.
Even though Miami is laid back, fun in the sun vacation spot, everyone at this meeting was
about business. The energy in the room was palpable. The atmosphere and the room set-up
was conducive to the discussion and the work that needed to take place. There was the main
hall and even break out rooms, for more focused discussions.

I loved seeing the flags of the states around the room. Seeing the delegates look for their state
flags and gather to take pictures was also incredible. Ohio shared a table with delegates from
North Carolina. Meeting people that I will be working with over the next year was great and
putting faces with names that I’ve seen in the past was also a plus.

I sat in the HIM Reimagined session. The one thing that I walked away with was our
profession as we know it is changing. As we evolve and grow, we change. The key driver of the
change is technology. There was spirited and passionate discussion on the effects of
technology on our profession particularly in areas like coding. The artificial intelligence (AI)
revolution has been here for a while and it has touched many industries. It has even touched
the clinical healthcare industry with the use of robotic surgery in medicine. To think that AI
would not touch HIM in any way would be a disservice to providing knowledge and education
for those newly entering into our profession. Changing the education landscape and making
the bachelors degree the entry level degree into the profession, specifically in management
positions, was a hot topic. The other issue in our session was specialization in the technical
skills. Lastly, it was suggested to look at skills of coding and begin to apply critical thinking
skills needed in education to transform coding into a more auditing role or function, which sets
the framework in preparation of any new technological advance. People will still be necessary
to validate documentation and validate the code descriptions. We really need to consider
broadening our horizons and consider training in auditing for our coders.

As a newly elected OHIMA board member, I am excited about the opportunity and challenges
that we face. I am also thankful and grateful to our past and current board members and
executives who work tirelessly to ensure that OHIMA is well represented, that we are
positioned to take action for our state and that we are prepared to lead the charge before us.

About the Author 

Clarice Warner, RHIA, CCS-P, CPC, CHC is the Director of Education Services at Professional Reimbursement Network.  She serves on the OHIMA Board as a 1st Year Director working on the Public Good strategy. 

Are you interested in volunteering with OHIMA's Board of Directors?  Through November 15, 2018 - we are accepting nominations for all elected positions. For more information, visit our website.

Medical Identity Theft

 

 

RESOURCES IN SLIDESHOW

Medical Identity Theft Response Checklist for Consumers

Medicare Fraud Resources

Medicaid Fraud Resources

Office of Inspector General

 

 

 

 

 

 

 

 

 

Halloween Mishaps

by Dianna Foley, RHIA, CHPS, CCS 

Each of the five children of the Klutz family were involved in mishaps on Halloween keeping both their parents and the local ER busy.  Assign ICD-10-CM diagnosis and external cause codes for each of their injuries.

 
Egon, the oldest child, kicked off the parade to the ER.  He’d begun trick or treating, and he and his bag of candy went flying onto the cement, when he fell from his skateboard after colliding with a bicyclist on the sidewalk.  Since he had suffered about 30 seconds loss of consciousness, his parents decided to take him to the ER.  The ER doctor examined him for fractures, but concluded Egon had a concussion.

Just as they returned to their single-family two-story brick home, Peter, the middle child, ran home from the next-door neighbor’s trailer holding his left arm, which was bleeding.  He told his parents that he’d been playing in the neighbor’s backyard with their pet goat, when inexplicably, without provocation, the goat bite his left forearm and elbow.  Mr. Klutz put Peter in the car and made a return trip to the ER where the lacerations from the goat bites were cleaned and closed with a few stitches.

Turns out that it was a good thing Mrs. Klutz was at home with Egon since, as no sooner had Mr. Klutz left with Peter, than she got a call that her oldest daughter, Janine, had fallen off a pile of haystacks she’d been climbing in Mr. McGillicuddy’s barn where a Halloween party was being held.  Mrs. Klutz texted Mr. Klutz who was still in the ER with Peter that he should be expecting Janine to arrive shortly.  Upon examination in the ER, Janine was determined to have a Colles fracture of her right wrist.  She was splinted and both she and Peter left with their dad to return home.

Meanwhile, young Raymond was running through the family’s kitchen with a sheet over his head pretending to be a ghost.  He tripped over the dog who was lying in the middle of the kitchen, and immediately began crying.  Mrs. Klutz took one look at the little finger of his left hand, which was bent at an awkward angle, and packed him, Egon, and Dana into the car for yet another ER visit.  They passed Mr. Klutz, Peter, and Janine coming home as they went along the way.  Once at the ER, the doctor performed a reduction of the PIP joint dislocation, splinted the finger, and sent Raymond home.

The nursing staff had given little Dana a lollipop while she was standing in the corridor with her mother waiting for Raymond to be discharged.  At some point, she had pulled the sugary treat off the stick and swallowed it, but she immediately began choking, the lollipop having become stuck in her esophagus.  A quick thinking resident performed a Heimlich maneuver on her, and Dana coughed up the lollipop.  By this time, Raymond was discharged, and Mrs. Klutz took Raymond and Dana back home.  Thus ending the Halloween Mishaps for the Klutz family……at least for this year!


Click HERE for the answers.

Updated Recertification Policies Delayed Until 1/1/2020

Per AHIMA, the recertification timeline cycle changes and new CEU domains that were previously published to become effective on November 1, 2018 have been delayed by the Certification Department at AHIMA to ensure strategic alignment and an effective, error-free implementation. The previously published information was approved by the Commission on Certification of Health Informatics and Information Management (CCHIIM) and allowed for an individual to report in the CEU Center (starting on 11/1/2018) using either the new domains or under the existing domains until 12/31/2019. The revised plan will be to use only the new domains starting on 1/1/2020.  For more information, see the AHIMA website.

A Day in the Life of OHIMA’s Executive Director: Part 1

by Lauren Manson, RHIA – Executive Director, OHIMA 

I have had writing this article on my to-do list for quite some time.  Long to-do lists that grow and never shrink are just part of the life of an Executive Director.  Working for a small non-profit, there is always more to do and never enough time. 

Many people – inside and outside the association – are curious about my work as the Executive Director of the Ohio Health Information Management Association.  My sister commented once that she had no idea what an Executive Director actually did.  She just knew that I was on my computer all the time.  She’s a nurse.  And all nurses who function as a nurse – regardless of in what setting they work – do basically the same general things.  They are a vital part of direct patient care and planning that care, they act as a patient advocate, and provide patient education and support. 

Along those same lines … all associations – regardless of industry – do the same basic things.  And there is an association for everything.  There are associations for nurses.  For podiatrists.  For the professionals who do snow removal.  For truck drivers.  And of course, Health Information Management professionals. 

I came from the HIM industry (rather than from another association).  I used to travel around the nation implementing Electronic Medical Records in radiology practices.  Loved the work.  Traveled all week every week for about 3 years.  It is said that people who travel full-time will burn out after about 2-3 years.  And boy was that true!  Right about when I hit 3 years of traveling, I never wanted to see the inside of another hotel room.  Ever.  Again.  And still … 7+ years later.  I STILL don’t care for traveling – even for vacations – because of those 3 years of living out of a hotel.  Maybe one day, I will enjoy travel again.  But for now, I love sleeping in my own bed every night.  While I was traveling and working as an HIM professional implementing EMRs, I never dreamed that working on the association side of HIM would be in my future.  But it was!

I soon found that being an HIM professional and being an association executive are two very different things.  When I became the Executive Director of OHIMA, I had to learn how to be an association executive.  And I learned quickly that all associations – regardless of industry do the same basic 5 things:

1. Continuing Education (meetings, online education, etc.)
2. Advocacy (promoting the profession, occasional lobbying, etc.) 
3. Membership Engagement (awards and scholarships, communication via social media, e-newsletters, etc.)  
4. Resources (providing updates on the industry, being a resource to answer questions for not only association members but also the general public and other organizations) 
5. Administration (running a non-profit business involves working with the Board of Directors, strategic planning, managing staff, volunteers, and finances, etc.)

My life as Executive Director centers around these 5 tasks.  And no two days are the same.  Depending on the time of year, the OHIMA Central Office focuses on different projects.  In the winter, we spend much of our time prepping for the Annual Meeting and Trade Show (it takes many checklists and timelines with hundreds of line items to make our big conference happen and run smoothly!).  In June, we are working with the Board of Directors to prepare strategies and the budget for the new fiscal year beginning July 1st.  In the autumn, we have several events including the Fall Coding Seminar, HIM Advocacy Day at the Statehouse, the national AHIMA Convention, and more.  We stay very busy here! 

The next article in this “Day in the Life” series will highlight a few days in my work life.  And later in another article, you will meet some of our other staff members in the OHIMA Central Office!  Together with our great staff and volunteers, we make it all happen.

This is me working in my home office.
Without any makeup on.
(I can’t believe I am posting this!)
But this is what I look like most days.

If you want to write a “Day in the Life” article about your HIM job...
contact me at ohima@ohima.org!  I’d love to help you write it! 

Uncertain Diagnosis

What constitutes an uncertain diagnosis?  Do the same guidelines apply to both inpatient and outpatient code assignment as relates to the topic of uncertain diagnoses?  “In the kNOW” attempts to clarify the uncertainty surrounding uncertain diagnoses in this installment.

Let’s begin with a review of the Official Coding Guidelines in an effort to gain clarity.  Section II.H (Selection of Principal Diagnosis; Uncertain Diagnosis) as well as Section III.C. (Reporting Additional Diagnoses; Uncertain Diagnosis) address uncertain diagnosis code assignment.  An important piece of information to focus on here is that these guidelines only apply to inpatient admissions to certain facilities: short-term acute care, long-term care, and psychiatric hospitals to be specific.  This is our first clue that there is going to be a difference in how uncertain diagnoses are addressed based on inpatient or outpatient status.  By reviewing the guideline at Section IV.H. (Diagnostic Coding and Reporting Guidelines for Outpatient Services; Uncertain Diagnosis), we can see that coders are instructed not to code any term that indicates uncertainty.  Instead, coders are directed to code to the highest degree of certainty which could be a sign, symptom, or abnormal test result.  

Returning to the guideline at Section III.C., it goes on to state that uncertain diagnoses documented as such at the time of discharge should be coded as if they exist.  The rationale for assigning these codes is that diagnostic and possibly therapeutic services have been provided with potential need for additional workup or observation.  In the 4th Qtr. 2017 Coding Clinic, clarification was provided stating that even though a condition may have been worked up and/or received treatment, if at discharge it had been ruled out, it should not be coded.  The term “ruled out” means that the diagnosis has been eliminated and is no longer uncertain.  The focus is on the status at the time of discharge.

The terms that are listed as indicating uncertainty include the following:

• Likely
• Suspected
• Probable
• Questionable
• Possible
• Still to be ruled out

This list is not exhaustive as the guideline says “or other similar terms”.  This has created some confusion among coders as they try to determine what constitutes an uncertain diagnostic statement.  Additionally, if Section IV.H. is reviewed again, the term “working diagnosis” is listed as one that correlates with uncertainty.  

Coding Clinic in the 1st Qtr. 2018 stated that “concern for” is another term which qualifies as an uncertain diagnosis and the 1st Qtr. 2014 Coding Clinic included “appears to be” in the same category, along with “consistent with”, “compatible with”, “indicative of”, “suggestive of”, and “comparable with” mentioned in the 3rd Qtr. 2005 Coding Clinic.

1st Qtr. 2012 Coding Clinic puts the coding of “borderline” diagnoses outside the “uncertain” category.  A diagnosis characterized as “borderline” should be coded as if it has been confirmed.  If there is a specific Index entry under “Borderline”, such as for hypertension (R03.0), then that code should be assigned.  If the borderline condition is not indexed under “Borderline”, then code the condition as if it exists; for example, borderline osteoporosis would be coded to osteoporosis (M81.0).  

One further point of clarification from the 1st Qtr. 2014 Coding Clinic is that the phrase “evidence of” is not considered uncertain.  Therefore, it would be appropriate to assign code C78.7 (secondary malignancy of the liver) from the description “evidence of liver metastasis” in the outpatient setting. 

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.

Match That External Cause Game

Click HERE to print the game.  Click HERE for the answers.

Coding Acute Pancreatitis and Chronic Pancreatitis (Fall Coding Seminar - Jeopardy Game Clarification)

During the Coding Jeopardy Game at OHIMA’s recent Fall Coding Seminar (September 14, 2018), there was much discussion after an answer was revealed.  The question was: "ICD-10-CM code assignment for acute and chronic pancreatitis."  The correct answers were:

K85.90 for the acute pancreatitis
K86.1 for the chronic pancreatitis
K86.81 for exocrine pancreatic insufficiency

Here is the rationale for the codes...

Official Coding Guideline I.B.8 states:

Acute and Chronic Conditions - If the same condition is described as both acute (subacute) and chronic, and separate subentries exist in the Alphabetic Index at the same indentation level, code both and sequence the acute (subacute) code first.

Therefore, both K85.90 and K86.1 are correct and sequenced appropriately.

Now comes the part that raised discussion.  Under K86.1, there is a “Code also” note stating to assign K86.81 for the exocrine pancreatic insufficiency.  This note is also found under K90.0 for celiac disease, K86.0 for alcohol-induced chronic pancreatitis, the C25 category for cancer of the pancreas, and the category E84 for cystic fibrosis.  This “Code also” note does not indicate the phrase “if applicable” as other “Code also” notes do.  See the difference in the type of “Code also” note by comparing with the one at K74 for fibrosis and cirrhosis of the liver which states “Code also, if applicable, viral hepatitis”.  In the case of K86.81, coders are being directed to add the K86.81 for the conditions listed above. 

4th Qtr. 2016 Coding Clinic weighed in on exocrine pancreatic insufficiency (EPI) by stating that chronic pancreatitis is the most common cause of EPI, and listing several other etiologies including cystic fibrosis, pancreatic duct obstructions, and pancreatic cancer.  That would be consistent with the “Code also” note coders see under those conditions indicating the need to assign the code.

Hopefully, this fully clarifies the rationale behind the code assignments listed as correct in the game.

 

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.

All About OHIMA - Word Search Game

How much do you know about OHIMA?  Learn about OHIMA and what opportunities we offer with this All About OHIMA Word Search!  Click HERE to print the word search.  Click HERE for the answers.

 

Updated Recertification Policies Coming Soon!

UPDATE as of 10/29/2018: The below updated Recertification Polices have been delayed until January 1, 2020.  For full details, click HERE.

http://ohiohima.blogspot.com/2018/10/updated-recertification-policies.html

If you have AHIMA credentials, this affects you!  Changes will include:

• New Continuing Education Domains
• New Recertification Timeline for grace, inactive, and revocation periods

New policies will go into effect on November 1, 2018.  For full details on the update, see AHIMA’s article from the July issue of Certification Connection.