Monday, November 26, 2018

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.

Monday, November 19, 2018

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.

Tuesday, November 13, 2018

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.

Tuesday, November 6, 2018

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

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.