Tuesday, June 25, 2019

In My Rearview Mirror

I am truly fortunate and not because of money, position, or title.  No, I am fortunate because I was able to live in moments of meaning that mattered to the Health Information Management (HIM) profession.  My year as President on the Board of Directors of the Ohio Heath Information Management Association (OHIMA) has been a time of serving the HIM membership in Ohio and advocating for patients throughout the United States.  The entire 2018-2019 year has been a string of moments of meaning for our profession.  It amazes me to look in my rearview and see myself in those moments.  It has been an honor for me to serve the profession I’m passionate about and you, the HIM professionals in Ohio who make our work so meaningful.

I only want to highlight some of the moments of meaning in my rearview mirror:

·         I began my year as President by participating in the 2018 American Health Information Management Association’s (AHIMA) Leadership Conference.  Component State Associations (CSAs) send first-time Board members from each state to listen, learn, and participate in general session and breakout session activities designed to communicate the AHIMA mission and strategies.  CSA participants then go back to their state associations and align their Board strategies with those of AHIMA.  It is important for all HIM professionals to be on one accord throughout the United States.  What a wave of service we create!  The 2018 Leadership Conference was even more meaningful because participants heard from our new AHIMA Chief Executive Officer, Dr. Wylecia Wiggs Harris.  It was thrilling to hear her plan to move AHIMA forward in a direction of usefulness and purpose.  She encouraged us all to participate in strengthening our desire and resolve to work with her to keep the HIM profession relevant, useful, and prosperous.

·         In September 2018, I attended my first AHIMA Annual Convention and Exhibit.  Our national convention begins with the convening of our House of Delegates (HoD) Meeting.  The HoD includes Executive Board members and elected Delegates from each state and tasks them with addressing HIM industry issues while using the parliamentary governing process of making decisions for AHIMA. The following day, the opening ceremony for the Convention was held at the newly completed Miami Beach Convention Center in Florida.  AHIMA was the first organization to hold an event there!  Many were moved many to tears when the Marjory Stoneman Douglas High School Eagle Regiment Marching Band as they performed the music for the opening ceremony.  The remainder of the Convention was filled with nationally known keynote speakers as well as leading HIM professionals facilitating the breakout sessions.

·         During the year, Board members were hard at work on a project that would have a positive impact on the people who live in Ohio and across Ohio’s healthcare industry.  The project was led by Kristin Nelson, your President-elect, and our OHIMA Executive Director, Lauren Manson.  With collaboration and brainstorming sessions during all board meetings, the “What is HIM?” video was created!  It debuted on Monday, March 18, 2019, the first day of the 2019 OHIMA Annual Meeting!  The OHIMA Board received so much positive feedback which prompted us to submit the video for the AHIMA Triumph Award in Innovation!

·         The week after the conclusion of the 2019 OHIMA Annual Meeting, I flew to Washington, D.C. for the 2019 AHIMA Advocacy Summit.  Nearly 200 CSA members were in attendance to advocate for HIM issues on Capitol Hill.  We met with our Congressmen/Congresswomen and Senators bring awareness to and advocate change in legislation.  Our “asks” were to align HIPAA Right of Access with the ONC Health IT Certification Functionality; to extend the HIPAA Individual Right of Access to Non-Covered Entities; to encourage Note Sharing with patients in real time; and to remove language in the 1999 Omnibus that prohibits the Department of Health and Human Services (HHS) from collaborating with HIM industry leaders to develop a unique health identifier (UHI) for a national Patient Matching system.  AHIMA does a phenomenal job coordinating appointments with each congressional office.  It was an incredible experience to see so many HIM professionals representing AHIMA converging over Capitol Hill in its entirety with a unified goal in their hearts.  Our voices were heard because on June 12, 2019, the U.S. House of Representatives considered a bipartisan amendment offered by Representative Bill Foster (IL) and Representative Mike Kelly (PA) to HR 2740, the Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act of 2020 which seeks to strike language in the Labor-HHS Appropriations bill that prohibits the US Department of Health and Human Services from spending any federal dollars to promulgate or adopt a national patient identifier.” (AHIMA Policy and Government Relations Team; Email, June 11, 2019) 

·         April 26, 2019 marked the 2019 Educator’s Day event in Columbus, OH.  As a first time attendee, I was fortunate to be with the top HIM educators in Ohio.  The presentation by the Commission on Certification for Health Informatics and Information Management (CCHIIM) clarified the near-future changes coming to the certification and recertification standards and procedures of Health Informatics and Information Management (HIIM) programs throughout the United States.  Watching and listening at this event strengthened my respect and admiration for those who are dedicated to teaching, instructing, and mentoring the HIIM professionals of the future.

During this year of serving you, the gifted and talented members of OHIMA, I have experienced so many emotions; inspired, excited, grateful, and passionate are just a few.  Mostly, I am thankful to each of you for allowing me to represent you during the moments of meaning this year.  Take good care of yourselves and each other.  Thank you!

Krystal Phillips
2018-2019 OHIMA Board President

About the Author

Krystal Phillips, RHIA, CHTS-IS is a HIM coder at OSU Veterinary Medical Center and an adjunct professor at Columbus State Community College in Columbus, Ohio.  Krystal currently serves on the OHIMA 2018-19 Board as President and Delegate. 

Monday, June 17, 2019

Juggling Definitions for Sepsis

by Adriane Martin, DO, FACOS, CCDS

Sepsis’ complexity and frequent definition updates propose challenges for CDI and coding professionals but it’s also a gray area in clinical medicine.
The most recent definition of sepsis, also known as sepsis-3, was proposed by the Third International Consensus Definitions Task Force in January of 2016 as “a life-threatening organ dysfunction resulting from a dysregulated host response to infection.” A change of greater than or equal to 2 from the baseline Sequential Organ Failure Assessment (SOFA) score was noted to be representative of organ dysfunction. This group also recommended that the terms septicemia, severe sepsis, and sepsis syndrome be eliminated from the definition.
The task force went on to outline septic shock as sepsis with persistent hypotension, despite adequate fluid resuscitation, requiring vasopressors to maintain a mean arterial pressure greater than or equal to 65 mmHg and a serum lactate level greater than 2 millimoles per liter (mmol/L). The Third International Consensus Definitions Task Force seems to have clearly defined sepsis and identified the SOFA score as a tool to determine the presence of organ dysfunction.
Sepsis confusion
So why the confusion? The Third International Consensus Definitions Task Force’s view on sepsis has not been adopted by all societies, physicians, or payers. Many of these groups and individuals still hold to the sepsis definition put forth by the 2001  International Sepsis Definitions Conference, also known as the sepsis-2 definition.  
The definition of sepsis was originally published in a 1992 article based on discussions from the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. In this consensus opinion, sepsis was defined as a clinical syndrome in the presence of infection and a systemic inflammatory response (SIRS) unexplained by anything other than infection.
In 1992, the criteria to define SIRS included two or more of the following: fever/hypothermia, leukocytosis/leukopenia/bandemia, tachycardia, or tachypnea.
In 2001, the expansion of criteria used to define systemic inflammation was introduced, which included the original four SIRS criteria plus several others, including altered mental status, hyperbilirubinemia, and thrombocytopenia. Severe sepsis was defined as sepsis with associated organ dysfunction. Septic shock was defined as a sepsis-induced hypotension, despite adequate fluid resuscitation, along with organ dysfunction or hypoperfusion abnormalities.
These two different consensus definitions are not mutually exclusive, and often the diagnosis of sepsis is supported by criteria from both consensus definitions. The real issue becomes what happens when the diagnosis of sepsis is met by one consensus definition but not the other.
From a coding standpoint, the 2019 ICD-10 CM Official Guidelines for Coding and Reporting state that “the assignment of a diagnosis code is based on the diagnostic statement that the condition exists. Code assignment is not based on the clinical criteria used by the provider to establish the diagnosis.”
Based on this guideline, it would seem the criteria used to define sepsis should not be a point of dissidence for CDI or coding professionals but , this is not the case since payer requirements vary.
For example, CMS supports the sepsis-2 consensus and has not adopted the sepsis-3 consensus definition. On the other hand, some commercial payers and non-traditional Medicare payers are using the sepsis-3 consensus definition which leads to confusion and potential denials
CMS’ Early Management Bundle, Severe Sepsis, and Septic Shock, which is a process measure related to quality of care initiatives represents another challenge. The intent of this sep-1 bundle is to ensure healthcare providers follow  best practices for patients with severe sepsis or who have diagnosis for sepsis with criteria for severe sepsis present.
The sep-1 bundle uses the sepsis-2 criteria to establish the presence of severe sepsis. Using criteria to define sepsis/severe sepsis other than those outlined by the sepsis-2 consensus might result in the bundle not being appropriately implemented therefore negatively affecting performance under this measure.
The sepsis controversy will continue as long as there is more than one definition of sepsis being used by payers, institutions, and providers. Communication amongst coding teams, CDI specialists, and providers, is a must to ensure accurate capture and reporting of sepsis.

Editor’s note: This article originally appeared in JustCoding. Dr. Martin is vice president of Enjoin in Eads, Tennessee. She has provided clinical insight and education as part of the pre-bill review process since 2014. She is board-certified in general surgery, assists with documentation improvement, and provides specialty-to-specialty physician education in areas related to ICD-10, with a focus on surgical procedures and ICD-10-PCS. Opinions expressed are that of the author and do not necessarily represent HCPro, ACDIS, or any of its subsidiaries.
Copyright Association of Clinical Documentation Improvement Specialists (ACDIS).  Article reprinted with permission. 

Tuesday, June 11, 2019

Coding Hernias

This edition of “In the kNOW”  presents information on coding hernias.  Correctly assigning hernia codes requires coders to first determine what type of hernia is being repaired.  A coder must identify if the hernia is inguinal, femoral, incisional, umbilical, ventral, hiatal, etc.  Let’s look at the differences in the types of hernias in more detail.

Source: https://anatomyinnerbody.com/inguinal-hernia-in-females-pictures/inguinal-hernia-in-females-pictures-hernia-repair-abroad-at-affordable-pirce-in-budapest-hungary/
A hernia occurs when there is a weakness in muscle or tissue and strain, which causes an organ to bulge through the weakened area.  Straining such as heavy lifting, coughing, and constipation contributes to the occurrence of hernias.  Obesity is another factor that contributes to the development of hernias.

Hernias can occur in many areas of the body, and as illustrated above, often occur in the abdomen. Inguinal hernias appear in the lower abdominal area usually as a result of intestines or fat protruding through the abdominal wall.  Direct inguinal hernias do not enter the inguinal canal, while indirect inguinal hernias do.  Femoral hernias occur in the low part of the abdomen or upper thigh.

Ventral hernia is a term for any hernia that occurs along the midline of the abdominal wall.  There are three types of ventral hernias.  An umbilical hernia occurs at the belly button area. Epigastric hernias occur in the upper abdomen between the umbilicus and the lower sternal area.  Incisional hernias occur where there has been a previous surgical incision.  These hernias arise due to the fact that the previous incision did not totally heal, leaving a weak area, which lends itself to herniation.

Spigelian hernias arise in the lower abdomen fascia between the lateral oblique and rectus muscles.  In ICD-10-CM, spigelian hernias are coded to ventral hernias.

There are hernias that occur in other regions of the body, for example hiatal hernias.  This type of hernia is the result of the top part of the stomach protruding through the diaphragm.  The area of the protrusion is the hole in the diaphragm through which the esophagus passes to connect with the stomach.  If a portion of the stomach bulges into that opening, a hiatal hernia is created.  Also, consider hernias that occur internally in the abdomen.  These hernias may be seen in patients who have had bariatric surgery.  ICD-10-CM directs coders to assign codes for internal or intra-abdominal hernias as abdominal hernias. 

Once the type of hernia has been identified other factors may need to be considered such as:
  • Initial vs. recurrent
  • Reducible vs. incarcerated/strangulated/obstructed/irreducible (all of which are coded in ICD-10-CM to Hernia, by site, with obstruction)
  • Presence of gangrene
  • Unilateral vs. bilateral

Coding professionals must be sure to follow the Index entries carefully when assigning hernia codes.  For example, when assigning a code for a bilateral inguinal hernia with obstruction, it could be easy to stop at code K40.30 for inguinal hernia with obstruction.  However, the correct code is actually K40.00, which captures the bilateral component.

After the correct diagnosis has been captured, the coder will turn to assigning the code for hernia repair, which will be discussed in the next installment.
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, June 5, 2019

A Day (or a few…) in the Life of OHIMA’s Executive Director: PART 2

by Lauren Manson, RHIA – Executive Director, OHIMA 

As a non-profit association Executive Director, no two days are the same. Some days, I am an event planner.  Other days, I am a lobbyist.  Today, I am attempting to be a blogger writing this article.  Haha!  Here are a few example days in my life as the Executive Director of OHIMA…(during the autumn 2018 when I began writing this article ha!). 


8:30 AM  As I drink my coffee with pumpkin spice creamer, I begin my day checking emails and posting on OHIMA’s social media accounts.  I keep an ongoing file of posts for our Facebook and LinkedIn pages so I’m not scrambling to find something to post each day.  Thankfully, a volunteer manages our Twitter account because I have no idea what is worthy of a twitter … tweet … whatever ... these days! 

9:10 AM I post this week’s blog article.  It’s quick to post since our Coding Education Coordinator, Dianna Foley, wrote it and her grammar is always pristine.

9:45 AM  A phone call with Krystal Phillips, our Board President, discussing the strategies and agenda for our Board Meeting tomorrow.  I also send a quick email to the Board Members reminding them to review the meeting materials before the meeting. 

10:05 AM  I work on getting my notes and materials together for the Board Meeting.  We will be taking advantage of all the brains in one room and doing some brainstorming for a big project we’ve been working on.  Stay tuned at the OHIMA Annual Meeting for the big reveal!

11:45 AM  Working from home makes meals easier … lunch is leftovers from last night’s dinner!  Eh, I will just leave my dishes in the sink.  Luckily, I don’t have co-workers to frown at my dirty dishes.   More emails … 

12:20 PM  The Fall Coding Seminar is quickly approaching but even 6 months in advance, there are things to do for the Annual Meeting as well.  So I check our timelines to ensure that we are on track for all our meetings.  I can’t sing.  I ain’t crafty.  But I am organized!  My organization skills are key helping the OHIMA Central Office manage the 20+ projects going on at any given time in our association!  I add a few items to my to-do lists and send tasks to our other staff members.

1:00 PM Time for an AHIMA conference call!  Each month, AHIMA hosts a conference call with all the 52 Component State Associations’ Executive Directors.  Sometimes I present … this time, I am just a participant and listen in (trying not to check emails while I do – we are all guilty of this, right!?).

2:00 PM  My eyes are tired from looking at my computer so I print off the Hilton contracts for the OHIMA 2021 and 2022 Annual Meetings and review them in preparation for contract negotiations.  Columbus is becoming quite the popular location for national meetings, and as a result we are having to book venues further and further in advance!  2022!?!?  How can we possibly anticipate what our needs will be in 5 years??  We have to try … otherwise, we will be stuck having our meeting in a field out in the boondocks.

3:15 PM Phone call with Rick Tully from the Ohio Medicaid Office about the Statewide Authorization Form they are creating.  He hopes that OHIMA members will help distribute this form once it’s finalized.  He invites me to a committee meeting next week to discuss the comments submitted on the draft form.

3:30 PM I want to take advantage of the Vistaprint sale ending today so I put on my marketing hat on and design a postcard to advertise the Fall Coding Seminar.  We do have a graphic designer that we pay to design the Annual Meeting Program and Exhibitor Prospectus but with our small budget, we can’t afford to pay her for every little thing that needs designed.  So with some software tools like Canva, I fake it!  Not bad … eh? 

5:15 PM   More emails … I check in with my remote staff (we all work from home and occasionally, we meet up for an in-person meeting to regroup). 

6:00 PM I have book club tonight but I stop by Costco to pick up soup to feed our 40 volunteers attending the Board Meeting tomorrow.  I ordered Subway wraps earlier in the week – but because it is autumn, some soups would be great to go with it!  Again, working in a small budget, we find ways to maximize our funds. 

9:45 PM I get home from book club (whoops, I didn’t get a chance to read the book this month!  Oh well!).  I check emails one last time and then load my car for the Board Meeting tomorrow. 

10:15 PM Getting to bed early so I can be fresh and perky for the Board Members tomorrow! 

DAY 2 (a week ish later …)

7:30 AM  Sipping coffee with vanilla caramel creamer this morning.  As usual, I begin my day with responding to emails and posting on OHIMA’s social media pages.  Today’s social media posts are soliciting nominations for OHIMA’s Board elections!  I check the status of the nominations received and shoot an email to the Nominating Committee Chair.  I send this month’s “OHIMA News” e-newsletter content to Bethany, my Executive Assistant, so she can create and schedule the e-newsletter for this month. 

8:30 AM Because I have meetings outside the home office today, I take a break to shower and put on real shoes.  Working from home, my feet live in slippers most days!  But I do love my heels (does "buying shoes" count as a hobby?)!  

9:30 AM I drive downtown for a committee meeting with Ohio Medicaid about the Statewide Authorization Form.  There are several associations involved in this committee.  I am happy that HIM is represented at the table for this project.  I will be sharing the comments compiled by our HIM members on the draft form which I hope are applied to the form.  More often than not, politics are involved with these governmental agency projects which complicates the process. 

11:00 AM Since I am just across the street, I attend the Ohio House Health Committee Meeting.  Occasionally, there are state bills that OHIMA must get involved in and bills start with hearings in the Ohio House and Senate Health Committees.  

12:00 PM I usually try to schedule my work outings on the same day if I can - I am all about efficiency!  Therefore, I visit several new properties that offer meeting space.  If our Fall Coding Seminar gets any bigger, we will outgrow our space and I will have to come up with an alternative plan. 

2:00 PM Back in the home office and checking emails … I return a few phone calls regarding questions about the Fall Coding Early Bird Registration.  The majority of communication comes via email these days but the phone rings a couple times a day.  

2:30 PM We have been working diligently to finalize the speakers for the OHIMA 2019 Annual Meeting.  Bethany, my Executive Assistant, put together the speaker agreements.  I review and finalize each one and send them out to our 30+ speakers for 2019!  This is always a big project, but it is a good opportunity to touch base with each speaker about details of their presentation, etc.  There is still an Inpatient Coding slot on Wednesday that needs filled.  I reach out to one of my vendor contacts to see if they’d have a fitting presentation for this slot.  

4:45 PM Phone call with our accountant about the year-end tax form.  We talk depreciation… oh fun (I have a business minor but calculating depreciation is not something I have to do every day!  I joke about pulling my college accounting books out of my basement to help me calculate the year-end depreciation. Luckily, we have an outside accountant to help us with this!).  After our phone call, I run financial reports, gather the documentation, and send our accountant the information needed to compile the 990 tax form. 

5:30 PM Back to back conference calls with the Student & New Graduate Committee and the Young Professional Committee.  It’s always refreshing to brainstorm with the new HIM professionals who are our future! 

7:00 PM One of the challenges of working from home is separating your work life from your personal life since they are in the same location!  I close my office door and put my feet up.  Everything else can wait until tomorrow … for now, I am going to watch “This is Us” and probably shed a few tears (if you watch the show, you understand!). 

A Random Saturday …

10:03 AM I update the registration fees on our website since the Early Bird Registration closed at midnight for our upcoming Fall Coding Seminar.

10:30 AM I answer a few emails.  I try not to work too much on the weekends (except when I travel to attend conferences or there are things that MUST get done ASAP!) … but this weekend, I want to take advantage of this beautiful weather and get my jigsaw out for an Annual Meeting d├ęcor project!  I recruit my dad because he has a truck and we head to Home Depot to get sheets of plywood.  The pictures tell the rest of the story….

3:30 PM With the letters cut out … I decide that painting them can wait until another day.

(And this is the final result at the OHIMA Annual Meeting!  This was our Hollywood-themed event!) 


If you 'd like to write a “Day in the Life” article about your HIM job...contact me at ohima@ohima.org!  We'd love to publish it - and I can assist if you need help writing it!  These "Day in the Life" articles help provide valuable insight into the diverse job roles that HIM professionals can do!