Monday, August 31, 2020

HIM’s Unique Role Around the Social Determinants of Health

by Hayley Studer, CPA, FHFMA

Social determinants of health (SDoH) are the non-medical factors like housing, education, transportation, access to food, or other socio-economic factors that impact anywhere from 60-80% of a person’s health. Although SDoH discussions have become much more prevalent in healthcare overall, we have underestimated the role that Health Information Management (HIM) personnel can play in this arena. I see five key areas where HIM can bring significant value to SDoH discussions:


Codifying Information for Reimbursement

HIM professionals are able to take data elements from a patient’s medical record and turn them into codes used for payment purposes. Historically, these codes have almost solely focused on the medical condition of the patient. As research has shown us, the medical components only represent a portion of a person’s overall health. To capture a complete picture of a patient’s health status, we must also look at their socio-economic conditions. The addition of “Z-codes” have given us a limited ability to codify some of these factors, but additional work needs to be done to truly capture a more complete picture. Developing new codes to capture the root cause of a person’s medical condition and addressing the holistic factors comprising a person’s health will become increasingly important as new value-based payment models emerge. HIM personnel can offer insight on how to best codify this additional information.


Information Management

Data is key when developing new payment models. How we capture data, where it’s located, and ensuring its integrity are all points that need consideration. The HIM team has always played a key role in managing data and should have a primary seat at the table during these discussions. If screening tools are used, do they become a permanent part of the patient’s medical record? What forms are used to capture this data and where does it originate? Just like any new medical form, HIM should be involved to help create, review and approve forms used to document SDoH data.



Closely following the data management piece is the technology component. Today, SDoH data may be collected in disparate systems, sometimes manually, and oftentimes not at all. HIM professionals can help identify these points of data collection and work with the Information Technology teams to help integrate the data into the electronic health record. Consistent electronic documentation will be key to accurately capturing new SDoH data, allowing us to scale solutions and ultimately gain a full picture of our patients’ health status. New SDoH technologies are popping up frequently and HIM professionals can play a key role in helping to develop these new solutions.



As programs identifying SDoH issues become more commonplace and SDoH data collection expands, privacy concerns arise. Does the standard medical treatment consent form cover this new area as well, or will additional language and disclosures be required? As SDoH issues are addressed, how will information be shared with outside entities? HIM team members often fill this privacy role and their perspective is critical as these discussions ensue to ensure regulatory compliance is maintained.



Research surrounding SDoH issues is another area requiring HIM input. Studying SDoH areas and incorporating them into a patient’s medical treatment is still a relatively new area, so many research studies and pilot programs are being done. Laying out parameters for the data collection and how it can be used, as well as incorporating the four areas discussed above into the research project requires a skillset possessed by a HIM professional. HIM’s ability to tie together bits of information to tell a story is a requirement for a good research study and can also prove beneficial when applying for grants or relaying project results.


As healthcare continues to enter the SDoH arena, new roles will open up for HIM professionals to use their skillsets and provide value in new ways. By building on the traditional roles of data management, technology, and privacy, HIM can help healthcare entities explore new avenues for SDoH research and reimbursement. HIM’s unique skills can help round out a team to make sure additional areas are addressed and more complete programs are rolled-out.


About the Author 

Hayley Studer, CPA, FHFMA has spent over 20 years in healthcare finance, most recently as the VP, Revenue Cycle at a large health system. Deciding that she wanted to focus on community work, Hayley joined a national contact center as Chief Mission Officer to oversee their charitable activities and work on multi-sector partnerships to address social issues in their communities.  Seeing a need to bridge the gap between addressing social determinants of health issues and advocating for new healthcare payment models, Hayley started her own company, achi, LLC. A CPA and Fellow in the Healthcare Financial Management Association, Hayley holds a BSBA with majors in Accounting and Healthcare Administration from Bowling Green State University.   



Monday, August 24, 2020

Coding Musculoskeletal Drug Delivery Devices

This edition of “Spotlight on CPT” will present information regarding the coding for drug delivery devices found in the Musculoskeletal System of CPT.  A drug delivery system is a method of supplying medication, particularly antibiotics but also other therapeutic substances, to a targeted area of the body.  Different methodologies include beads, nails, or spacers.  Treatment with drug delivery devices can focus on the specific site of osteomyelitis, or aid in the prevention of infection post-joint replacement surgery. 




With the 2020 CPT code updates, six new codes were added relative to these devices.  These new codes allow for capturing the work involved with the manual preparation/mixing and insertion of the medication or with their removal.  These six codes, 20700-20705, are all add-on codes that are to be assigned in addition to the code for the primary procedure.  Notice that the code pairs focus on an anatomic location, ie. subfascial, intramedullary, or intra-articular.

20700-manual preparation and insertion of drug-delivery device(s), deep (eg, subfascial)

20701-removal of drug-delivery device(s), deep (eg, subfascial) 

20702-manual preparation and insertion of drug-delivery device(s), intramedullary

20703-removal of drug-delivery device(s), intramedullary

20704-manual preparation and insertion of drug-delivery device(s), intra-articular

20705-removal of drug-delivery device(s), intra-articular

It are several important notes to be aware of regarding the use of these codes.  First, if prefabricated drug devices are utilized, these codes do not apply.  Second, these codes may only be reported once per anatomical site.  Finally, while the new removal codes are meant to be used as add-on codes, if the only procedure performed is the removal of the drug delivery system without a primary procedure, the appropriate removal code is 20680.  

Now, light has been shed on coding for drug delivery systems.

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.