Putting Together Our "What is HIM" Video

I’m sure many of you find it difficult to explain to someone not only what we do as HIM professionals but what we are capable of doing. Would you agree?

As you may know, one of the OHIMA board’s strategies is “innovation”, therefore we thought it would be a great innovative idea to put together a “what is HIM video” that can be used for HR recruiters, students and the general public.

We assumed the majority of the work was selecting the vendor and we would simply tell them what we wanted and they would take it from there.  Little did we know the intricate steps needed before the end product could be delivered.  After talking with many vendors and viewing sample videos we settled on one that was a bit more cutting edge and had done videos for Ohio State, Pelotonia and Cardinal Health to name a few. Next up was deciding the type of video we wanted.  Animated? Animated with voice over? Panel Interview?  A day in the life of an HIM professional? In the end, animation with voice over won out in order to be able to use the video longer as well as hold the viewer’s attention with eye catching graphics. 

The most work was scripting out the video along with timing.  We knew almost immediately that we did not want the video to be long. Short sweet and to the point was our objective.  The OHIMA Board of  Directors put our heads together and came up with key job settings, titles and functions showcasing our talents especially focusing on the jobs that are the future of our HIM profession.

Next we had to pick out a style which included deciding on whether we wanted all icon based graphics or to include people in our graphics or a combination of both.  It was decided that having both icons and people graphics was a must so we could feature the strong collaboration focus HIM professionals often have.

Auditions for voice over was by far the coolest part of making the video. The vendor sent us a link with several voice auditions to choose from with differing ages, genders and voice qualities.  The vendor explained that they only give the person auditioning a small paragraph and little direction just to see where they will go with it.  The vendor then “storyboarded” our script which is this sort of “visual path” that runs alongside the finished script. This allowed us to work with the vendor on creating the remaining artwork and visuals necessary for the animation.  We had several revisional rounds before finalizing the storyboard.  The final step was sound design to enhance the animation we carefully selected.

At last, it was time for our “call to action”.  We revealed the video at the 2019 OHIMA Annual Meeting on Monday morning. The video played at the OHIMA booth and flyers were placed in packets with a QR code to the video.  The video is also available on the OHIMA website.  We encourage everyone to share this video with human resource representatives, students and anyone else that might benefit.  We cannot wait to see what this video will do for our profession!

About the Author 

Kristin Nelson, MS, RHIA is the current Director of Innovation, incoming President-Elect of the OHIMA 2019-20 Board of Directors and Program Manager of Education at The Ohio State University Wexner Medical Center.

Lobar Pneumonia

Visit newer blog post on Lobar Pneumonia HERE.

Change - a concept with which coding professionals are all too familiar.   This “In the kNOW” delves into an example of why it is so vital to constantly update a coding professional’s knowledge base by examining the diagnosis of lobar pneumonia and reviewing relevant Coding Clinics related to that diagnosis.  

Lobar pneumonia is type of pneumonia that affects an entire pulmonary lobe or multiple lobes of the lung.  In the vast majority of cases, lobar pneumonia is caused by Streptococcus pneumonia.  As such, initial guidance from Coding Clinic back in 1985 instructed coders to code the diagnosis of lobar pneumonia to pneumococcal pneumonia, which under ICD-9 coded to 481 and under ICD-10 codes to J13.

Fast forward to 2009, when another question surfaces, this time regarding the appropriate coding for multilobar pneumonia.  Now coding professionals are instructed to query the physician for the specific type of pneumonia.  If no further clarification is obtained, then the code to be used is 486 (ICD-9) (J18.9 ICD-10) for an unspecified pneumonia.  It had been determined that the term “lobar pneumonia” was outdated, and that lobar pneumonia actually had many causes not just pneumococcal (which traditionally affected one lobe but could encompass several lobes).

In a recent 3rd Qtr. 2018 update, Coding Clinic once again addressed the coding for a lobar pneumonia diagnosis.  Guidance provided that when a diagnosis of “lobe pneumonia” (such as left lower lobe pneumonia) was documented, it is to be considered lobar pneumonia and coded to J18.1.  This is true regardless of whether the documentation indicates one lobe, multiple lobes, or a partial lobe are impacted.     

Code J18.1 is specific to the location of the pneumonia rather than the causative organism.  Should the documentation further specify the agent responsible, then there are combination codes available under “Pneumonia, lobar” in the Alphabetic Index to capture that information.  For example, E. coli lobar pneumonia codes to J15.5.      

Assignment of J18.1 for the unspecified lobar pneumonia results in the MS-DRG of 195-Simple Pneumonia and Pleurisy w/o CC/MCC with a reimbursement weight of 0.6868.  Hemophilus influenzae, pneumococcal, streptococcal, or specified organism NEC types of lobar pneumonia will all fall into the same MS-DRG of 195.  Note that Klebsiella pneumoniae, Pseudomonas, Escherichia coli, and Proteus specific lobar pneumonias will result in assignment to MS-DRG 179-Respiratory Infections and Inflammations w/o CC/MCC with a reimbursement weight of 0.9215.  

This brings us back to querying the physician.  While it is possible to code lobe or lobar pneumonia, there is the potential for increased reimbursement as illustrated above, should the physician be able to specify the exact type of pneumonia.  Therefore, it may be beneficial for a coder to query the physician for the exact type of lobar pneumonia affecting the patient.

Review of this one diagnosis, lobar pneumonia, is just one incidence of the changes that coding professionals see on a frequent basis.  A coder can never assume that information learned years ago is still relevant today.  Medicine is changing it an ever-increasing speed, in turn influencing how we code.  It is our responsibility to maintain a commitment to life-long learning to ensure we keep up with those changes. 

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.

The Value of HIM in Long Term Care/Post-Acute Care

by Anissa McBreen, RHIT


As I opened the door and walked into the office, or probably most appropriate the hole in the wall, my eyes darted and scanned the enormous amounts of loose papers, charts stacked to the ceiling, and cabinets filled to the brim with what at that moment I could not make out. Did I just find the black hole? Or better yet, did I just walk right into the Bermuda Triangle? What in the world had I signed up for? What new role did I just take on that I had no clue what I was doing? What exactly was this thing called Medical Records? Was this the path I was designed to walk on? Was this what I had in mind when I signed up for the Associates program? And, what did it mean to work in a skilled nursing facility? So many questions but so little answers at that time. Slowly but surely the fear and anxiety overwhelmed me.

This true scenario was 27 years ago to the month! Since that day, I have graduated with an Associates, working on my Bachelor’s, own and still operate my own consulting business and partnered with another HIM professional providing consultation, workshops and policy and procedure manuals to over 75 skilled nursing facilities throughout Ohio. I have written articles on the value of HIM and I have sat on several committees to not only bring value but encourage and mentor. I also teach in the RHIT program as an Adjunct and just recently partnered with the Ohio Health Care Association to provide workshops.

So, why do I tell you all of this? Is it for you to see just how great I am? How far I have come since that day 27 years ago or make you think I have it all together in this field? Not at all! I share my story because I am proud of not only the field I work in, the resources I provide to other HIM, the friendships I have made, the accomplishments I have, but I do this because I want my fellow peers that work in Long Term Care to know they have a voice, they are valued, and they must come to the table to show the difference they can make!

Those of us working in LTC know that we are few and far between. We have credentialed and non-credentialed professionals in this non-traditional setting. Some work with peers who in our workplaces know exactly what value we bring and what HIM stands for and we have those that have no clue and quite honestly do not want to know. Because of the perceptions of us just being a ‘file clerk” and because the role is changing from day-to-day and because of not only the rules and regulations, but this is the time that you must come to the table. Now is the time for you to take the fear and anxiety I felt 27 years ago and move forward! If I can do it, so can you.

I have talked with several of you that work in this non-traditional setting and I have heard your barriers, gaps, and lack of resources. I have mentored and given out lots of recommendations and advice. And, I have been on my soap-box more times than I can remember. Whether you are credentialed or not, I want you to sit at the table with me and bring your passion and expertise. I want you to feel your worth and value and be able to come up with solutions and recommendations to share with your organization. Okay, I can see the eye rolling and I can hear you say, “Anissa that’s great but I have done this before, and no one cares”. Well, then do it again! And again, and again and again. And don’t stop until your voice is heard. The future for us is incredible. Now more than ever we must show our value to our organization. Whether you schedule a meeting with your Administrator or ask to be a part of the QAPI committee, you cannot be silent. I feel so strongly about this that I will be speaking at OHIMA on this subject with my good friend, Tosha Roberts. We have put together a great presentation to get you started on the conversation with your organization and the tools, resources and tips to be successful. I feel so confident and so passionate in the area that I am working on some workshops and networking to help you succeed in this non-traditional role.
While you might not have had the experience, I had 27 years ago or maybe you currently do sit at the table, your job is not done! We must continue to show our worth and value and what we can do as a HIM professional to show the organization that we can make a difference!

I hope to see you at the OHIMA 2019 Annual Meeting. Now, go to the table. I see an empty seat just for you!

Anissa McBreen has been providing consulting services and educational workshops to Long Term Care/Post-Acute organizations for over 27 years. Under her leadership, HIM departments have developed and maintained compliance with state and federal regulations. She has also developed HIM programs for HIPAA and QAPI and provided policy and procedure manuals. She is an RHIT working towards her RHIA. Anissa is a highly driven professional and has a passion to educate those working in non-traditional settings to be successful HIM professionals. She can be reached at mjmcbreen@aol.com for questions, networking information or just table conversation between HIM professionals.

Release of Information

 

 

 

 

For more detailed information on Release of Information, click HERE for full presentation slides.

 

 

 

 

When is it appropriate to use other clinicians' documentation to record a diagnosis?

A 2019 Official Coding Guideline update addressed using other providers’ documentation for assignment of specific diagnosis codes.  This installment of “In the kNOW” explores when it is appropriate to use the documentation of clinicians in a patient’s record to record a diagnosis.

Previously, the Official Coding Guidelines outlined several “qualifiers” of conditions where it was acceptable for coding professionals to use documentation by a clinician to capture the code.  These “qualifiers” include:

• BMI
• NIHSS
• Coma scale
• Depth of non-pressure chronic ulcers
• Stage of pressure ulcers

The same guideline (I.B.14) shared that the patient’s provider, who is considered their physician, or other healthcare practitioner legally accountable for establishing the patient’s diagnosis, must be the one who documents the associated diagnosis, such as obesity, stroke, or pressure ulcer.  Since the “qualifiers” listed above provide more detail regarding the diagnosis established by the provider, it is acceptable to utilize the documentation of a clinician such as a dietitian for the BMI, a nurse for pressure ulcer stage, or even an emergency medical technician for the coma scale.

With the 2019 Official Coding Guideline update, we see that the previous title of this applicable guideline changes from “Documentation for BMI, Depth of Non-pressure ulcers, Pressure Ulcer Stages, Coma Scale, and NIH Stroke Scale” to “Documentation by Clinicians Other than the Patient's Provider”.  While all the above information remains under this guideline, a new section has been added which addresses code assignment for social determinants of health. 

Codes for social determinants of health are found in categories Z55-Z65.  This section is entitled “Persons with potential health hazards related to socioeconomic and psychosocial circumstances”.  Within this section, coding professionals find codes that identify the following:

• Problems related to education/literacy
• Z55.3 Underachievement in school
• Problems related to employment/unemployment
• Z56.2 Threat of job loss
• Problems related to housing and economic circumstances
• Z59.0 Homelessness
• Problems related to upbringing
• Z62.1 Parental overprotection
• Problems related to other psychosocial circumstances
• Z65.2 Problems related to release from prison

These are just a few of the areas and codes represented in this section. 

The rationale for being able to use the clinician documentation to assign these codes is that they are not medical diagnoses but rather they reflect social information.  Additionally, this point is echoed in ICD-10-CM/PCS Coding Clinic, First Quarter 2018 pg: 18.    

A further Official Coding Guideline update involves the coding of BMI at I.C.21.c.3.  Coding professionals are instructed not to code the BMI unless a related diagnosis of overweight or obesity is documented by the provider and meets the definition of reportable diagnosis.  The same update states that BMI is not to be coded for pregnant patients. 

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.

OHIMA 2019 Annual Meeting & Trade Show

Submit your registration for the OHIMA 2019 Annual Meeting & Trade Show by Tuesday, February 26th to take advantage of the Early Bird discounted rates.  Registration rates will increase after this date!  Receive a $60 discount for OHIMA members and 17 AHIMA & AAPC CEUs if you attend all three days.  If you haven't done so already, send your registration and payment today!

Functional Endoscopic Sinus Surgery

FESS.  Functional Endoscopic Sinus Surgery are procedures performed to open sinus cavities in order to promote airflow and drainage.  This inaugural installment of “Spotlight on CPT” looks at appropriate coding for FESS from a CPT perspective.

Properly coding outpatient endoscopic sinus surgery procedures begins with understanding the notes that pertain to those codes.   Some notes pertain to the entire sinus endoscopy section, while others are parenthetical notes that pertain to the specific code that they follow.  Many of the parenthetical notes dictate which, if any, other codes from the sinus endoscopy section can be coded in conjunction with the code the note follows.  As seen with all endoscopic type procedures, the initial section note instructs coders that a diagnostic endoscopy is included with a surgical sinus endoscopy and specific to surgical sinus procedures, sinusotomy is also included.  It is, however, permissible to assign a separate code for stereotactic computer-assisted navigation (61782) if it is performed in conjunction with an FESS procedure. 

Another note clarifies that all the codes in the range of 31233-31298 are considered unilateral unless noted otherwise.  Code 31231, which begins the FESS section, is unilateral or bilateral, which is important to note.  Additionally, the three diagnostic codes (31231-31235) include the inspection of all the following areas: 

• Interior of the nasal cavity 
• Middle and superior meatus 
• Turbinates 
• Spheno-ethmoid recess

When one or more of the areas is not examined either because it is deemed not clinically necessary, altered anatomy precludes the inspection, or it is not technically feasible to perform the inspection, then a modifier should be added to indicate the reduction in service.  Modifier 52 is used if a repeat examination is not planned, or if a repeat examination will be done, then modifier 53 should be used.

In the 2018 CPT code updates, several combinations codes were introduced that combined a total ethmoidectomy procedure with frontal and sphenoid sinus procedures.  The key piece to assigning these codes correctly is that the ethmoidectomy must be a total procedure, meaning both anterior and posterior; otherwise, if only a partial ethmoidectomy is performed, two separate codes will be assigned; 31254 for the partial ethmoidectomy, and either 31276, 31287, or 31288 as appropriate for the other sinus procedures.

Another new combination code bundled frontal and sphenoid sinus ostial dilation (31298) when performed ipsilaterally.  Coders should take note that this code does not include maxillary sinus dilation (31295) thereby making it appropriate to assign the 31295 in addition to the 31298 if all three sinus ostia are dilated.

CPT Assistant clarification from February of 2016 indicates that packing used at the conclusion of an FESS procedure and any stent or implant placement is all considered part of the work incorporated with the FESS codes.  However, there are two drug-eluting implant codes specifically for the ethmoid sinus:

0406T Nasal endoscopy, surgical, ethmoid sinus, placement of drug-eluting implant
 
0407T Nasal endoscopy, surgical, ethmoid sinus, placement of drug-eluting implant with biopsy, polypectomy, or debridement

These are category III CPT codes which are temporary CPT codes and must be reported in lieu of an unlisted category I CPT code.   Unlisted code 31299 is to be used for placement of a drug-eluting implant in any sinus except the ethmoid.  The two temporary codes above may be assigned when the placement of the drug-eluting implant is a stand-alone procedure only.  Information provided in the notes precludes assignment of the implants with any other ipsilateral ethmoid procedure.

Now, light has been shed on FESS coding in CPT.

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.