HIM LEADER SPOTLIGHT: Dee Mandley, RHIT, CCS, CCS-P

Name	Dee Mandley
Employer	Self-Employed
Current Job Title	President
Job Duties and/or Educational Background	Owner operator of D. Mandley & Associates, LLC. My job duties vary depending on the project at hand.  My education is associates degree, CCS and CCS-P certifications.
How did you progress to your current leadership position?	I have held various HIM roles throughout my 30+ year career.  I started as a coder and worked my way up to HIM director.  I also worked several years for contract companies and went off to work for myself 12 years ago.
What are ways that you motivate and inspire your team?  Please identify what type of team you are referring to (i.e. your direct reports at work, a committee, a different organization you are part of).	My team are the coding contractors who work for me.  I pay them well and send them little notes occasionally letting them know how appreciative I am of them.  Sometimes I’ll send them Starbucks gift cards.
How do you select a mentor?  What traits do you look for?	Someone who is up-to-date on HIM practices, volunteers at a local, state, or national levels.  Must be a good verbal and written communicator and provide good follow up and patience with people who are learning the ropes.
What professional organizations are you associated with?  Has your participation in these organizations enhanced your leadership capabilities?  If so, how?	EOHIMA, NOHIMA, OHIMA, AHIMA.  I have held various roles at each of these associations.  The connections I have made over the years enhanced my ability to venture off on my own.  I worked very hard to make a name for myself through volunteering.
What advice would you give someone aspiring to be a leader?	I truly believe leadership skills are obtained through observing others in leadership roles and going above and beyond in every work situation.  Never burn bridges and always look for ways to improve whether it be through additional education or personal research.

Reflections on Retirement: Life After HIM

by Marie Janes, MEd, RHIA, FAHIMA with Mona Burke

Over the course of my many years as an HIM professional, there’s one quote that sums up my outlook and it’s by Groucho Marx. Groucho said, 'There's one thing I always wanted to do before I quit...retire!'  For those who have had their fair share of ups and downs in HIM and are still working in the field, congratulations. One day, you will reach this plateau and deciding to retire is one way to close that chapter of your life.

I wouldn’t be alone thinking that a career in HIM can be challenging, but it’s also rewarding and always interesting. I will be 63 years old this August and learned that the optimum time for me to retire is on the first of the month that follows my 65^th birthday, which will be September 1, 2019. This is significant for me, because that date will also be my 47^th wedding anniversary!

A good friend and colleague, Mona (Jackson) Burke, agreed to share her experiences related to life after full time employment as an educator in HIT. Mona holds the credentials of RHIA, FAHIMA, and is Emeritus Faculty at BGSU, as well as a Faculty Liaison at the AHIMA. Her retirement date was one year ago in May 2016.

The literature tells us to “prepare” for retirement, but what does that really mean? Financial security? Engaging in hobbies? Providing service to our community? Those sound easy enough, but it’s a more involved process. As Mona shared with me, “Retiring was one of the most anxiety provoking, if not the most anxiety provoking experience of my career, really.” She attributes this to changes in pension/retirement plans, number of decisions that are interconnected (changing one may affect another), dependents and their needs, as well as one’s age. Not everyone facing retirement is 65 or older. So, how do you know when it’s right to move on? Self-discovery is a good place to begin.

As HIM professionals, we may feel constrained when it comes to future employment opportunities, but using transferable skills and talents provides new opportunities. Mona shared, “I'd be less than truthful to say I was not worried about finding another position at 54.” Leaving full time employment allows a person to consider flexibility in a schedule, as well as types of work one might enjoy doing. For example, Mona spent a fair portion of this past year during some freelance consulting work including some work for AHIMA, textbook publishing companies, and physician practice settings. Think about what you might want to do, instead of what you have to do.  There is a wide-open field of job prospects within HIM and outside of the profession. And yes, here is where I put in the standard “get a job as a Walmart Greeter!” that I hear all the time!

Mona summed up her experience with her biggest surprise following retirement, “I was amazed to truly find out how much time I had spent working evenings and weekends as an instructor and program director, and how much it had been affecting me. Much more so than I would have ever thought and admitted while I was working full time.” As an educator, I can relate. But even for those of you considering retirement from other HIM careers, it’s good to know that working in health care has done one thing for us more than any other profession—and that is to adapt to change.

If you’d like to share your retirement story, please contact Marie Janes at marie.janes@utoledo.edu.

Coding Heart Failure

This installment of “In the kNOW” is going to review recent Coding Clinic information related to the coding of heart failure.  First, let’s review heart failure in general noting that there are three types of heart failure: left-sided, right-sided, and congestive.

In left-sided heart failure, the blood is not pumped out to the rest of the body efficiently causing the left ventricle to work harder to supply blood flow.  There are two types of left-sided heart failure: heart failure with reduced ejection fraction (HFrEF)(systolic), and heart failure with preserved ejection fraction (HFpEF)(diastolic).  The ejection fraction is a measurement (percentage) of how much blood is being pumped out by the left ventricle with each contraction.  Normal ejection fractions generally run between 50%-70%.  In heart failure with preserved ejection fraction, contraction of heart muscles is normal, but relaxation of the ventricles is abnormal due to stiffness, thus limiting the amount of blood that can fill the heart.  In heart failure with reduced ejection fraction, the contraction part of the process is abnormal and not enough blood enters the circulation.  Because the terminology of HFrER and HFpEF is more widely accepted now, coders may use those terms to assign codes for systolic or diastolic heart failure respectively or a combination of both if applicable.  Keep in mind that additional clarifying terms may impact code assignment, such as acute, chronic, or acute on chronic.   

                                    Acute                   Chronic           Acute on Chronic       Unspecified
Systolic                        I50.21                    I50.22              I50.23                           I50.20
Diastolic                       I50.31                    I50.32              I50.33                           I50.30
Systolic & Diastolic       I50.41                    I50.42              I50.43                           I50.40
Unspecified                                                                                                          I50.9

Left-sided heart failure is often the precursor for right-sided heart failure.  Failure of left ventricular function causes a back-up of pressure to the lungs and ultimately, the right side of the heart.  This domino effect continues with fluid backing-up in the veins.

Congestive heart failure (CHF) (I50.9) is manifested with swelling in bodily tissues, especially legs and ankles.  Shortness of breath may occur when fluid backs-up and collects in lung tissue (pulmonary edema).  CHF happens when the heart is not pumping out blood at a normal rate, and back-up into the veins occurs.  

It is important to note that the American Heart Association has established a classification system for heart failure, A-D.  Class or stage A means that objectively there is no evidence of cardiovascular disease, and that ordinary physical activity is not limited and does not produce any symptoms.  Bearing this in mind, Coding Clinic has indicated that it is inappropriate to code stage A heart failure to I50.9 as the patient does not yet have the disease, even though they have risk factors.  Coders are therefore instructed to use Z91.89, Other specified personal risk factors, not elsewhere classified, to indicate the increased risk status.  Additional codes could be assigned for other conditions which might factor into the risk level such as hypertension or coronary artery disease.

When systolic/diastolic dysfunction is noted along with congestive heart failure, there must be linkage in the documentation to assign systolic or diastolic CHF.  For example, if documentation states chronic CHF with systolic dysfunction, the provider has indicated a relationship using the term “with” so code I50.22 can be assigned.  If on the other hand, the provider stated chronic CHF and systolic dysfunction, there is no linkage and only code I50.9 can be assigned.

Finally, coders have been instructed to assign I11.0 (hypertensive heart disease) in conjunction with an I50.- (heart failure) code to correctly code hypertension and heart failure even in the absence of provider documentation specifically linking the two conditions.  Coders are reminded that there is a presumptive relationship between hypertension and heart involvement, and that these conditions should be coded using the combination code of I11.0 and then the appropriate heart failure code by following the “use additional code” note unless documentation by the provider states that the conditions are unrelated. 

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.