HCPro.com: Briefings on Coding Compliance Strategies

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August 2008 (Volume 11, Issue 8)	view entire issue

Get acquainted with chronic conditions
How do you define chronic? Many medical dictionaries and Web sites describe chronic diseases as long lasting or recurrent. The Agency for Healthcare Research and Quality prefers a more substantial definition; it says that chronic conditions are "expected to last one year and result in limitations in self-care, independent living, and social interactions or in the need for ongoing medical intervention." "I think this is a really good definition," says Leatrice Ford, RN, BSN, CCS, CEO and founder of ConsultCare Partners, LLC, in Louisville, KY. "[Chronic conditions] either impair somebody or require continuing medical attention. They can be chronically stable with some recurrences."

Focus on documentation for new ICD-9 codes
Education among coders and physicians will help prevent a flood of physician queries that might otherwise result when the 2009 IPPS code changes take effect. "It's great to have the new codes, but if we don't have the documentation, we can't use them," says Kathryn DeVault, RHIA, CCS, manager of professional practice resources at the American Health Information Management Association (AHIMA) in Chicago. "The landscape has changed so much. We're coding for data, coding for reimbursement, coding for profiling. You really need to show that specificity for all of these tasks."

Don't 'grab and run' with diagnoses
If they don't perform a thorough record review, clinical documentation improvement (CDI) specialists may fail to catch many DRG-changing complications and comorbidities (CC) and major CCs. Or they may overlook clues that can lead to improved capture of severity of illness. For example, they may miss the opportunity to change a simple pneumonia to a gram-negative pneumonia through a physician query.

It's a balancing act: Maintaining acid-base balance
Complex processes go on inside the body in order to maintain homeostasis, or the status of being chemically balanced. What a person does, or what happens to a person, may change this delicate balance of chemicals. But the body has defense mechanisms that work constantly to prevent change and to return it to a stable chemical makeup should a change occur. Physicians become accustomed to seeing certain tests ordered for a sick patient. These test results help them draw conclusions about whether a patient has a particular condition.

Other recently-published articles from Briefings on Coding Compliance Strategies:

New guidance may create additional query opportunities

MS-DRGs on OIG radar: Ensure compliant coding

CMS discusses RAC expansion, ICD-10, and never events

CMS issues updated payment rates and wage indexes for FY 2009: Know how to apply the new data files

Go back to the source when coding secondary diabetes

Work with physicians to obtain clear-cut documentation for pressure ulcers

Get a bloody good understanding of GI hemorrhage

Clear up morphology and neoplasm code confusion

Brush up on the 2009 ICD-9-CM carcinoid codes

Examine postoperative condition coding

One-day stays

Look forward to improved complications data

Guidelines explain new codes for pressure ulcer staging, VAP

Avoid the trap of probable diagnoses

Get to know MIPPA’s hospital-related provisions

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