Chemotherapy documentation challenges warrant CDI attention
Given the extremely high cost of chemotherapy services, it is likely that third-party payers, including Medicare, will scrutinize these services, says Glenn Krauss RHIA, CCS, CCS-P, C-CDIS, in an article for JustCoding.com.
Here is a breakdown of areas generally targeted by payers including Medicare and their related documentation difficulty:
- Medical necessity for the supplied diagnosis: Often the clinician fails to provide the specific location of the cancer. A clinical documentation specialist can query the physician to ensure appropriate documentation.
- Coverage exclusion for specific drugs based on clinical trial effectiveness: Coders should reference local coverage determinations that generally spell out which diagnoses are considered covered benefits for common chemotherapeutic agents.
- Proper charging and billing of drug units: Just documenting patients’ nausea and vomiting is not always sufficient to support payment of anti-emetic medicines.
- Documentation to support IV administration units of service: Accurate coding for this requires clear start and stop times for IV chemotherapy administration. It is particularly problematic because clinicians do not always document the order of sequential therapy.
CDI programs might consider designating a team member specifically for the chemotherapy service line, Krauss says. A part-time specialist or member of the existing team may be enough depending on the monthly volume of patients in the chemotherapy department and the number of new patients who begin chemotherapy each month.
Focus initially on validating documentation and providing feedback to clinicians regarding documentation of IV therapy administration. The CDI specialist can help bridge the gap between customary medical record documentation and the level and detail of documentation necessary to properly and accurately capture all IV administration charges.
JustCoding.com subscribers can read the complete article online.
About the Author: Melissa Varnavas, CPC, ACDIS associate director, editor for CDI Strategies, CDI Journal. She has several writing awards from various newsletter and newspaper organizations.
Lynne Spryszak | Apr 11, 2009 | Reply
This is an important area of coverage by the CDS, especially in those facilities where CDI programs have expanded into the outpatient arena.
For inpatient oncology units, opportunities exist to clarify whether the leukemia being treated is acute versus chronic, and the various types of lymphomas, which have several different codes bases on type and histology.
As Glenn points out, a big issue is that oncologists often neglect to document the exact location, not only of the site being treated, but whether it’s a primary or secondary neoplasm. The record often contains such wording as “metastatic breast cancer” which provides no direction for the HIM professional.
Or, the patient is admitted for treatment of an obstruction and the documentation states only “lung cancer” or “history of colon cancer”. This documentation does not provide the specificity needed in order to assign the neoplasm as the principal diagnosis because the notes do not support a clear relationship between the presenting problem and the underlying neoplasm.
This article is a good reminder to re-familiarize ourselves with the several coding guidelines established that govern the reporting of neoplastic disease.