CMS posts ICD-10 Fact Sheet

During a recent planning call for the ACDIS 2010 conference in Chicago, the group discussed  creating a session specifically targeting ICD-10 challenges in the clinical documentation improvement world. Opinions on the matter were mixed. (I’ll post later this week with a list of potential topics the committee hopes to cover.)

While most people are aware that CMS plans to implement the new data set for ICD-10 come 2013, they’re unsure about how to proceed with transition planning and whether or not CDI specialists need to get involved in that planning process. General consensus seems to be that HIM leaders need to work closely with other department leaders to communicate the impact of ICD-10 and plan implementation strategies. CDI managers and department leaders should reach out to HIM counterparts and try to stay as informed as possible about ongoing changes.

CMS recently posted a fact sheet regarding ICD-10 that summarizes structural differences between the new system and its predecessor, ICD-9. It also explains how organizations and facilities should plan for the change and provides a list of helpful Web sites.

We also recently received a press release from 3M regarding its new 3M™ ICD-10 Code Translation Tool, a new software application that helps convert ICD-9 based applications to ICD-10. The release says the new program uses menu-driven features to convert existing systems and software applications to ICD-10. It also says the tool can be customized to create mappings for specific facility needs. Aside from its nifty new program, 3M does offer a free .pdf of frequently asked questions regarding ICD-10 that you may find useful for additional background reading.

You can also read more at ACDIS sister Blog ICD-10 Watch.

If all this seems to fall into the category of “too much information,” fear not. We’ll continue to keep you informed of what’s happening in the ICD-10 realm periodically.

Focus on improved documentation of physicians’ clinical thinking, not DRG “buzzwords”

CGI Federal, the RAC for Region B (Indiana, Michigan, Minnesota, Wisconsin, Ohio, Kentucky, Illinois), has found a soft target: Medicaid claims for 1-2 day stays. RACs are contracted with other third party payers such as Medicaid to data mine historical provider coding and billing patterns and recoup past payments. Many of these denials and financial recoupments are “self-inflicted” by hospitals, often because physicians aren’t documenting patients’ risk factors or other clinical concerns, only vague symptoms such as chest pain (i.e., “chest pain rule out MI, start MI protocol”).

Too many CDI programs are focused on case mix and DRGs instead of taking a collaborative approach with physicians to improve documentation throughout the record. With nationwide RAC rollout upon us and complex record reviews slated to begin early next year, CDI specialists should work with physicians to help stave off this threat. One area in which CDI specialists can help is encouraging physicians to document their clinical thought processes, judgment, and medical decision making to complement and support diagnostic documentation.

We can’t make up what the doctor is thinking. We need to take documentation improvement to the next level, which is promoting and stressing to the physicians the importance of their patient clinical assessment—i.e., diagnoses, supported by a short discussion of additional clinical concerns and rationales that paves the way for the chosen plan of care.

Encouraging physicians to improve documentation of their thought processes is easier said than done, but an effective tactic is engaging physicians in a discussion on the interrelationship between E/M level assignment, clinical documentation (both in the office and in the hospital), and medical necessity.

While you can’t instruct physicians on what E/M level to select for his or her services—an inducement violation under Stark Law—you can help physicians understand the importance of complete and accurate clinical documentation in establishing medical necessity, the backbone of all E/M assignments.

For more information on education physicians on the concept of medical necessity as it relates to their E/M billing, refer to the following Job Aid on Trailblazer’s Web site. Some of the guidance Trailblazer provides includes the following:

Information used by Medicare is contained within the medical record documentation of history, examination and medical decision-making. Medical necessity of E/M services is based on the following attributes of the service that affected the physician’s documented work:

• Number, acuity and severity/duration of problems addressed through history, physical and medical decision-making.
• The context of the encounter among all other services previously rendered for the same problem.
• Complexity of documented comorbidities that clearly influenced physician work.
• Physical scope encompassed by the problems (number of physical systems affected by the problems).

Identify all the presenting complaint(s) and/or reason(s) for the visit for which physician work occurred:

• Demonstrate clearly the history, physical and extent of medical decision-making associated with each problem.
• Demonstrate clearly how physician work (expressed in terms of mental effort, physical effort, time spent and risk to the patient) was affected by comorbidities or chronic problems listed.

Using the Trailblazer guidance, teach physicians that the standard of documentation is the assessment with the plan right next to it. The physician will be making a conscious, concerted effort to document relevant clinical concerns, including patient risk factors and other clinical elements. These are all instrumental in establishing medical necessity for admission through explicit and easily inferred clinical judgment. For example:

Assessment: Concern with acute renal failure. Patient was found on the ground, broke her hip and couldn’t get up for two days. BUN and creatinine are 40/2.6. Patient not producing urine.

Plan: Starting patient on 1L bolus of fluid and continue down to 250ccs/hour. Strict measurement of ins and outs.

The above documentation can be taken right out of a medical record and placed into a RAC appeals letter. But if the doctor just writes “acute renal failure—hydrate the patient,” the result is a weaker record that allows less room for appeal.

CDI specialists should be able to look through the record, find the missing diagnoses, talk to the doctor about it, and tell them how providing this documentation improves their practice of medicine. CDI specialists should review the record in its totality.

Some good news for CDI specialists in their battle to engage physicians in documentation buy-in: The days of separate hospital and physician payment may be numbered. The writing is on the wall for a closer alignment between physician and hospital payment. Take a look at this pilot project of 12 New Jersey hospitals and their participating physicians. Called “gainsharing,” the program offers physicians financial incentives to work with hospitals in lowering costs in a variety of ways. The program also includes stringent quality controls to protect patients, according to the press release.

AHIMA calls for CDI presentations

Could CDI be becoming a healthcare buzz word? It seems like everywhere I looked over the past few weeks healthcare documentation improvement specialists played a prominent role.

Remember I mentioned the Health Care Compliance Association’s upcoming CDI presentation at its Physician Practice Compliance Conference in Philadelphia?  This week I heard about American Health Information Management Association’s (AHIMA) call for speakers for its June 2010 conference.

The AHIMA program focuses on CDI and coding and takes place in San Antonio, TX. Over the two-day speakers are expected to talk about CDI program challenges and best practices and explore the difficulties of communicating across CDI and HIM channels.  According to the AHIMA release, the deadline for presentation proposals is Friday, October 23.  For information, contact Kathy DeVault, RHIA, CCS, manager of professional resources at AHIMA at Kathy.DeVault@ahima.org.

Don’t worry the AHIMA program doesn’t overlap with the ACDIS 2010 annual show in Chicago — that’s June 3-4 (or 2-5 if you plan to attend the pre conference and take the CCDS exam). And not to repeat myself, but how great is it to watch the documentation improvement profession gain the credence it deserves from its sister organizations. Communicating a consistent message at a variety of professional organizations can help CDI illustrate its value to rest of the healthcare system in America.

Audio conference: Annual MS-DRG program Tuesday

You already understand the importance of MS-DRG selection. Picking the most appropriate principal diagnosis as well as valid secondaries is critical to ensure accurate MS-DRG assignment. New challenges such as Recovery Audit Contractors (RAC) scruitney coupled with increased focus on present on admission (POA) indicators and quality measures increases the need for comprehensive understading of changes to MS-DRGs.

Two of our favorite speakers— Gloryanne Bryant, BA, RHIA, RHIT, CCS, CCDS, regional managing director HIM (Revenue Cycle N. California) for Kaiser Permanente in Oakland, CA and Robert S. Gold, MD, founder and CEO of DCBA, Inc., in Atlanta, GA— team up this coming Tuesday, September 29, at 1 p.m. EST, for the seventh annual DRG Update audio conference 2010 IPPS MS-DRG Update: Analyze the Rule and Understand the Impact.

The program examines changes in the 2010 MS-DRG list, defines various rules and regulations, and illustrates ideas to manage coding for MS-DRGs and documentation improvement.

Does your hospital use the Epic software system? Let’s hear about it

Hi ACDIS members, I’ve had a few questions recently regarding the Epic software system. It was a subject of a member’s question on the most recent quarterly conference call, and I’ve since received a few additional e-mails from facilities that are going to Epic, or plan to do so, and are looking for help from experienced Epic users who have been using the system to leave electronic queries and interface with physicians.

If you would like to share your e-mail address, please feel free to leave it right here by leaving a comment on this post, or you can e-mail me directly at bmurphy@cdiassociation.com.

With more and more facilities going electronic, it would be great to see members sharing best practices, implementation strategies, and other ways of helping one another out with this important transition.

Take care,

Brian

Missouri CDI head to Kansas City Thursday

Those who live in Missouri may cringe, but many Americans hear Missouri and think of two things

The official emblem of the Kaw nation. Kansas City was named after the tribe that lived there. Guess where these native Missourians live now.

the St. Louis Arch and the Kansas City Royals. Joann Agin, RHIT, may have a bit more reason to cringe than most, as she operates as regional manager of data quality from St. Joseph Medical Center, in Kansas City and has been working to get the first Kansas City CDI group meeting going.

The meeting takes place this Thursday, September 24, 4:30-6 p.m., at St. Joseph Medical Center. The agenda includes:

1. Introductions
2. Designation as official chapter of ACDIS
3. Presentations from National ACDIS Convention May, 2009, by Glennis Fuller and Sarah Hoyt
4. New topics for discussion
   • Production Standards-who has standards, what are they? Is it based on insurance?
   • Software-What type of software is being used at various institutions?
   • Share examples of written queries
5. Determine frequency of future meetings, location, volunteers
6. Book drawing for Physician Queries Handbook provided by ACDIS. Must be present to win.

On that last agenda item, I think Joann should make it a trivia game for who can come up with the most interesting Kansas City fact. You all know how much fun I have finding these obscure tid-bits. Well, here’s one that’s not too obscure maybe Joann will use on Thursday. Did you know that Kansas City was named after the Kansa Indians, or Kaws, who inhabited the area? Guess where the headquarters of the tribe resides now.

Anyone interested in attending this week’s, or future Missouri meetings, should contact Joann at 816/943-2115 or by e-mail at jagin@carondelet.com.

North Carolina Chapter offers credentialing challenge

Good afternoon fellow ACDIS members,

NC ACDIS leaders Jennifer Love, Leah Taylor, and Cathy Dickey (not pictured Abby Steelhammer) challenge others to set certification goals.

The North Carolina ACDIS Chapter is moving forward with a goal —  to have 20% of its members become Certified Clinical Documentation Specialists (CCDS) by the next annual conference.

ACDIS estimates that roughly 300 people will have registered to take the exam by the end of 2009. More than 100 CDI professionals took the exam after the ACDIS conference in Las Vegas in May. Since then support for the CCDS credential has grown.

Similarly, the North Carolina ACDIS Chapter has been meeting quarterly over the past year. This summer its members elected an administrative leadership team that includes myself (Jennifer Love) vice president, Leah Taylor president, Cathy Dickey treasurer, and Abby Steelhammer secretary.

We understand the importance of doing quality work and feel honored to be making history.  We will be forming study groups soon. We hope that you will join us at your local chapters and engage in this friendly competition to elevate the role of CDI specialist through the value of the CCDS credential.

To learn more about certification, visit www.cdiassociation.com. To learn more about the North Carolina Chapter’s challenge e-mail j.love@novanthealth.org.

Minnesota CDI reflect importance of local gatherings

Minnesota may have 10,000 lakes but its CDI population hasn’t hit that highwater mark quite yet.

Minnesota's known as the Land of 10,000 Lakes. So far the lakes outnumber CDI but not for long.

Thanks to Michelle Callahan’s reservoir of good will, however, more than a dozen professionals turned out for the first Minnesota gathering of CDI,  Wednesday, September 16. Participants introduced themselves and talked about a variety of complex issues from electronic query systems to obtaining physician support for the CDI program. They talked about the function and form of the group and determined how the group might proceed with future meetings.

What particularly impressed me about the meeting wasn’t so different from what impresses me about other local ACDIS groups and CDI professionals individually— participants’ generosity.  Callahan, a registered nurse and lead clinical documentation improvement specialist over at Hennepin County Medical Center in Minneapolis, started collecting names and reaching out to nearby facilities to determine if there was enough interest in generating a group meeting. She volunteered to host the first session. She set up a meeting room, booked a conference line, and on the day of the gathering facilitated the conversation. During the meeting others shared their stories, talked about daily challenges and management successes.

It may not seem like much on the surface — an occasional meeting with others from your profession — but if you look at just the right angle under just the right light a universe of information is reflected back. Maybe the Land of the 10,000 Lakes doesn’t need 10,000 CDI, just the encouragement and continued participation of others in the area should be enough.

Mark LeBlanc, RN, CCDS, from Park Nicollet Health Services, hosts the next Minnesota meeting on October 28, 2-3:30 p.m. For information, e-mail Mark.LeBlanc@ParkNicollet.com.

HCCA physician compliance and documentation initiatives

On a recent planning call regarding the 2010 ACDIS conference, participants requested a session about enlisting assistance from risk management and corporate compliance for CDI.   So, I was pleased to see our friend Betty B. Bibbins, MD, FACOG, CHC, C-CDI, president and chief medical officer of DocuComp LLC., listed as general session speaker at the Health Care Compliance Association’s Physician Practice Compliance Conference in Philadelphia, October 11–13. As ACDIS Director Brian Murphy, CPC, said when he heard the news “it’s really great to see the integration of CDI in various venues.”

Bibbins session,Clinical Documentation Improvement Programs and Physician Advisors: Working Together to Improve Effectiveness takes place Monday, October 12. During the session, she’ll discuss  the importance of CDI to physician practices within the inpatient and office settings and provide a basic overview of the goals and mission of CDI programs.

Teresa M. Bivens, CPC, CHC, deputy compliance officer at the University of Louisville/HSC, also offers a presentation to physicians regarding the importance of appropriate documentation titled The Lighter Side of Documentation. During her program, participants will play a game a real life clinical documentation “Mad Libs,” and she’ll explain how proper documentation can help keep government investigators at bay.

Gather a harvest of networking opportunities

Time to harvest local chapter knowledge.

Up here in lovely Massachusetts the past few evenings there’s been a sweet chill. I’m talking about the kind of cold that actually makes us grumpy New Englanders happy. It’s also the kind of cold that gets the yellow jackets, especially those that hum around the orchard, buzzing.

Let me make another harvest-time allusion to say its not just the Cortland trees bearing fruit this fall. All the grassroots gathering and the local hard work seems to have generated a plethora of networking offerings for ACDIS members. I just thought I’d take a moment or two to let you know about a few of them.

Oregon
This coming Friday, September 18, 9 a.m. to 2 p.m., Oregon holds its first local ACDIS meeting. We are very excited and grateful to Linda Haynes, RHIT, CCDS, a documentation specialist at Meridian Park Hospital in Tualatin, for organizing what looks to be a very robust meeting. Registration and continental breakfast begin at 9 a.m., followed by welcome and introductions from 9:30-10:30 a.m. Haynes scheduled two presentations, one in the morning and one after lunch (which is on your own).  The group adjourns at 2 p.m. If you do plan to attend, please let her know as soon as possible by phone at 503/692-8864 or by e-mail at lhaynes@lhs.org.

Maryland
The Maryland CDS Workgroup meeting is also slated for Friday, September 18, 1:30-3 p. m., at the Maryland Hospital Association Headquarters in Elkridge, MD. For information contact co-chair Christine Mobley, RN, by e-mail at Christine.Mobley@dimensionshealth.org, or call 301/618-6507.

New Jersey
The NJ ACDIS Chapter meets September 25, 2 p.m., at Reimbursement Review Associates, Inc., 385 West Ferris St. Rte. 18 South, East Brunswick, NJ. But Deborah Gardner-Brown requests participants register by this Friday, September 18, so she can plan for the meeting. Contact Deborah directly for information at 732/238-4511 or by e-mail at dgardnerbr@aol.com.