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Q&A: Coding mixed cardiogenic and septic shock

Have CDI questions?

Have CDI questions?

Q: If the attending documented, “likely mixed cardiogenic and septic shock,” can I assign codes R57.0 and R65.21?

A: Refer to the documentation within the code book. If you open the book to the R57 code grouping (Shock not elsewhere classified) listed below there is an Excludes1 note. Remember, Excludes 1 notes instruct us that we cannot use codes from this grouping with those listed within the Excludes 1 note. Cardiogenic shock (R57.2) falls within this grouping. Also listed is R65.2 septic shock. Purely relying on the coding conventions, I would conclude that we cannot code septic shock with cardiogenic shock. See the image below. [more]

Guest Post: New ICD-10-CM/PCS codes up the ante in coding compliance, part 3: Right heart failure

James S. Kennedy, MD, CCS, CDIP

by James S. Kennedy, MD, CCS, CDIP

Editor’s note: With the fiscal year 2018 ICD-10-CM/PCS codes released, Kennedy unpacked some of the compliance pitfalls and opportunities awaiting CDI and coding professionals when these new codes are implemented on October 1. Some of these issues may be addressed in the 2018 ICD-10-CM Official Guidelines for Coding and Reporting or the American Hospital Association’s Coding Clinic, Fourth Quarter, 2017, so be sure to compare Kennedy’s opinions with these documents. This article is part three in a three-part series. Click here to read parts one and two!

Right Heart Failure

Notice that we now have new codes for acute, chronic, and acute-on-chronic right heart failure. Remember also that Coding Clinic, Third Quarter, 2013, p. 33, states that the documented term of “decompensated” indicates that there has been a flare-up (acute phase) of a chronic condition. [more]

Note from the CCDS Coordinator: Happy birthday, ACDIS!

Penny

CCDS Coordinator Penny Richards

by Penny Richards

ACDIS and I are both celebrating our birthday this week. ACDIS is turning 10. I turned 10 a long time ago.

In 2007 (the year of ACDIS’ “birth”):

  • Apple launched the iPhone
  • Bob Barker appeared for the last time as host of “The Price is Right”
  • “Harry Potter and Order of the Phoenix” debuted in theaters
  • Helen Mirren won the Oscar for best actress for “The Queen”
  • The Boston Red Sox swept the Colorado Rockies to take the World Series

In the year of my birth: [more]

Guest Post: New ICD-10-CM/PCS codes up the ante in coding compliance, part 2: Pediatric Glasgow coma scales

James S. Kennedy, MD, CCS, CDIP

by James S. Kennedy, MD, CCS, CDIP

Editor’s note: With the fiscal year 2018 ICD-10-CM/PCS codes released, Kennedy unpacked some of the compliance pitfalls and opportunities awaiting CDI and coding professionals when these new codes are implemented on October 1. Some of these issues may be addressed in the 2018 ICD-10-CM Official Guidelines for Coding and Reporting or the American Hospital Association’s Coding Clinic, Fourth Quarter, 2017, so be sure to compare Kennedy’s opinions with these documents. This article is part two in a three-part series. Click here to read part one. Return to the blog next week to read part three!

Pediatric Glasgow coma scales

In what should have been a welcome change, the National Center for Health Statistics amended the ICD-10-CM Alphabetic Index to allow for reporting of the clinical descriptors of the pediatric Glasgow coma scale. Notice that in the best motor response section, “flexion to pain” gets three points in the clinical scale whereas “withdrawal from pain” gets four points. Now notice how ICD-10-CM manages these conditions in 2018: [more]

Note from the Instructor: Your 2018 IPPS Final Rule questions, answered

Allen Frady

Allen Frady, RN-BSN, CCDS, CCS, CRC

By Allen Frady, RN-BSN, CCDS, CCS, CRC

Yesterday, 845+ codes took effect thanks to the fiscal year 2018 IPPS Final Rule, which was released at the beginning of August. As you review the updates, additions, and deletions in this year’s rule, I wanted to answer some of your burning questions to help guide you through this transition.

1.) Is it true that chronic obstructive pulmonary disease (COPD) does not have to be sequenced before pneumonia?

The Index for 2017 had the language “use additional code to identify infection.” This was misinterpreted as applying to conditions such as pneumonia by both coders using the index and the AHA’s Coding Clinic. “Use additional code” means that a subsequent diagnosis must be sequenced as a secondary code. However, “use additional code to identify infection,” usually means to assign an additional organism code from the organism code category of B95 to B97. [more]

Guest Post: Using coding, CDI to transform hospitals’ revenue integrity, part 2

Want to write for ACDIS? Send us your ideas!

Want to write for ACDIS? Send us your ideas!

by Amber Sterling, RN, BSN, CCDS, and Jana Armstrong, RHIA, CPC

Seven lessons learned in physician education

The following lessons were learned at KRMC and proved to be instrumental in improving communication between physicians, CDI staff, and coders: [more]

Guest Post: Using coding, CDI to transform hospitals’ revenue integrity, part 1

Want to write for ACDIS? Send us your ideas!

Want to write for ACDIS? Send us your ideas!

by Amber Sterling, RN, BSN, CCDS, and Jana Armstrong, RHIA, CPC

Most healthcare systems already have a proven process in place to monitor revenue integrity and ensure correct reimbursement. More than 60% of hospital executives believe revenue integrity is essential to their organization’s financial stability and sustainability, according to a survey by Craneware, Inc.

But does revenue integrity extend beyond charge masters and billing? Kalispell Regional Medical Center (KRMC), one of the “100 Great Community Hospital” according to Becker’s Hospital review, says yes.

For KRMC, revenue integrity focuses on three operational pillars: clinical coding, CDI, and physician education. At KRMC and many other health systems, revenue integrity is a three-legged stool: [more]

Guest Post: New ICD-10-CM/PCS codes up the ante in coding compliance, part 1: Myocardial infarction

James S. Kennedy, MD, CCS, CDIP

by James S. Kennedy, MD, CCS, CDIP

Editor’s note: With the fiscal year 2018 ICD-10-CM/PCS codes released, Kennedy unpacked some of the compliance pitfalls and opportunities awaiting CDI and coding professionals when these new codes are implemented on October 1. Some of these issues may be addressed in the 2018 ICD-10-CM Official Guidelines for Coding and Reporting or the American Hospital Association’s Coding Clinic, Fourth Quarter, 2017, so be sure to compare Kennedy’s opinions with these documents. This article is part one in a three-part series. Return to the blog next week for the next installment! [more]

CDI Week 2017: Celebrations nationwide

Last week, ACDIS celebrated our seventh annual CDI Week, recognizing professionals across the country for the incredible work that they do. Facilities and local chapters nationwide joined the fun, embracing the 2017 theme, “The Wild West: New Frontiers in CDI,” fully.

We were lucky enough to get our hands on a few photos from last week’s activities. Please enjoy this little slideshow we put together. Thanks for another great CDI Week!

Guest post: 2018 ICD-10 codes—when the heart needs a helping hand

McCall_Shannon_darkbg

Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS

by Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS

Congestive heart failure (CHF) is a commonly diagnosed condition where the ventricles or the lower chambers of the heart do not work effectively. The heart serves as a pump to get blood in and then out of the heart to circulate to the rest of the body. When any type of pump doesn’t work efficiently backups can occur.

The most common form of CHF is left ventricular failure, however left-sided failure can also lead to right ventricular failure as a ripple effect. There are two common types of CHF, one whereby the ventricle cannot contract normally, known as systolic heart failure, and one where the ventricle cannot relax normally due to stiffness, known as diastolic failure. Some patients may have a combination of both systolic and diastolic failure.

The causes of heart failure include hypertension, coronary artery disease, and valvular diseases, as well as cardiomyopathies. [more]