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Thanksgiving mishaps? There’s an ICD-10 code for that!

It's Thanksgiving! Time to celebrate all the ICD-10 codes you (hopefully) won't actually encounter this holiday.

It’s Thanksgiving! Time to celebrate all the ICD-10 codes you (hopefully) won’t actually encounter this holiday.

As we prepare for the Thanksgiving holiday with family and friends and give thanks for all of our blessings, it is important to be ready with appropriate codes to accurately document any holiday mishaps.

Here’s a short list to help you quickly and efficiently communicate the information required to file a complaint claim:

For incidents with a fresh (live, not saucy) turkey:

  • W61.42 Struck by turkey
  • W61.43 Pecked by turkey
  • W61.49 Other contact with turkey

For general kitchen and meal prep actions:

  • Y93.G1 Activity, food prep and cleanup
  • Y21.2 Undetermined event involving hot water
  • Y93.G3 Activity, cooking and baking

For dealing with obnoxious Uncle Leo who insisted on pushing his way to the dessert table:

  • Y04.2 Assault by strike against or bumped into by another person

For your mother-in-law’s criticism of the lumpy gravy (which we know was not lumpy):

  • Z63.1 Problems in relationship with in-laws

For activities post-meal to work off effects of R63.2 Polyphagia (overeating):

  • W21.01 Struck by football

For Friday morning:

  • W72.820 Sleep deprivation

Editor’s note: The ACDIS office will be closed for the Thanksgiving holiday and will reopen on November 28. Please send along your most common documentation improvement opportunities either in the comment section or via email to mvarnavas@acdis.org.

A look back: 2015’s noteworthy quotes

Time to celebrate a year's worth of CDI accomplishments!

Time to celebrate a year’s worth of CDI accomplishments!

Another tradition in my household is to take some time around the dinner table on New Year’s day to talk about some of the things we’re grateful for that happened to us in the year that passed. Such reminisces often raise interesting thoughts. All together as a family, we each remember something slightly different, in different way, and when these thoughts come together they create a cohesive whole that gains additional significance.

So I thought I’d take a look back at our year in CDI and pull our little CDI family together in the form of salient quotes from the pages of the CDI Journal the past year. Some interesting themes emerged. ICD-10-CM/PCS implementation was threatened but eventually implemented. CDI programs continued to expand their scope from CC/MCC capture to quality concerns. Programs expanded scope into pediatric and outpatient arenas, too. Some things remained the same, too. Central among them remains the fact that CDI program’s core function is assisting physicians in crafting the most complete and accurate chart possible.

What quotes from 2015 will you take with you into 2016? Let us know in the comments section below!

“It isn’t about the code set per se, it is about documentation improvement. We have to continue to assess documentation quality, and that’s true regardless of which code set you are working within.” ~Kathy DeVault, MSL, RHIA, CCS, CCSP, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer

“CDI staff are asking specific questions about ethical behavior. The new [ACDIS Code of Ethics] is founded on the real-life concerns of CDI professionals.” ~Michelle McCormack, RN, BSN, CCDS, CRCR

“You can train people on the technical aspects of the job, but teaching a person to think critically can be difficult, so it is incredibly important to hire the right person.” ~Lisa Romanello, RN, CCDS

“Documentation improvement programs need to become patient centered and follow documentation improvement opportunities across the care continuum, including ambulatory, inpatient, and postacute care.” ~James P. Fee, MD, CCS, CCDS

“Best practice would be to make your queries a permanent part of the medical record to demonstrate CDI/coding efforts in obtaining clarification regardless of the outcome.” ~Cheryl Ericson, MS, RN, CCDS, CDI-P, CDI education director at ezDI

“My biggest reward has been learning what CDI is all about and having the opportunity to continually grow in the field.” ~Fran Platt, BSN, RN

“Each CDI specialist and coding professional must be open-minded and willing to listen to differing opinions, and be able to contribute positively to the discussion of each case.” ~Walter Houlihan, MBA, RHIA, CCS

“Children’s hospitals are now paying more attention to how documented pediatric terminology affects APR-DRG assignment and its reimbursement, particularly since bundled payments are part of CMS’ game plan.” ~James S. Kennedy, MD, CCS, CDIP

“Switching to ICD-10 from ICD-9 is a very costly endeavor, and many healthcare facilities and healthcare-related companies have invested millions of dollars on systems and training.” ~Rebecca A. “Ali” Williams, MSN, RN, CCDS

“The opportunity to network and share documents, tools, and processes has allowed the profession to grow from a group of people who reviewed charts to a profession that drives patient care improvement through the support of accurate and compliant documentation.” ~Fran Jurcak, RN, MSN, CCDS

Welcome Katy Rushlau to the ACDIS team

Katy Rushlau

Katy Rushlau

Maybe you’ve wondered how ACDIS Director Brian Murphy, ACDIS Membership Services Specialist Penny Richards, and I manage to keep everything here at ACDIS National going to so smoothly all the time. (Truth be told, we often wonder about that ourselves.)

Faithful blog readers know, however, that we really don’t do it all alone. We have a tremendous amount of support from our parent companies HCPro and BLR. Our production team puts our CDI Journal together. Our broadcast events team helps us create informative, well-run webinars. Our events team helps us make sure our annual conference consistently earns your accolades.

With all the new initiatives we have underway this year—more webinars, increased CDI Journal content, greater support of ACDIS local chapters, revision of the CCDS exam—we knew we needed some additional help.

Thank heavens for the newest member of the administrative team Katherine “Katy” Rushlau, who arrived just in time to be our new ACDIS editor. Katy comes to us from Emerson College in Boston where she majored in journalism and graduated with honors in the top 5% of her class. She has written for such prestigious publications as USA Today, The Boston Globe, and Boston.com. A native New Englander, Katy remains a “Mainer,” where her family still resides.

Believe it or not, Brian, Penny, and I, all come from journalism backgrounds too. (Brian actually still writes for the Daily Times Chronicle covering the Reading football team every autumn.) So, Katy will fit in terrific with the rest of us ex-Pats. In her new role, Katy will be instrumental in helping expand our social media outreach and content for our various publications including CDI Journal, CDI Strategies, and here on the ACDIS Blog. She’ll also be helping us manage our local chapter offerings, producing webinars, and eLearning, and host of other duties.

We know you’ll come to love her as much as we already have. Please take a minute to give her a warm “ACDIS” hello!

12 Days of Mishaps Ready for ICD-10 Coding

Looking for your holiday wishes to come true? The present of CDI education is waiting to be unwrapped during December's collection of local networking meetings.

Looking for your holiday wishes to come true?

Our good friend, Michelle A. Leppert, over at the ICD-10 Trainer Blog took great pains (pun intended) this holiday season to chart out a selection of misadventures related to the traditional holiday theme song “The 12 Days of Christmas.”

On the first day of Christmas the house cat attacks the partridge in a pear tree which causes the bird to start hurling pears at the residents hitting our “true love” in the head.

On the second day, those turtle doves decided to spit seeds in his eyes and on the third day their two-year old decided to chase the three french hens, mimicking their flight and falling from the edge of the couch instead. On the fourth day, in an attempt to escape the fluttering onslaught of four calling birds our true love tripped on the coffee table and crashed through the sliding glass doors. Happily our hero decided to get golden rings for the fifth day. Unhappily little Andrew decided to see if one of them fit up his nose. It didn’t.

A host of other (hysterical as long as its fictional) mishaps ensue as the remaining seven days of holiday cheer come and go. We can’t imagine what the emergency room staff felt about all this. They must have called in the case management team for a little intervention at some point.

If you need any holiday-related excuses for a little ICD-10-CM/PCS coding review this collection of posts will help keep you chuckling while you do it.

Happy Holidays!

Local Chapter Events: Maryland, Georgia meet Dec. 5

mdThe Maryland ACDIS Chapter has been meeting for more than five years. Although previously under the auspicious of the Maryland Hospital Association (MHA) (which still graciously houses the group’s monthly meetings), the group became an “official” ACDIS chapter back in 2013.

On Friday, December 5, 12:30- 3 p.m., at the MHA headquarters in Elkridge, the group once again hosts its annual holiday pot luck event. In addition to inviting attendees to bring a tasty tidbit of food to share, the group also collects donations for Toys for Tots Foundation.

In fact, many local chapters have incorporated charitable giving into their meeting agendas. The North Carolina and Virginia ACDIS Chapters often ask the host facility to identify a charity in their area and a donation suggestion. Often hosts choose nearby food pantries, collect canned goods, and deliver the items following the event.

Such charitable efforts go above and beyond expectations as leaders, hosts, and even attendees often come to local meetings on their own time and on their own dime taking personal time off to attend and working after hours to ensure the event’s success.

Kudos to all who not only ensure the sharing of CDI wealth but who share their good fortune with those less fortunate in their vicinity. For information about the upcoming Maryland event email Andrea Norris at anorris@uchs.org.

Additional meetings coming up include:

GeorgiaGeorgia
The Georgia ACDIS Chapter holds its winter meeting Friday, December 5, 8:30 a.m. to 2:30 p.m., at Lanier Technical College in Oakwood. Dorothy Sneed will present “The Clinical Documentation Role in Preventing Healthcare Fraud.” For information, email Georgia.acdis@gmail.com.

Maine
The Maine ACDIS Chapter meets Friday, December 12, noon to 4 p.m., at Maine General Medical Center in Augusta. For information email Cheryl McInnis, cheryl.mcinnis@mainegeneral.org, or Cathy Seluke cathy.seluke@mainegeneral.org.

New Jersey
The New Jersey ACDIS Chapter partnered with the Delaware AHIMA Chapter for a 21-part webinar series on ICD-10-CM/PCS titled, “Sharpening the Focus for Accurate Data and DRG Assignment,” which begins in November and continues through June 2015. For information, visit www.dehima.org/continuing-education/on-demand-education/icd-10-cmpcs-webinar-series.

 

New York
Suffolk County ACDIS Chapter meets Friday, January 9, 10 a.m., at Stony Brook University Hospital. For information, email Bernadette Slovensky at bernadette.Slovensky@stonybrookmedicine.edu.

Indiana
Indiana ACDIS plans its first quarterly meeting Wednesday, Janaury 14. For information, email Angie Green, AGreen3@ecommunity.com.

South Carolina
South Carolina ACDIS Chapter meets at Baptist Hospital in Easley on January 16. For information, email PJ Floyd, floyp@musc.edu.

Editor’s Note: For additional information about ACDIS networking and state and local events, visit the Local Chapter page of the ACDIS website or visit the ACDIS Blog and click on the Local Chapters category.

Guest Post: Night before Christmas (um, ICD-10)

shawn.macphee (426x640)

Shawn Macphee

As part of its fall 2014 meeting the Michigan ACDIS Chapter held an essay contest. Although in the following hardly constitutes an essay (I do hold a master’s degree in poetry believe it or not and this falls into poetic realm), it nevertheless easily earned honors and was thankfully turned over to us here at ACDIS to share with you this holiday season. Kudos to the Michigan ACDIS Chapter leaders and to the poet, Shawn MacPhee, MSN, RN, CCDS!

‘Twas the night before ICD-10, when all through the house

Over the hills of ICD-10 preparation

Over the hills of ICD-10 preparation

not a CDS was sleeping, their anxiety wouldn’t douse

The code books were ready, studied with care

In hopes that the documentation would be there

The coders were nestled, all snug in their beds

While visions of procedure codes danced in their heads

The CFO was restless, the CEO too

Trying to trust the CDS knew just what to do

The next morning dawn came with a shatter

The CDS staff worked without much chatter

Census sheets printed off in a flash

They made assignments in a dash

To the floors they ran, with DRG books in tow

The freshly waxed floors all a glow

The physicians all a rounding did appear

With their handy new CDI tip cards near

Progress notes were written, H&P’s too

The CDS’s reviewed the charts, looking for a clue

Diagnoses like asthma, a-fib and gout

The CDS staff was on the look out

Specificity was on their mind

Acute or chronic their goal to find

Then what to their wondering eyes did appear?

The etiology and manifestations weren’t quite clear

A query must be done – it was true

So up to the physician the CDS flew

The physician agreed, and thanked the nurse

He appreciated her for being terse

The documentation was added

The chart was complete

The CDS decided it was time to repeat.

Reading health records throughout the day

Feeling proud to be leading the way

You see, ICD-10 it’s not scary

Once implemented we shall all be merry

The day is almost over – relaxation in sight

So query now, query often, and to all a good night!

TBT: Watch out for uninvited turkeys

Don't use Thanksgiving as a time to talk turkey. Count your blessings. Be thankful. Use compassion for those less fortunate who surround you.

Don’t use Thanksgiving as a time to talk turkey. Count your blessings. Be thankful.

Editor’s Note: In social media memes Throw-back Thursday generally means sharing an old high school photo, something you most likely wish had been left unpublished. We’ve picked up the theme going back into our archives to highlight some salient tid-bit. Today, in honor of Thanksgiving we’ve pillaged the archives over at the ICD-10 Trainer for this pearl pulled from the New York City headlines.

A feral flock of wild turkeys has invaded New York City. Seriously. And with them, they bring all sorts of code-ready diseases and mishaps. But what happens when a turkey tries to cross Broadway? Well, if the bird is unlucky, it will get run over. New Yorkers stop for no fowl.

However, if the birds are smart enough to cross en masse, they could cause some serious traffic disruptions and possibly some traffic accidents. We’ll leave the specific injuries (contusions, lacerations, broken bones, etc.) out of the equation for the moment and look at the External Causes codes associated with traffic accidents.

ICD-10-CM includes multiple code possibilities for transport accidents in sections V00-V99. The introductory note for the section states:

This section is structured in 12 groups. Those relating to land transport accidents (V01-V89) reflect the victim’s mode of transport and are subdivided to identify the victim’s ‘counterpart’ or the type of event. The vehicle of which the injured person is an occupant is identified in the first two characters since it is seen as the most important factor to identify for prevention purposes. A transport accident is one in which the vehicle involved must be moving or running or in use for transport purposes at the time of the accident.

If the turkeys on the Great White Way caused an accident, we would likely head to V40 (car occupant injured in collision with pedestrian or animal). Our choices include:

  • V40.0, car driver injured in collision with pedestrian or animal in nontraffic accident
  • V40.1, car passenger injured in collision with pedestrian or animal in nontraffic accident
  • V40.2, person on outside of car injured in collision with pedestrian or animal in nontraffic accident
  • V40.3, unspecified car occupant injured in collision with pedestrian or animal in nontraffic accident
  • V40.4, person boarding or alighting a car injured in collision with pedestrian or animal
  • V40.5, car driver injured in collision with pedestrian or animal in traffic accident
  • V40.6, car passenger injured in collision with pedestrian or animal in traffic accident
  • V40.7, person on outside of car injured in collision with pedestrian or animal in traffic accident
  • V40.9, unspecified car occupant injured in collision with pedestrian or animal in traffic accident

All of these codes require a seventh character to indicate the encounter type, so you’ll also need two placeholder Xs so the seventh character ends up in the seventh spot.

So if you’re flocking to New York for the holidays, watch out for those wild birds.

Haunted Coding: The tell-tale chart

The month marked the 165th anniversary of Edgar Allan Poe’s death. We’re still not sure of the cause of Poe’s demise but there are have plenty of theories.

Raven

No more poor Poe.

First is the popular “he drank himself to death” theory that many people have heard. Poe was found “in great distress” outside of a polling place in Baltimore and died four days later. If Poe, who couldn’t really hold his liquor, did succumb to alcohol poisoning, how would we code it? First, we head to the Table of Drugs and Chemicals, then find alcohol and its 28 related entries. Apparently you can be poisoned by a lot of different types of alcohol.

In Poe’s case, it was probably ethanol (T51.0X-). In fact, 13 of the terms under alcohol in the Table of Drugs direct you to T51.0X-.

Now we need the intent behind the poisoning. We have specific codes for:

  • Accidental (unintentional)
  • Intentional self-harm
  • Assault
  • Undetermined

We also need a seventh character to denote the encounter. We have three choices:

  • A, initial encounter
  • D, subsequent encounter
  • S, sequela

Most likely, the alcohol poisoning (if that’s what put an end to the poet) was accidental, so we would report T51.0X1A.

However, we are faced with a more sinister possibility. Some have speculated that Poe was actually the victim of cooping, a method of voter fraud practiced by gangs in the 19th century. The gangs would kidnap people and take them around to various polling places so they could vote multiple times. After each successful casting of the ballot, the gang would reward their victim with alcohol.

You might be able to make a case for this being an assault, although that is probably a tough sell. You could also make a case for undetermined.

You’ll also find the following note under T51.01X-:

Excludes2:

  • Acute alcohol intoxication or ‘hangover’ effects (F10.129, F10.229, F10.929)
  • Drunkenness (F10.129, F10.229, F10.929)
  • Pathological alcohol intoxication (F10.129, F10.229, F10.929)

An Excludes2 note tells us that the conditions listed are not part of T50.1X-, but a patient could be suffering from one of these conditions as well. So if Poe’s doctor documented pathological alcohol intoxication, we would code it in addition to the alcohol poisoning.

Sadly Poe’s medical records have gone missing and shall be seen nevermore.

Editor’s Note: This article originally published on the ICD-10 Trainer Blog.

Halloween Extra: A play on Poe, “Nevermore a Delay”

Once upon a midnight dreary, as I labored on a query

monter under bedTo send to the doc whose documentation was a source of constant woe

As I nodded, nearly napping (that darn G47.411 again)

Suddenly there came a tapping

As of someone gently rapping, rapping at my cubicle wall

Tis just my manager, I muttered, coming for the query

Only this and nothing more

 

The silken, sad, muffled rustling of each chart that I sat shuffling

Thrilled me—filled me with fantastic terrors never felt before (oh wait, that’s just F41.1);

So that now, to still the beating of my heart, I stood repeating,

“Tis just my manager coming for the query

Just my manager looking for the query”

This it is and nothing more.

 

Presently my soul grew stronger; hesitating then no longer,

“Jill,” said I, “or Shannon, truly your forgiveness I implore;

But you know my lack of hearing (H90.0) caused by this incessant ringing (H93.13)

Left me thinking there was no one tapping at my cubicle door,

I scarce was sure I heard you”—here I opened wide the door—

Darkness there and nothing more.

 

Deep into that darkness peering, long I stood there wondering, fearing (more F41.1),

Doubting, dreaming dreams no mortal ever dared to dream before;

But the silence was unbroken (or am I just suffering H91.23?), and the stillness gave no token,

Until I heard this one word spoken—ICD-10

This I whispered and an echo murmured back—ICD-10

Merely this and nothing more.

Back into the chamber turning, all my soul within me burning (maybe it’s really R12 and not my soul),

Soon again I heard a tapping somewhat louder than before.

Open here I flung the door, to see a Raven of the days of yore;

Perched above the neighboring cubicle door

Perched contently above my next-door neighbor’s cubicle door

Then he spoke—ICD-10—and nothing more.

 

Wonderful, I muttered, now I’m seeing birds, I shuttered

I’ve started hallucinating a creepy bird of yore (R44.1, too bad it doesn’t specify what I’m seeing)

I really want to write this query

So I can code this record, I am weary (R53.83)

Weary of worrying when ICD-10 will be implemented

Quoth the raven, 2015

This he said and nothing more.

 

Listen bird, I said with feeling, please don’t let me be dreaming

Please tell me that ICD-10 is really coming soon

Currently our codes are lacking

We can’t even tell what’s catching

We don’t know what diseases we’re not tracking

Quoth the raven, 2015

This he said and nothing more.

 

“Be that word our sign of parting, bird my friend!” I grinned, upstarting—

“Get thee back into the tempest and spread the word to every coder!

Leave one black plume as a token of that joy thy beak hath spoken!

Leave my hopefulness unbroken!—quit the perch above my neighbors door!

Take thy beak from out my heart (S26.19, W61.99XA), and take thy form from off my neighbor’s door!”

Quoth the raven, 2015

This he said and nothing more.

Editor’s Note: This article originally published on the ICD-10 Trainer Blog

Guest Post: CDI benefits? Money, teddy bears, and more

Use teddy bear inspiration to promote your CDI efforts!

Use teddy bear inspiration to promote your CDI efforts!

By Vicki Sullivan Davis, RN

Doesn’t it burn you up when someone says that CDI programs are all about reimbursement? I can feel my face get red when I hear that statement! Of course, I remain composed, smile, and provide politically correct education to the individual. But deep down I have always wanted to say, “You are darn right CDI is about reimbursement! I work hard every day to make sure you and everyone else continue to have a place to work. I make sure our patients have the most updated equipment for imagining, the most advance surgical suites, a bigger emergency department, adequate nurses on the units, food to prepare, patients to see and E/Ms to bill!”

I want to say, “Yes, my job is to help make money for hospital and so is yours!” Every person in this industry needs be concerned with reimbursement; our survival depends on having money to provide resources for our patients! We provide for our futures through cost containment, efficiency monitoring, billing, staffing to volume, charging for supplies, and even decreasing the number of linens stocked in each room. All staff should be concerned with cost containment and revenue growth. CDI specialists are no different! Reimbursement is reimbursement, we just call it different things in different departments. Budgets, staffing, billing levels, supplies, etc.

Without bringing in adequate reimbursement, the hospital would have to close their doors despite anyone’s best efforts to control efficiency and quality. If we are not worried about reimbursement, we would not have the resources to provide services that are important to the community. We would not be able to sit and hold the hand of a dying patient. We would not be able to give out teddy bears to a scared child getting a chemo treatment. We would not be able to provide a warm blanket for a frail, confused, and aging patient. The impact of healthcare reform is so significant that we all must worry about the almighty dollar if we truly care about people.

But just because I say my job has an impact on reimbursement, doesn’t mean that I only focus on reimbursement.

The heart of our program focuses on the patient. As CDI specialists, making sure we capture severity of illness and risk of mortality (SOI/ROM) is essential, and the outcome of capturing SOI/ROM correctly happens to equate to reimbursement. CDI specialists are just charged with finding innovative ways to perpetuate our hospital’s future (for the patient’s sake!) So next time the next someone rants that your CDI program is “all about the money,” be proud he or she took time to notice your program, then smile and hand them a teddy bear.

Editor’s Note: Vicki Sullivan Davis is CDI manager at Cone Health System at Alamance Regional in Burlington, North Carolina, and past-speaker at ACDIS National Conference. Contact her at vdavis2@armc.com.