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

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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]

Symposium Speaker Highlight: McCall demystifies outpatient coding

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Shannon McCall, RHIA, CCS, CCS-P, CPC-I, CCDS

Editor’s note: As we did with the 10th annual ACDIS conference in May, we’ll take some time leading up to the ACDIS Symposium: Outpatient CDI to chat with a few of the speakers. The event takes place September 18-19 at the Hilton Oak Brook Resort & Conference Center in Oak Brook, Illinois. Today, we talked with Shannon McCall, RHIA, CCS, CCS-P, CPC-I, CCDS, the director of coding and HIM at HCPro in Middleton, Massachusetts. She manages the instructors of the Certified Coder Boot Camps and has extensive experience with coding for both physician and hospital services. She will be presenting “The Ins and Outs: Inpatient and Outpatient Coding” on Day 1 of the Symposium.

Q: There are so many differences between inpatient and outpatient coding! What would you say is the most difficult one(s) for those moving from the inpatient CDI world to wrap their minds around? (e.g., that words like probable, likely, suspected don’t count toward a diagnosis, that outpatient facilities not only use ICD-10 but also CP[SM] T, the different code sets each have their own set of guidelines and rules governing use?)

A: Documentation for outpatient encounters is much briefer than documentation for an inpatient admission so the application of the guidelines of only assigning codes for relevant diagnoses is important. Providers typically lack the documentation in their notes to clearly identify chronic conditions being clinically relevant in their decision making process. Since risk adjustment is based on diagnosis coding, the differences in procedure coding has no bearing.  [more]

ACDIS precon addresses coding, CDI, and more

Wow! My head is spinning. A beautiful 5+ hour flight from Boston last night. It was the longest sunset I’ve ever watched. By traveling across time zones I was able to see the sun set the entire time. What the light does to the clouds. . . simply a landscape for dreamland.

And while ICD-9-CM may not be your idea of dreamland, I swear I learned so much today that I might as well have been in intellectual heaven. Shannon McCall took a class of more than 100 people on a tour of the Manual, which she followed up with a lession in specific diagnoses and the importance of their related Coding Clinics. Shannon’s presentation in this area generated a number of discussions both in-session and outside of the pre-conference. She covered items like HIV and related illnesses, sepsis and septicemia (what a hot-button item, huh!), neoplasms, CKD, obesity, and so much more.

After lunch, we continued this conversation regarding the Coding Clinic guidelines about congestive heart failure, respiratory failure, pregnancy related conditions, and pressure ulcers. . .  Is now a good time to say “wow” again? Or, “my head is spinning,” again?

After all this Shannon gave us a quick tour of MS-DRGs, and a crash course in ICD-10. . . Did I already say “wow”?

ACDIS Precon: What you need to know before you go

More than 100 people signed up for the preconference “ICD-9 Coding Essentials: What every CDI specialist needs to know.” I’m personally looking forward to learning all about how CDI fits into the coding realm from Shannon McCall, RHIA, CCS, CPC-I.

I’ve participated in her Boot Camps before and know firsthand that she is a tremendous teacher. Students from her previous courses rave about her capabilities in their evaluations so I’m sure we’ll all learn a lot and have a good time, too. Last I spoke with Shannon she was working on gathering some Las Vegas themed music to help wake us up on Wednesday.

Speaking of which, if you are among the 100+ pre-conference attendees, head down to registration around 8 a.m. Grab a muffin or bagel and some coffee and take a minute to look over the bookstore. We’ll have an hour to get 100 people registered so be patient with us. Class starts at 9 a.m.

CDI implications included in IPPS proposed rule

The long-awaited fiscal year (FY) 2010 Inpatient Prospective Payment System (IPPS) proposed rule is out, and with it comes good and bad news for hospitals. Hospitals will see historically low payment updates with a phased-in documentation and coding adjustment (DCA) to take place over time.

The proposed update for acute care hospitals means an update of 2.1% for inflation minus a DCA of 1.9 percentage points. Long-term care hospitals will see a proposed update of 2.4% for inflation minus a DCA of 1.8 percentage points. These DCA adjustments reflect the differences between the changes in documentation and coding that do not reflect real changes in case-mix for discharges occurring during FY 2008, according to CMS.

These low rates won’t help hospitals struggling to keep their doors open in the midst of a worsening economy. “Hospitals that are counting on some sort of increase won’t really see anything this year,” says Kimberly Hoy, JD, CPC, director of Medicare compliance for HCPro, Inc. in Marblehead, MA. “Payments are going to stay flat, and that’s going to be tough for a lot of hospitals.”

Clinical documentation improvement programs as well as more diligent efforts by HIM are most likely the reasons behind more accurate coding that led to higher payments, agrees Shannon McCall, RHIA, CCS, CCS-P, CPC-I, director of HIM and coding for HCPro, Inc. in Marblehead, MA.

“CMS may have underestimated that facilities would create such effective clinical documentation improvement programs,” she says. “I think those programs were an integral part of all of this.”

And in light of decreased payment updates, hospitals that don’t currently have a clinical documentation program will need to think seriously about implementing one, says Gloryanne Bryant, RHIA, CCS, CHW senior director of corporate coding and HIM compliance in San Francisco.

“Hospitals will need to assess their current efforts to capture patient severity and acuity through documentation and coding to see if opportunities remain,” she says.



How much do you know about ICD-9-CM coding?

Are you frequently at odds with your coding staff because the documentation you’ve worked so hard to get doesn’t end up as a code on the final claim? Do your working DRG assignments get shot down too often? Does Coding Clinic or the ICD-9-CM Official Guidelines make your head spin?

If these or other scenarios sound familiar, you might want to consider coming out to Las Vegas a day early on Tuesday, May 13, for a special one-day pre-conference event: ICD-9 Coding Essentials: What every CDI specialist needs to know.

This one-day seminar provides an in-depth session on ICD-9-CM inpatient coding, the MS-DRGs system, and the forthcoming switch to ICD-10-CM. Tailored for clinical documentation specialists, participants will walk away with a firm understanding on how to use the ICD-9-CM Manual, the fundamentals of principal diagnosis assignment, and will learn how to assign the correct MS-DRG to cases with an MCC/CC as well as non-MCC/CC cases. You’ll also get up to speed on the forthcoming ICD-10-CM system.

Participants will receive one free copy of the 2009 ICD-9-CM Manual (Volumes 1, 2, 3) with admission.

Contact Shannon!

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Our conference brochure is almost done so please check the conference page for updates. But in the meantime, Shannon has offered up her e-mail address to take any questions you may have about this special pre-conference event. You can reach Shannon at smccall@hcpro.com