Coding, Classification & Reimbursement

Subject: Facility Clinical Indicators Committee & Guidelines

1.  Facility Clinical Indicators Committee & Guidelines

Posted 03-01-2017 15:13
Has anyone established a facility clinical indicators committee and developed associated guidelines for specific diagnoses (i.e. ABLA, Sepsis, Respiratory failure v. insufficiency)?  We are in the process of developing and I would be interested in seeing examples of guidelines that you have developed and how the process works at your facility. 

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Terri Benskin, MHA, RHIA, CCS
Manager, Coding and Data Management
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2.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-02-2017 08:37
We have purchased the CDI Pocket Guide from HCPro and found it extremely beneficial.  It is updated annually and has a great deal of information regarding clinical indicators and some coding rules, DRG's with weights and LOS and much more.  All of our CDI's have a copy and I highly recommend it.  Check it out.

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M Carmella Mercer, CCS, CCDS
CDI Specialist
Tift Regional Medical Center
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3.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-02-2017 09:13
  |   view attached
Encrypted email notification from Kearny County Hospital
Encrypted email message from "Nelda Laskey" (nlaskey@kearnycountyhospital.com)

This email contains a message that has been sent as an encrypted PDF document in order to ensure the secure delivery of its contents.

Open the encrypted PDF attachment to view your secure message.

To access this message, you should open the attached PDF using Adobe Acrobat Reader version 7.0 or higher. In order to view its contents, you must enter the password that will be communicated to you by the sender of this message.

If you have any problems viewing the encrypted message or do not know your password, please contact the sender of the message at the Hospital (620) 355-7111.

Note that Adobe Acrobat may restrict access to certain attachment types. If this is the case, you will need to inform the original sender and make alternative arrangements.


This email and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed. This message contains confidential information and is intended only for the individual named. If you are not the named addressee you should not disseminate, distribute or copy this email. Please notify the sender immediately if you have received this email by mistake and delete this email from your system. If you are not the intended recipient you are notified that disclosing, copying, distributing or taking any action in reliance on the contents of this information is strictly prohibited.


Attachment(s)



4.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-02-2017 10:18
Thanks Nelda. 

What is the password to open the file ?

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Julianna Perez
Manager, Medical Records
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5.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-14-2017 11:35
Edited by Jill Weber 03-14-2017 12:05
I am interested in your document.  If possible could you email me the password?  jillery10@gmail.com

Thanks!

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Jill Weber
Clinical Documentation Management Specialist
Cedars-Sinai Medical Center
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6.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-14-2017 11:58

I'm interested in tge document as well. Will you please email me a copy to:
Samanthasalgado46@gmail.com






7.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-14-2017 12:12

I am also interested.  Please email it to me at jaredp@uw.edu.  Thank you.

 

Jessica M Smith, RHIA, CCS

 






8.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-14-2017 12:19
I'm interested.  Please forward the document and password to lburke63@gmail.com.

Thanks,

Leola

Leola Burke MHSA,CCS 
NCHIMA Publications Chair 2016-2017
publications@nchima.org                                                    
"Experience the Power of ICD-10" 
www.poweroficd10.com
Independent ICD-10 Consultant                                 
AHIMA-Approved ICD-10-CM/PCS Trainer
AHIMA Ambassador
AHIMA Mentor
lburke63@gmail.com
919-357-3298 NC mobile

This electronic message may contain information that is confidential and/or legally privileged. It is intended only for the use of the individual(s) and entity named as recipients in the message. If you are not an intended recipient of this message, please notify the sender immediately and delete the material from any computer. Do not deliver, distribute or copy this message, and do not disclose its contents or take any action in reliance on the information it contains. Thank you.





9.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-14-2017 13:12
Nelda;
I am also interested in your document.  If possible could you email me the password?  sharonvi@optonline.net
Thanks!


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Sharon Villalobos
Coding Validation Auditor
HMS
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10.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-14-2017 13:55
I am also interested
Justformyjo@yahoo.com

Thank you

Sent from my iPhone




11.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-14-2017 14:56
Hi Nelda. I am also interested in your document please.

Sent from my iPad




12.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-15-2017 06:24
Hi Nelda,

Would you also send me the password to access the document.     ljwcoding@gmail.com

Thanks!

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Leonta Julien-Williams
Coding Director
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13.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-15-2017 09:07
I would also be interested in the password for this document.  My email is rjohna@uky.edu.

Thank you!

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Robin Johnson
Coding Compliance Coordinator
University of Kentucky Chandler Hospital
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14.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-15-2017 09:12
I would like to receive this as well please.   
Melody.brown@mymlc.com

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Melody L. Brown, RHIA
Medical Inpatient Coder
MOSAIC Life Care
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15.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-15-2017 10:08
I would also like to download the file you have posted please send me the password for the file at dwalkerthomas@lifespan.org
Thank You for sharing.

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Donna Walker-Thomas
Director of Coding
The Miriam Hospital
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16.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-15-2017 12:44
I'm interested in reviewing your document.  Will you send me the password please?
Thank you

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Crystal Parker
Coding Coordinator
New Hanover Regional Medical Center
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17.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-27-2017 15:38
I would be interested in the attachment as well if you would be willing to share the password to this document.

Thank you.

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Dina Williams
HIM Coding Manager
Cape Fear Valley Medical Center
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18.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-30-2017 15:54
I would also be interested in your documentation. We have been receiving several DRG changes for Sepsis and Acute Respiratory Failure. Thank you. cindiq@unionhospital.org

Cindi

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Cindi Quinn
Union Hospital
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19.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-31-2017 00:37
Hai Nelda

I would also be interested, could you send the pass word to this  'maranmro@yahoo.co.in'  mail.

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Manimaran Selvaraju
HIM Officer
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20.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-31-2017 08:54
Did anyone get the password for the attachment?

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Michele Tack RHIT
Coding Manager
St. Luke's Hospital of Duluth
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21.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-02-2017 10:03

I also would be interested in hearing what other facilities are doing.  We are having DRG revisions, especially with Medicaid, for Sepsis, ABLA and Acute Respiratory Failure.  We code what the physician uses for the diagnosis but then Medicaid doesn't think the diagnosis is supported by the documentation.  We have discussed this briefly during Medical Staff Meeting without resolution.  I don't feel comfortable questioning their diagnoses without some guidelines.  Thanking everyone in advance. 

Confidentiality Statement: The information transmitted by the following e-mail is intended only for the addressee and may contain confidential and/or privileged material. Any interception, review, retransmission, dissemination, or other use of, or taking of any action upon this information by persons or entities other than the intended recipient is prohibited by law and may subject them to criminal or civil liability. If you received this communication in error, please contact us immediately at (620) 355-7111 please dial 0 for an operator, and delete the communication from your computer or network system. Although this email and any attachments are believed to be free of any virus or other defect that might negatively affect any computer system into which it is received and opened, it is the responsibility of the recipient to ensure that it is virus free and no responsibility is accepted by the sender for any loss or damage arising in any way in the event that such a virus or defect exist.





22.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-15-2017 11:09
I reposted without the encryption saying I would also like to see what anyone has to offer.  We are getting DRG revisions, especially from Medicaid for Sepsis, ABLA and acute respiratory failure.  I am from Kansas.  Sorry for the confusion. 

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Nelda Laskey
RAC Coordinator/Coder
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23.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-17-2017 09:35
Nelda,

I'm still not able to open the file without the password.  Would you care to share with me?  I can be reached at rjohna@uky.edu.

Our facility is receiving denials based on patients not meeting clinical indicators for the coded/documented condition.  We refer those onto our CDI staff to appeal, and I'm not sure what the outcome of those denials.

Thanks, Robin

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Robin Johnson
Coding Compliance Coordinator
University of Kentucky Chandler Hospital
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24.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-24-2017 10:25
I would be interested as well- semiddleton@regmed.com

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Stormi Middleton
HIM Director
Morgan Memorial Hospital
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25.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-24-2017 13:36
Do you all consider cpap at night dependence on other machine requiring the Z code?
Can't find guidance
Robin Sewell CCS CPC CHTS-PW
Medical Liaison Services LLC 772-546-1414






26.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 03-27-2017 10:37
In my opinion it will depend on whether the provider documents dependence or not. I believe most coders would not interpret CPAP as dependence but would interpret invasive ventilator as dependence. Having said that, the answer is a clinical one that can only come from the provider. There is an article https://www.ncbi.nlm.nih.gov/pubmed/21194916 that points out most ventilator dependent conditions use a mix of invasive and noninvasive modalities. 
 

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JoEllen Cowan
Corporate Coding Compliance Manager
Optum360
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27.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 04-05-2017 21:55
Nelda,

I'm also in Kansas and we've been having a lot of denials regarding sepsis from Medicaid--particularly Sunflower and United.  We are constantly discussing sepsis criteria with our CDS and physicians because it seems like each physician, and each auditor, have different criteria for sepsis.  We are currently basing a lot of our sepsis appeals on lactate levels because that's what our physician liaison (spelling?) views as key criteria.  General consensus from what we hear is that the SOFA criteria is ridiculous and that a new definition of sepsis is going to be nationally discussed.

Regarding appealing sepsis with Sunflower, no luck yet.  We have actually taken a sepsis case to the state hearing level for United and the judge sided with United saying that when we made a contract with United we agreed to accept what United pays.  We're looking at possibly including clinical criteria in the next contract, but that's something the lawyers are going to have to figure out.  Until then Medicaid will continue to deny diagnoses with nebulous criteria at will and there's not much we can do about it except continue to protest.

We've had better luck with fighting our acute respiratory failure denials so I can share that criteria with you if you are interested.

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Alicia Kellogg, RHIT
Inpatient Coder
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28.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 04-06-2017 09:30

Glad to hear you are also from Kansas as I have several questions with Medicaid's DRG revisions.  I recently read an article that credential coders are not always required.  There can be exceptions to the requirement which wasn't part of the article.  My questions are:  Is a physician involved in denying a diagnosis?  Is only criteria used?  Are credential coders used 100% of the time?  Will Medicaid "share" their criteria with providers?

Thanks

Confidentiality Statement: The information transmitted by the following e-mail is intended only for the addressee and may contain confidential and/or privileged material. Any interception, review, retransmission, dissemination, or other use of, or taking of any action upon this information by persons or entities other than the intended recipient is prohibited by law and may subject them to criminal or civil liability. If you received this communication in error, please contact us immediately at (620) 355-7111 please dial 0 for an operator, and delete the communication from your computer or network system. Although this email and any attachments are believed to be free of any virus or other defect that might negatively affect any computer system into which it is received and opened, it is the responsibility of the recipient to ensure that it is virus free and no responsibility is accepted by the sender for any loss or damage arising in any way in the event that such a virus or defect exist.





29.  RE: Facility Clinical Indicators Committee & Guidelines

Posted 07-28-2017 10:50
Would you be willing to share your guidelines for coding ABLA and Sepsis.  I would need a password.   Thank You

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Lisa Fornal
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