Coding, Classification & Reimbursement

1.  Inpatient coding - how much is too much??

Posted 02-22-2017 07:21
Per coding guidelines on reporting additional diagnoses in the inpatient setting, additional conditions are reported if they require clinical evaluation, therapeutic treatment, diagnostic procedures, extended length of hospital stay, or increased nursing care and/or monitoring.

So...if a patient is given a medication during the inpatient admission, should there be a diagnosis for it?  What if these are considered their routine "home" meds??  What if it is given prophylacticly?

Is it appropriate to ask for the diagnosis related to the medication given for chronic conditions? 

The problem we are having is related to the difference in approach between CDI and coding in querying the physicians.  CDI is focusing on DRG and anything that affects SOI/ROM, which is understandable.  Coding is focused on a complete picture, and my question is, how complete do we want to be without sending endless queries? 

Any help would be greatly appreciated!!

Thanks!


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Jody Hester, RHIT
Coding Supervisor
TLRMC
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2.  RE: Inpatient coding - how much is too much??

Posted 02-22-2017 09:55
Inpatients require an admission medication reconsideration (in the orders) which includes the indication (diagnosis) for the medication.  This is signed by the physician.   Code chronic conditions treated with medication from this document.


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Julianna Perez
Manager, Medical Records
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3.  RE: Inpatient coding - how much is too much??

Posted 02-28-2017 08:02
Sorry for my late response!

Yes, we do have a med reconciliation, but it does not include the diagnoses for the meds that are given.

I do appreciate your help though.


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Jody Hester, RHIT
Coding Supervisor
TLRMC
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4.  RE: Inpatient coding - how much is too much??

Posted 18 days ago
Jodi,

Do you happen to have Meditech?  Under "home medications"  it does not list diagnoses. The medication list while they are here, has a diagnosis if it's prn but it not prn. there is no diagnosis.

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Cheryl Ervin
Director, Health Information Services
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5.  RE: Inpatient coding - how much is too much??

Posted 03-14-2017 06:26
I want to bump this back up.  Would you hold an inpatient chart to send a query for a diagnosis regarding home meds that are continued in the hospital?

Thanks!

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Jody Hester, RHIT
Coding Supervisor
TLRMC
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6.  RE: Inpatient coding - how much is too much??

Posted 03-14-2017 16:33
Hello

I work in CDI and we would not query for the utilization of long term meds on a routine basis unless that long term med would support treatment for another condition. 

I think providers would become frustrated with endless queries and would begin to ignore other queries of greater importance. 

Not sure if I understood this question correctly, but that would be my opinion. I also dont think providers should have to link the meds to diagnosis. 

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GregZobelgzobel@majorhospital.org
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7.  RE: Inpatient coding - how much is too much??

Posted 15 days ago
I work as a CDI, but we do not usually query for diagnosis for home medications. There are situations that I use home medications as one of the clinical indicators associated with  signs and symptoms presented by the patient.  Yesterday, I posted a query: patient was documented being disoriented to time, place situation and person, advanced age 97 years old, brought to hospital due to fractured hip secondary to mechanical fall.  Patient is on Memantine 10 mg PO BID. I queried MD for diagnosis.

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Merle Swoope
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8.  RE: Inpatient coding - how much is too much??

Posted 03-28-2017 11:06
I would definitely assign a code for a chronic condition that is documented in the chart and is currently being treated or monitored. However, I would not query a physician, for example, for hypertension that is not documented just because lisinopril is listed in the home meds. The physician should be documenting relevant chronic conditions elsewhere in the chart, such as in the history and physical. If the hypertension is not mentioned anywhere in the chart, I would wonder if maybe the patient isn't still taking it and the reconciliation list is wrong or if possibly the lisinopril is being used for some other reason. I know coders want the coding to be as accurate and complete as possible, but we really do have to pick our battles with queries. If we query the physician to get codes that don't "make a difference" so to speak, many physicians will stop responding to queries altogether. We don't want to be the gnat in their faces; we want to be the gentle reminder of what's most important. :)

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Irena Millington
ICD-10 Educator
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