News - Diagnostic Meeting

09-21-06-Cancelled

Outpatient/ER/Diagnostic meeting

September 2006- Summary Notes

The meeting for 09-21-06 was cancelled. This is a summary for the month of September which will be placed in the indexes under meeting minutes.

Staffing.

Bobbie Vannatter has accepted the position of Corporate Coding Manager.
Scott Pennington resigned as outpatient supervisor. His responsibilities will transition to Bobbie until a replacement for his position is found.
Barbara King retired. Her position was filled by Kim Turner, Senior Medical Records Associate.
Kendra Snellgrove is a new part-time outpatient coder. She started on 09-21-06 and will be working on Thursday and Sunday.
Kara Stanford has completed her outpatient training and is now working at Grant.

New radiology services ZAR/ZAG.   Coders had given feedback that they were seeing less radiology cases and that numerous un-coded diagnostic accounts were showing up on the Bill Hold list. It was clarified that new patient types, ZAR/ZAG, had been created which included mammograms and other diagnostic x-rays. These were not added to Medical Record’s DNFB which created a large back-log of un-coded radiology cases. Bobbie ran a listing of these cases and placed it on the Q drive (124 pages!).

Coding Calendar Process Change. Per Bobbie’s note on 09-02-06, the process for the coding calendar was changed. Coders no longer need to list the date they are coding but will place their names on the current calendar day. They will indicate the campus (R or G) and which pages were taken.

GRANT EMSTAT- GOOD NEWS!!!!.   Per Bobbie’s note of 08-18-06, the EMSTAT for Grant cases is now available on ORB.

Compliance ENDOSCOPY Audit. Per Bobbie’s note of 09-10-06, a compliance audit was performed on outpatient Endoscopy cases. Several documentation issues and charging problems were found. However, coding results were 96% accurate.

RMH-Women’s Breast Health Center (ZBI). The were some problems with these cases included charging issues. Coders had been instructed to hold these cases. As of 08-30-06 all issues have been resolved and cases can be coded. If there are any cases which have charge problems, follow the process for charge problems. Apply the T 8600 and a free form note specifying the problem. Then send the cases to Vicki and copy Bobbie.

3M Coding Tutorial. Mary Sue has downloaded a tutorial for the 3M encoder. Per Bobbie’s note of 09-10-06, this tutorial is for coders who do not have any experience with the 3M encoder. New coders may be assigned this tutorial by their educators. This is NOT for experienced coders.

Category V23 Codes. Medical Records received feedback from a compliance audit of clinic cases that we were incorrectly sequencing codes from category V23. Per clarification note of 09-01-06, codes from category V23 should be listed as the principal or first-listed diagnosis. This will be further discussed at the next outpatient meeting.

CPT 93621 (EP with left atrial pacing and recording from coronary sinus or left atrium). Per clarification note on 09-21-06, we had previously instructed coders to assign 93621 when the catheter was placed in the coronary sinus/left atrium. However, we have received clarification from the EP lab that when a catheter is placed, recording is ALWAYS done. Pacing may or may not be done. So the coder needs to see documentation in the “location paced” section of the Witt that specifies the coronary sinus/left atrium was paced. While investigating this issue, the EP lab also said that there is currently a problem with the available selections in the “location paced” field. There is no option for left atrium. EP will address this at their next meeting (09-22-06).

ER-OBV. Coders have given feedback that a significant number of ER-OBV cases are skipped because not all ER coders are trained on OBV. Coders then may have a large number of OBV cases on a particular day. Since these are often complex and time consuming cases, this impacts productivity negatively. Bobbie is aware of this issue and OBV education for ER coders is being planned. It may take some time to start this training as there is currently a major training in place for VIR coding. However, ER-OBV training is a priority and will be addressed.

DOS Errors.   We continue to see date of service errors on Failed Claims feedback cases. These happen mostly on OBV cases and ER cases where the patients may be in for two or more days.   Be sure to review the documentation carefully and select the correct date of service.   If the case has an incorrect admit or discharge date, be sure to send these to Mary Sue Collins for correction. If Mary Sue is unavailable, please send them to Mickey Crager.

ER DENIED FOR MEDICAL NECESSITY. We also continue to see ER cases where the CT/chest x-ray/EKG etc are denied for medical necessity. Be sure to review the ER record carefully and the reports to be sure you are not missing signs/symptoms/diagnoses which are documented and which meet necessity for these procedures.

T CODED CASES WITH CODER INITIALS AND ADMIT DGN. We have feedback that there are a significant amount of radiology T coded cases which have the coder’s initials and an admit diagnosis entered. Please be sure to follow the process for diagnostics.

Check the charges
Look for the report
Then code and abstract the case
This is easier to happen with those coders who use GUI rather than the character based Star. Coders who use GUI usually bring up the case and they may be putting their initials in on the visit screen. Do not put your initials in the case unless it can be coded.
We will discuss further at the next outpatient meeting