Archive for February, 2019

FLU SEASON’S HERE: CODING RESPIRATORY INFLUENZA

Posted by Samantha Serfass on February 19, 2019 in Blog, General, News

FLU SEASON’S HERE – Coding Respiratory Influenza

Every year, influenza season is considered to stretch from October through May.  The peak occurs between December through February, causing a lot of hospital encounters— whether as inpatients, emergency department visits, or physician office visits.

Within the medical world, there are different types of influenza viruses.  In order to reflect the type of influenza appropriately, the coding professional must carefully examine the documentation provided by the physician in order to assign the correct influenza code.  Within this article, we will discuss the different types of influenza and the documentation/coding nuances for each.

Sometimes the type of influenza will not be identified, but the physician will still document “influenza” and treat it as such.  Within the alphabetical index, this would be considered an unidentified influenza virus (J11.x).  Other times, the physician will order a nasal swab and it will come back positive for Influenza A or Influenza B.  In these cases, the influenza would be indexed as Influenza, identified influenza virus, NEC (J10.x).

Novel A Influenza virus is considered to be an influenza arising from animal origin, and is actually somewhat rare.  Some of the key words the physician must document in order to assign a code for Novel A are: “novel”, “avian”, “swine”, “H1N1”, “H5N1”.  The inclusive list of sub terms can be found within the alphabetical index and are also listed in the tabular index under J09. X.  These codes can only be assigned on confirmed cases of Novel Influenza because these are nationally reported infectious diseases.  If the physician uses equivocal terms such as “possible” or “probable” a code from the J09 section should not be assigned and the physician should be queried for clarification.

There are times when the coder will see documentation of “influenza like illness”.  In the alphabetical index, there is a specific entry for this, which directs the coder back to the main term of influenza.  Because there is a specific alphabetical index entry, this diagnosis is appropriate for assignment on both inpatient and outpatient cases.

Under all specified influenza types, there is a subset of manifestations defined by the word “with”.  Referring back to the Official Coding Guidelines for ICD-10-CM and PCS, the diagnoses listed under the term “with” are assumed to be linked and can be coded as such (i.e., influenza with pneumonia).

It’s important to remember chart documentation is critical when assigning the appropriate code for influenza.  The coder should carefully review the alphabetical index entries and assign the most appropriate code.  Remember that Novel A Influenza and Influenza A are not the same.  Influenza A is most common, whereas Novel A Influenza is rather rare.

Robyn McCoart

Director of Client Services, Excite Health Partners

Revenue Cycle: Increasing Revenue, Decreasing Deficiencies

Posted by Samantha Serfass on February 5, 2019 in Blog, News

Revenue Cycle:

Increasing Revenue, Decreasing Deficiencies 

Revenue Cycle Systems were the first applications used to help mature the Healthcare Industry, and by the mid to late ’90’s Clinical Systems followed. When EHR vendors started “advertising” integrated enterprise systems, most hospitals already had a Revenue Cycle system in place.

Project Directors and Project Managers alike are seeing a common thread when implementing an enterprise system. Often times during an implementation, the Revenue Cycle doesn’t see the full picture of their workflow from beginning to end.

Excite Health Partners’ VP of EHR Services & Implementation, Todd Klein, has seen this first hand. During an installation of a prominent enterprise system, a presentation from order entry to bill being paid was requested. After two rounds of iterations, the vendor provided the presentation. Todd stepped into a Project Director role after re-testing the system allowing for inconsistencies to be found. The re-test corrected charging issues, resulting in millions of dollars saved. The Emergency Department and Laboratory modules were also big contributors to the improvements.

Excite Health Partners has seen an increase in Revenue Cycle issues among new clients. In the later part of 2018, a client upgraded to the latest enterprise wide system incurring several issues costing them well over $25,000 in revenue on an annual basis. Workflows were not properly thought out and systems were not fully configured or tested.  Underestimating the value of testing can be detrimental.

Often times vendors test the new release with little to no issues at their corporate office. It’s important to note that each facility structure, billing rules and payer plans all contribute significantly to the hospital’s financial system. We offered a Revenue Cycle Project Manager as well as several analysts to help correct the issues our client was facing.

While there are several approaches to ensure the Revenue Cycle quality, it’s vital to use rigger in the testing and to know the workflow. Three important testing areas to focus on are:

  • Charge Testing
  • Parallel Testing
  • End-to-End Integrated Script Testing

On average a hospital can leave at least 1.4 million dollars on the table. Although that estimate will fluctuate based on the source of information, the problem is typically capturing charges or poor documentation. The Emergency Department is one of the largest contributors to this deficiency. By providing “At Risk Revenue Cycle Consulting”, Excite Health Partners is committed to combatting Revenue Cycle issues.

Our services increase revenue where deficiencies exist.  The service starts with an assessment, which identifies the amount of revenue we’ll help you increase.  Afterward, we produce an “At Risk Contract” where we partner with your organization with the goal of increasing your revenue.

When implementing an enterprise system or upgrading to a new release, make sure the system has been thoroughly tested.  If you feel dollars are being left on the table, partner with someone who will share the risks.

Todd Klein

VP EHR Services & Digital Solutions