Archive for January, 2020

BREAKING IT DOWN: EGD WITH ENDOSCOPIC ULTRASOUND

Posted by Samantha Serfass on January 31, 2020 in Blog, General, News

Breaking It Down: EGD with Endoscopic Ultrasound

Esophagogastroduodenoscopies with endoscopic ultrasound examination can appear rather confusing, especially when additional procedures such as fine needle aspirations or injections of adjacent structures are also performed in tandem with the original procedure.

The first thing to remember is that all of the Upper EUS codes are subsets of the parent code, 43235 Esophagogastroduodenoscopy.  If you look at the code book, all of the codes under 43235 start with “with”.  Keeping this in mind, you will realize it is always assumed that an entire EGD has been performed (esophagus, stomach, 2nd portion of duodenum) prior to the insertion of the echoendoscope.  Also note that there is a separate code for esophagoscopy with EUS, meaning the stomach and/or duodenum is not entered with the scope.

For the purpose of the EGD’s with EUS, the GI system is broken down into three basic regions:

  1. Esophagus
  2. Stomach
  3. Duodenum (or surgically altered stomach where the jejunum is examined distal to the anastomosis)

The next thing to distinguish is the subtle verbiage differences in the code descriptions, namely AND versus OR, which helps identify the best code for the operative scenario.  For these procedures, the word “and” (esophagus, stomach, AND either duodenum or surgically altered stomach…) means that all three regions have to be evaluated using ultrasound.  When “OR” is used, the intent is to reflect that two out of the three regions are evaluated.  Typically, 43237 is used when the EUS probe is inserted through the esophagus and into the stomach, but does not reach the duodenum. 

Of note, it is also assumed that adjacent structures are always visualized during an ultrasound, even though the only codes that specifically state “and adjacent structures” are 43237 and 43238.  Adjacent structures is defined as not only the walls of the GI tract, but other structures such as the liver, biliary tract, pancreas, lymph nodes.

When determining the correct code assignment, remember that the code descriptions for endoscopic ultrasound refer specifically to the ultrasound probe, and the depth to which it is inserted.  A complete esophagogastroduodenoscopy has to be performed prior to the EUS in order to correctly choose a code from this section as evidenced by the code format contained in the CPT book.

CODES WITH THEIR DEFINITIONS:

43235 Esophagogastroduodenoscopy
43237 with EUS limited to esophagus, stomach or duodenum and adjacent structures
43238 with EUS with fine needle aspiration (Includes EUS limited to esophagus, stomach, or duodenum and adjacent structures)
43242 with EUS with FNA (includes EUs of esophagus, stomach, and either duodenum or surgically altered stomach where the jejunum is examined distal to the anastomosis)
43253 with EUS guided transmural injection of diagnostic or therapeutic substance (includes EUS exam of esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis)
43259 with EUS including the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis

For additional uses for EUS, check out Excellent Endoscopy.

Robyn McCoart, RHIT

Managing Auditor, Excite health Partners

DATA- DRIVEN STRATEGIES: REDUCING DUPLICATE RECORDS

Posted by Samantha Serfass on January 21, 2020 in Blog, News

DATA- DRIVEN STRATEGIES: REDUCING DUPLICATE RECORDS

Improving analytics and implementing data-driven strategies are proving to be on the forefront of healthcare organizations agendas. Approximately 88% of hospitals have some sort of data-driven strategy with a dedicated analytic team (1). Value based payment models have forced provider organizations to invest more in data tools and strategies. Some organizations are even trying to monetize their data. New AI capabilities are taking advantage of the large data sets like never before. While a data-driven strategy is important knowing the quality of your data is key.

According to AHIMA, “most hospitals have between 5-10% duplicate medical records and health systems that are multi-facility have an average duplicate rate of 20%” (2). The more complex a health system is, the higher percentage of duplicate records can be found. A prime example occurred in Houston, TX. In 2016, Harris Health System reported 2,488 records with the name of “Maria Garcia”— of those records, 231 shared the same birthdate (3). Recording and analyzing the data is crucial to help identify and eliminate duplicate, incomplete or overlapping data from the system.

Reducing the amount of duplicate data can help reduce the total spend. The expense of a duplicate medical record costs on average $800 per Emergency Department visit and upward of $1950 per Inpatient stay. It can cost a hospital on average $1.5 million, and throughout the industry the cost is estimated at over $6 billion (4).

Identifying why the duplicate medical record occurred is vital to decrease issues. Duplicate medical records are created as a result of patient identification errors, which typically occur during the inpatient registration. However, errors in both the Emergency Department and Outpatient Clinics can contribute to the error rate. Although biometric devices prove useful to initially identify patients, the issue lies within the registration system.

Registration systems often do not leverage advanced logic to help identify an existing patient. A simple error such as a misspelled name can result in an incorrect, duplicated medical record. This error could potentially end up costing the hospital around $1950.

At Excite Health Partners, we understand the importance of quality data. We work to implement solutions leveraging advanced logic (similar to Google searches) to ensure the right patient is found within your EHR.

Regardless of the presence of biometrics, our team of experienced professionals work efficiently to integrate the solutions within your environment. Our approach reduces patient check-in time, producing a positive RIO for the organization. Improving the quality of data and decreasing the cost of errors, Excite Health Partners has the best fit solutions for your organizational needs.

Todd Klein

CIO VP of EHR Services & Digital Services

Sources:

  1. Health IT Analytics
  2. AHIMA
  3. Lab Soft News
  4. Black Book Market Research