General

IN THE KNOW: CODING THE PETERSEN SPACE

Posted by Samantha Serfass on October 28, 2019 in General

In The Know: Coding the Petersen Space

Did you know that an internal hernia can occur in a Petersen space? But what is a Petersen space?

Petersen space is the defect space that can sometimes occur in the mesentery between the alimentary loop of a gastrojejunostomy and the lower part of transverse colon mesentery after a gastric surgery.1

One of the complications that can arise following any type of gastrojejunostomy is a Petersen space hernia.

A Petersen space hernia can develop “when the intestinal loops protrude through the defect between the small bowel limbs, the transverse mesocolon and the retroperitoneum.” 2

The hernia can occur anywhere from days to years after a gastric bypass.

Because it is an internal hernia, it is usually not visible thru the abdominal wall (i.e. protrusion like ventral hernias or umbilical hernias) and symptoms include severe abdominal pain and sometimes obstruction.1

Because of the increasing prevalence of gastric bypass, the occurrence of a hernia in Peterson’s space is more common than it used to be.  Prior to this, it was typically only seen in the small amount of cases where a bypass was performed after gastric resection for things like severe ulcers and stomach cancer.

How do you code repair of a Petersen Space hernia?

In the coding scenario for a laparoscopic repair of an internal Petersen space hernia presented in AHA Coding Clinic for ICD-10-CM/PCS, First Quarter 2018, the correct ICD-10-CM PCS code would be “0DQV4ZZ Repair of mesentery, percutaneous endoscopic approach.” 3

If an open repair of the mesentery is performed for a Petersen Space hernia the appropriate PCS code would be 0DQV0ZZ Repair of mesentery, open approach.

Be sure and read the whole Operative Report description of the procedure for accurate code assignment.

Lorrie Strait, RHIT, CCS

Manager HIM Services

References:

1. https://www.ncbi.nlm.nih.gov › pmc › articles › PMC319962

2. https://www.sciencedirect.com/science/article/pii/S2210261211000447

3. AHA Coding Clinic for ICD-10-CM/PCS, First Quarter 2018

Desktop Support Engineer

Posted by Samantha Serfass on August 29, 2019 in Additional Vendors, General, Job

Desktop Support Engineer
Evansville, IN

Since 2010, Excite Health Partners has been a growing leader in the Healthcare consulting and staffing industry. We are committed to the development of the HIT industry, which is why we ensure our employees are educated, prepared and confident. We understand our employees are the backbone of our company, so we work to find the best fit position for each of our unique professionals.

Qualifications
At Excite, we want you to succeed. We want to help you reach your goals and find a satisfying and challenging work environment. For the Desktop Support Engineer position, you should meet the following criteria:

  • At least 3 years desktop or network support experience
  • Technical background experience
  • Basic Technical Certified (A+ or Network +etc.)
  • Previous experience with installation/support for hardware, operating systems & computer software
  • Troubleshoot network & server issues
  • Offer Tier 2 support for entire Network
  • EMR/ Healthcare experience, preferred
  • Strong verbal, organizational and written skills
  • Bachelor’s degree or related field experience

Joining the Team
Excite understands that employees are the cornerstone to our success. We are proud to offer the following benefits:
• Competitive compensation
• Health, Vision, Dental plan
• Life and long-term disability
• 401k plan with designated company match
• Weekly pay

Epic Integration Leader

Posted by Samantha Serfass on August 28, 2019 in Epic, General, Job

Epic Integration Leader

Detroit, MI

Since 2010, Excite Health Partners has been a growing leader in the Healthcare consulting and staffing industry. We are committed to the development of the HIT industry, which is why we ensure our employees are educated, prepared and confident. We understand our employees are the backbone of our company, so we work to find the best fit position for each of our unique professionals.

Qualifications

At Excite, we want you to succeed. We want to help you reach your goals and find a satisfying and challenging work environment. For the Epic Integration Leader position, you should meet the following criteria:

  • At least 3 years Epic Integrations experience (at multi-hospital system)
  • Experience implementing new Epic modules
  • Experience managing and overseeing interface configurations based on specific workflows
  • Experience coordinating and supervising logistics
  • Strong critical thinking and leadership skills

Joining the Team

Excite understands that employees are the cornerstone to our success. We are proud to offer the following benefits:

  • Competitive compensation
  • Health, Vision, Dental plan
  • Life and long-term disability
  • 401k plan with designated company match
  • Weekly pay

Cerner CoPath Analyst

Posted by Samantha Serfass on June 11, 2019 in General

Cerner CoPath Analyst

Pittsburgh, PA

Since 2010, Excite Health Partners has been a growing leader in the Healthcare consulting and staffing industry. We are committed to the development of the HIT industry, which is why we ensure our employees are educated, prepared and confident. We understand our employees are the backbone of our company, so we work to find the best fit position for each of our unique professionals.

Qualifications

At Excite, we want you to succeed. We want to help you reach your goals and find a satisfying and challenging work environment. For the Cerner CoPath Analyst position, you should meet the following criteria:

Joining the Team

Excite understands that employees are the cornerstone to our success. We are proud to offer the following benefits:

  • Competitive compensation
  • Health, Vision, Dental plan
  • Life and long-term disability
  • 401k plan with designated company match
  • Weekly pay

Breaking Down Denials: CC/MCC Denials

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

BREAKING DOWN DENIALS: CC/MCC DENIALS 

When someone in the healthcare industry hears the word “denial”, many things can come to mind.  There are many different types and kinds of denials; what could be said about denials could fill a book. To narrow the conversation, let’s touch on one specific type of denial that has become more prevalent for hospitals in recent years. 

A documented and coded diagnosis acting as a CC or MCC for the DRG is denied by the payer with the claim that the clinical picture does not support that it is a true and valid diagnosis.  By removing the diagnosis code, the DRG is reduced, resulting in a reduced payment to the hospital.

This type of denial has been called various things which can create confusion when assigning the appropriate person to address it.

A few examples are:

  • “clinical denials” which could also mean denial of admission to an inpatient bed stating the patient’s clinical picture does not warrant inpatient care
  • “DRG denials” which could also mean the entire admission was denied, not just a denied diagnosis changing the DRG
  • “Coding denials” which tends to sound like this is a coder issue when in fact it is not a coding issue at all

Payers have learned how to target the types of inpatient discharges that lend well to this type of challenge.  Common targets include DRGs with a single CC or MCC where the CC or MCC is acute renal failure/injury, acute respiratory failure, encephalopathy, malnutrition, or sepsis.

If this is not a coding specific issue, then where does the problem lie?  The Center for Medicare and Medicaid Services (CMS) has not stated any one criterion as the official clinical criteria for all to follow.  As a result, many payers including the RACs have created their own criteria or adapted existing criteria in the industry such as AKIN (Acute Kidney Injury Network), RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease), or KDIGO (The Kidney Disease: Improving Global Outcomes).  Providers most often do not know what individual payer criteria is being used.  Physicians have not been educated on when additional documentation is needed to support certain conditions that they diagnose and document. 

The coding teams are stuck in the middle.   Facilities can trend what different payers are targeting and the basis of their denials.  Armed with this information, coders still cannot diagnose the patient.  Even with outlined criteria to follow, conditions documented in the record and not ruled out cannot be ignored by the coder.  The coder cannot make the determination that a documented diagnosis is not valid and choose not to code it. 

What’s a hospital to do?  Hospitals should create a team to review these types of denials and fight back whenever possible.  Some hospitals have taken the extra steps to create internal clinical guidelines to give direction and promote consistency; however, payers may still deny diagnoses based on their own criteria.  Offer as much education on the issue as possible to physicians, CDI staff, and coders.

Who should review and argue the cases? The best person to review these denials and write up an appeal letter would be the very person that documented the diagnosis in question, the physician.  However, it is a rare hospital that has a medical staff member with the time and willingness to do so.  So, the task should fall to someone with strong writing skills with a clinical background that can create a strong argument in support of a documented diagnosis by outlining the patient’s clinical picture in detail.

From a different angle: Coding was initially created for the primary purpose of statistics and research.  Coded data can play a key role in value-based care and other programs based on patient care outcomes and quality of care indicators.  While Official Coding Guidelines offer clear direction on when to assign a secondary diagnosis code, the guidelines could be a part of the problem.  The guidelines state additional conditions are coded when they affect patient care by requiring clinical evaluation, therapeutic treatment, diagnostic procedures, they extended the length of stay, or necessitate increased nursing care and/or monitoring.  But what the guidelines neglect to include are conditions that create a patient health risk for the future.

One example includes patients with morbid obesity that decline nutritional counseling or any other type of intervention.  Because the condition is not being addressed, some payers are denying it as a secondary code/s.  As patients develop obesity related conditions in the future, there will be limited data for research of obesity related health problems because the condition of obesity is not being coded now.  This also could create a problem with quality of care analysis when patients’ conditions are uncontrolled due to unaddressed obesity such as diabetes, respiratory conditions, joint problems, and cardiac disease.

 Every denial should be reviewed and where possible and appropriate, challenged.  Payers may tend to target facilities that do not argue or fight back.  Do not accept a payer’s denial at face value.  Review the case.  If there is enough clinical support in the record to argue, do so.  The continued challenge is what constitutes “enough clinical support”?  Not even CMS answers that for us.

Lisa Marks

VP of HIM Services

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

Senior Project Manager- Shaker Heights, OH

Posted by Samantha Serfass on January 7, 2019 in Additional Vendors, General, Job

Senior Project Manager – Shaker Heights, OH

Since 2010, Excite Health Partners has been a growing leader in the Healthcare consulting and staffing industry. We are committed to the development of the HIT industry, which is why we ensure our employees are educated, prepared and confident. We understand our employees are the backbone of our company, so we work to find the best fit position for each of our unique professionals.

Qualifications

At Excite, we want you to succeed. We want to help you reach your goals and find a satisfying and challenging work environment. For the Senior Project Manager position, you should meet the following criteria:

  • At least 7 years of project management experienced, required
  • Project Management Professional (PMP), preferred
  • Build and implement Lean process workflows – project & portfolio management
  • Identify and resolve issues and conflicts within various project teams
  • Assist department talent management: talent selection, conduct performance reviews, maintain team dynamics
  • Strong communication, organizational and leadership skills
  • Bachelor’s degree or related field experience

Joining the Team

Excite understands that employees are the cornerstone to our success. We are proud to offer the following benefits:

  • Competitive compensation
  • Health, Vision, Dental plan
  • Life and long-term disability
  • 401k plan with designated company match
  • Weekly pay

IP/OPS Coder – Remote

Posted by Samantha Serfass on November 6, 2018 in General

Remote IP/OPS Coder

Remote

Since 2010, Excite Health Partners has been a growing leader in the Healthcare consulting and staffing industry. We are committed to the development of the HIM industry, which is why we ensure our employees are educated, prepared and confident. We understand our employees are the backbone of our company, so we work to find the best fit position for each of our unique professionals.

Qualifications

At Excite, we value your unique background and want to be sure your experience matches the job. For the Remote IP/OPS Coder position, you should meet the following criteria:

  • Must have at least 3 years working with Epic, 3M 360
  • Must have 3-5 years’ experience in IP-DRG coding
  • Must have 1-2 years’ experience in SDS and OBS coding
  • Level 1 trauma experience preferred, but not required
  • Must be AHIMA (RHIA, RHIT, CCS) certification

Joining the Team

Excite understands that employees are the cornerstone to our success. We are proud to offer the following benefits:

  • Competitive compensation
  • Health, Vision, Dental plan
  • Life and long-term disability
  • 401k plan with designated company match
  • Weekly pay
  • Direct deposit

TBI: Coding Traumatic Brain Injuries

Posted by Samantha Serfass on August 21, 2018 in Blog, General

TBI: Coding Traumatic Brain Injuries

The correct coding of Traumatic Brain Injury (TBI) can cause confusion… no pun intended. The coder needs to understand not only the definition of a Traumatic Brain Injury, but also must recognize the difference between coding a Personal History of TBI and reporting a residual condition or sequela, that is a result of a TBI.

The Centers for Disease Control and Prevention (CDC) defines TBI as a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury.  Severity may range from mild to severe. Disabilities resulting from a TBI depend upon the severity of the injury, the location of the injury, and the age and general health of the individual.   All TBI’s are serious injuries, as they are brain injuries.  Oftentimes, the brain can be left with areas that are irreversibly damaged. Each year, TBI’s contribute to a substantial number of deaths and cases of permanent disability. There are various types of residual effects that a person can exhibit after the acute phase of the injury has ended.

In ICD-10-CM the term “Late Effect” has been replaced with “Sequela”. A sequela is the residual effect after the acute phase of an illness or injury has ended.  There is no time limit for use of a sequela code. The code for the acute phase of the illness or injury that led to the sequela is never reported with a code for the sequela.

Coding of Sequela requires 2 codes:

The nature of the sequela is sequenced first, with the sequela codes sequenced second.

Additional guidelines for reporting sequela of injuries:

The code that describes the sequela is reported 1st, followed by the code for the specific injury with a 7th character “S”, to identify the condition as a sequela of the injury.  The “S” is added only to the injury code.

 

Example:

Patient experienced a fall down steps, with loss of consciousness, resulting in a traumatic subdural hemorrhage. Physician documents injury occurred 3 years ago.. There are no apparent sequela, late effect, or residual conditions.

Assign code:  Z87.20   Personal History of Traumatic Brain Injury

 

Same patient, but documentation supports patient has a mild cognitive impairment as a result of the previous TBI.

Assign Codes:  G31.84  Mild Cognitive Impairment, so stated

                           S06.5X9S  Traumatic Subdural Hemorrhage with Loss of Consciousness of Unspecified Duration, Sequela.

 

Please note:

“Codes from categories Z85 through Z92 are used to indicate a personal history of a previous condition. When the condition mentioned is still present or still under treatment, or if a complication is present, a code from the series Z85 through Z92 is not assigned.”

Reference:

Format and Conventions and Current Coding Practices for ICD-10-CM and ICD-10-PCS

Z Codes & External Cause of Morbidity Codes/Codes Representing Patient History, Status, or Problems

Software Spotlight: McKesson

Posted by Samantha Serfass on January 5, 2018 in Blog, General

 Spotlight on McKesson

August Software Spotlight: McKesson

McKesson

McKesson Corporation is a healthcare information technology, medical-surgical supplies and pharmaceutical distributor. As a healthcare information technology distributor, McKesson provides numerous healthcare entities with electronic medical records, data analyses, and facility management software.  The company was founded in 1833 by John McKesson and Charles Olcott and was originally called Olcott & McKesson.  Olcott & Mckesson was originally based in New York and created to sell imported chemicals and therapeutic drugs.

Now, McKesson is headquartered in San Francisco and employees over 76,000 people. They are the largest healthcare services corporation in the nation with more than $179 billion in annual revenue.  The corporation, which is ran by CEO John Hammergren, has one of the highest annual sales in the United States.  McKesson bases their business practice around shared values.  According to www.mckesson.com, “McKesson is in business for better health. As a company working with health care stakeholders in every setting, we are charting the course toward a stronger, more sustainable future for the entire industry.”

5 interesting facts about McKesson:

  1. McKesson is the oldest healthcare services corporation in the United States.

 

  1. In 2015, McKesson was ranked 11 on Fortune 500

 

  1. 50% of hospitals in the United States, 20% of physicians and 100% of health plans are served by McKesson

 

  1. According to McKesson.com, they are number 1 in medical-management software and services to payers.

 

  1. McKesson is one of seven founding members of CommonWell Health Alliance. Which, according to commonwellalliance.org, is an organization that is “creating and executing a vendor-neutral platform that breaks down the technological and process barriers that currently inhibit effective health data exchange.”