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PROTECTING YOUR NETWORK AGAINST CYBER ATTACKS

Posted by Samantha Serfass on October 8, 2019 in Blog, News

PROTECTING YOUR NETWORK AGAINST CYBER ATTACKS


With security as an increasing focus in the healthcare space, CIO’s and CTO’s spend significant time ensuring the safety and privacy of patient information. However, the varying degrees of security attacks and privacy concerns leave IT specialists and stakeholders with a never-ending list of concerns.

Types of Security attacks (although not an all-inclusive list):

  • ADVANCE PERSISTENT THREATS (APT) – a security threat to the network remaining undetected for an extended period of time, most common when the data is of high-value.
  • AI ATTACKS – an attack which can automate identity, crack passwords and DOS making these attacks much more formidable.
  • DISTRIBUTE DENIAL OF SERVICE (DDoS) – the goal is to deny access to the server by overwhelming the target system by flooding it with network traffic.
  • MALWARE – a stealthy approach, without end-users knowledge, to put code on a device (i.e.: Trojan Horse).
  • PASSWORD ATTACK – an unsecured source attempting to break in or obtain a user’s password.
  • PHISHING – Social engineering to obtain information or approval to run code on a device.  C-suite you’re a Favorite target for an attach like this.
  • PHYSICAL SECURITY & DRIVE BY ATTACK – an unsecured wireless environment allowing threats to easily attack the system.
  • RANSOMWARE –blocks access to date with the threats to permanently compromise the data unless a ransom is paid.

Social engineering is the foundation of several attacks. These attacks occur when a source acts as a trusted advisor gaining access to codes and passwords for various devices. These attacks provide the source with the ability to obtain damaging information and/or create a foothold in the network to further exploit security issues.

IT and cyber-attacks in the healthcare industry rate as one of the most damaging and costly occurrences compared to other industries. As a whole, the healthcare industry spends an estimated $6 billion dollars a year dealing with security attacks and breaches.

According to one of the latest Becker’s reports, more than 5 million US patients can be accessed online by just a basic web browser. The below diagram published by the HIPAA Journal, shows rise in the number of reported data breaches.

Image from: HIPAA Journal

Steps to prevent a security break and ensure the privacy and safety of information is secure is a fraction of what an organization could lose in a cyberattack. Addressing these five items can help to eliminate the possibility of future threats and attacks.

  1. NETWORK ACCESS: Access to the network can be as easy as identify the SID (Security Identify) and a password breaker available on the internet for free. Make sure the wireless connection doesn’t advertise the SID and that communications are encrypted.  Using an advanced authentication protocol as the environment will handle like a Kerberos and Network Encryption protocols like IPsec will help safeguard the network.
  2. PROFESSIONAL INSTALLATION: Hiring highly qualified staff to administer the network and DMZ (the entry way into your network from public networks). This will ensure firewalls, protocol and port analyzers are proactivity looking for breaches. Conducting a penetration by a 3rd party will also confirm safety measures are correctly in place.
  3. SECURE DEVICES: Ensure the network and PC devices are locked down. Leveraging bio identification technology or a 3rd party code generator for two-factor authentication will help improve overall security of the system. Utilize a three-factor authentication and additional security to access addition data or performing sensitive activation (i.e. ordering narcotics) is also another way to safeguard high-valued information.  Lastly, having end-users security policies in place and enforced will also increase protection.
  4. 3rd PARTY ASSISTANCE: Use 3rd parties who specialize in healthcare security when necessary. It’s important to include security that covers the protection of medical devices and patient devices/wearables such as heart monitors.

At Excite Health Partners we use consultants and partners who specialize in Healthcare IT.  We can perform assessments to ensure the environment and the patient’s data is well protected. 

Todd Klein, CIO VP of EHR Services & Digital Solutions

ASSIGNING & SEQUENCING: ADDRESSING PAIN CODES

Posted by Samantha Serfass on September 23, 2019 in Blog, News

Assigning & Sequencing: Addressing Pain Codes

Codes to define pain were present in ICD-9-CM, first being published in 2006.  Prior to this, most alphabetical index entries directed the coder to index pain, by site or the underlying cause of the pain.  The codes were created specifically to reflect treatment of pain only, such in cases of pain management.  Although the guidelines have not changed through the years, there is still some confusion about coding and sequencing pain codes.

The first rule of successfully utilizing the pain codes is to follow the alphabetical and tabular index, and to understand the guidelines. 

In the alphabetical index under PAIN, there is a subheading for “acute” which leads the coder to code R52 Pain, Unspecified.  However, listed under R52 is a list of EXCLUDES 1 notes for acute and chronic pain, not elsewhere classified (G89.-) and also localized pain, unspecified type which directs the coder to code to pain, by site (i.e., abdominal pain R10.-; back pain M54.9, etc.)

Under the G89.- section, there are very specific entries for types of pain:

  • G89.0    Central Pain Syndrome
  • G89.1    Acute pain, not elsewhere classified
  • G89.11  Acute pain due to trauma
  • G89.12  Acute post-thoracotomy pain
  • G89.18  Other acute postprocedural pain
  • G89.2    Chronic pain, not elsewhere classified
  • G89.21  Chronic pain due to trauma
  • G89.22  Chronic post-thoracotomy pain
  • G89.28  Other chronic postprocedural pain
  • G89.29  Other chronic pain
  • G89.3    Neoplasm related pain (acute)(chronic)
  • G89.4    Chronic pain syndrome

Other than Central Pain Syndrome and Neoplasm Related Pain, correct code assignment relies on clear physician documentation of “acute” or “chronic” to assign a code from this section.    

When a patient presents and is admitted specifically for pain control, the coder may sequence the pain code as principal diagnosis (or first listed).  An example of this would be:  a patient with lung cancer (previously resected) with metastasis to brain and bone is admitted for treatment of his bone pain caused by the metastasis.  There is no treatment directed at the cancer itself (i.e., chemotherapy or radiation therapy) so the coder may sequence Neoplasm-related pain, G89.3, as the principle diagnosis followed by the neoplasm codes.  As evidenced by the tabular index, the physician does not need to specify whether the pain is acute or chronic, as both of these are designated nonessential modifiers after the code description.

If the patient presents for attention to the site of the pain for further clinical work-up or any reason other than primary pain control, then the site of the pain is coded, and depending on the documentation an additional code from the G89.- section may be used. 

For example: a patient has a fracture of the ulna and had recently undergone a reduction of the fracture with casting.  The patient returns with complaints of acute pain at the site of the fracture.  After x-ray it is found that the fracture has slightly displaced, so another reduction and casting is performed.  The code for the ulnar fracture would be sequenced first, and the code G89.11 Acute pain due to trauma may be coded as a secondary diagnosis. 

Likewise, if a patient presents to the emergency department for acute abdominal pain, it is not appropriate to assign a code from G89- as the physician did not specify the acute pain as being due to trauma, post-thoracotomy, or other postprocedural pain.  This is an instance where the coder would assign the code for site of the pain (abdomen) only.

There are two chronic pain codes, G89.2 Chronic pain, not elsewhere classified, and G89.4 Chronic pain syndrome, which is described as chronic pain associated with significant psychosocial dysfunction.  Pain with psychosocial dysfunction typically means pain that is so debilitating that it interferes with activities of daily living and has resulting psychological disorders such as depression.  Again, the physician documentation must be very clear in noting that the patient has chronic pain syndrome in order to assign this code.

In summary, pain codes can be very helpful in further defining the type or extent of pain a patient is experiencing and give a clear picture of the focus of treatment and utilization of resources.  The coder must carefully review the documentation in order to determine if it is appropriate to assign a code from category G89, and then which code within that category should be used.

Robyn McCoart, RHIT

Managing Auditor, Excite Health Partners

DATA ABSTRACTION: DECREASING PROJECT SETBACKS

Posted by Samantha Serfass on September 12, 2019 in Blog, News

DATA ABSTRACTION: DECREASING PROJECT SETBACKS

Healthcare systems face several types of chart demands when focusing on abstraction projects. From abstracting patient data in an outpatient setting prior to Go-Live, to abstracting medication for in-hospital patients before activation – the list of abstracting needs is ever changing.

With the increase of Mergers & Acquisitions, converting charts and patient information from one system to another has been a key focus for many healthcare systems. While abstraction projects can face several challenges, remote abstraction projects bring their own set of unique problems.

Technology is a major obstacle to tackle during remote projects. Excite established a “Remote Hardware Requirement Guide” that helps to ensure all professionals have the proper elements needed for the remote project.

Although issues with internet providers can generate issues, ensuring all hardware requirements are up to standards will help eliminate numerous problems. Increasing technical resources on a remote abstraction project can also help free up the health system’s help desk when issues arise.

Clinical resources are an important factor in eliminating issues during a remote abstraction project.

By creating a collaborative environment, these resources can double check the work output is performed correctly.

Refining internal processes and tools to improve efficiency between management and teams also helps decrease issues. Progress trackers are setup to monitor each patient’s chart so abstractors can input the data into the new EMR system. Daily progress reports are another key element to track the project’s development. Project management tools like “burn down charts” allow leadership teams to track and monitor the teams progress and issues.

It’s important to continue to document, communicate, and adapt during abstraction projects. Excite Health Partners recently worked with a healthcare system to remotely support their abstraction needs, through our experience and expertise we have the resources to help with various abstraction project demands.

Todd Klein, CIO VP of EHR Services & Digital Solutions

HEALTH INFORMATION MANAGEMENT: CODING ANXIETY

Posted by Samantha Serfass on August 28, 2019 in Blog, News

HEALTH INFORMATION MANAGEMENT: CODING ANXIETY

Anxiety is a normal and often healthy emotion. However, when a person regularly feels disproportionate levels of anxiety, it may become a medical disorder. Anxiety is often described as a feeling of worry, nervousness, or unease. Typically, these feelings occur when faced with an imminent event which is often an event with an uncertain outcome.

 Factors that put people at risk of an anxiety disorder are:

  • Chemical imbalances
  • Long-lasting stress
  • Family history of anxiety
  • Trauma
  • Abuse of biological agents such as alcohol, drugs, or prescription medication.

Common medical conditions that may cause anxiety include asthma, diabetes, heart disease, hyperthyroidism, and hypothyroidism. Proper documentation of anxiety disorders is the key to capturing the patient’s condition in ICD-10-CM. Most often, the physician simply documents anxiety in the patient’s record. The U.S. Department of Health and Human Services recognizes five major types of anxiety disorders, and each have ICD-10-CM diagnosis codes.  

Generalized Anxiety Disorder (GAD)

GAD is an anxiety disorder characterized by chronic anxiety, exaggerated worry and tension.  This can be present even when there is little or nothing to provoke it. 

Obsessive-Compulsive Disorder (OCD)

OCD is an anxiety disorder that is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors may include frequent hand washing, counting, checking, and cleaning.

Panic Disorder

Panic disorder is an anxiety disorder that is characterized by unexpected and repeated episodes of intense fear which can be accompanied by physical symptoms such as chest pain, heart palpitations, shortness of breath, or dizziness.

Post -Traumatic Stress Disorder (PTSD)

PTSD is an anxiety disorder that can develop after exposure to a terrifying event or ordeal.  These events often may involve grave physical harm which occurred or was threatened.  Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat. 

Social Phobia (or Social Anxiety Disorder)

Social Phobia, or Social Anxiety Disorder is an anxiety disorder that is characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations.  It can be limited to only one type of situation such as fear of public speaking or fear of eating in front of others.  In its most severe form, this disorder may cause a person to experience symptoms anytime they are around other people.

A physical examination and a psychological evaluation are necessary to make a diagnosis of anxiety. Sequencing anxiety codes will depend on the circumstance of the admission and the physician’s documentation in the medical record. While anxiety appears normally in everyday life and is useful when alerting a person to danger, it can become concerning when it disrupts normal activities.

Cynthia Alder-Smith, RHIT CCS

Auditor/ Educator Excite Health Partners

Mergers and Acquisition: Improving The Bottom Line

Posted by Samantha Serfass on August 19, 2019 in Blog, News

Mergers & Acquisition: Improving The Bottom Line

The transition from volume-based care to value-based care has been a driving force in the rise of merger and acquisitions in the recent years. Mergers and acquisitions allow organizations to tighten operations, streamline services and increase revenue. Many of the mergers and joint ventures are changing reimbursement models to cover the health of a populations all while reducing costs.

When merging two organization in ACO model, efficiency is key. An organization focusing on leveraging technology and increasing patient engagement is better suited to accommodate the public while targeting costs for the ACO.

Integration conversations are an important component surround mergers & acquisition. Integrating operations, IT assets, and supporting services as well as sharing of data between the two originations are vital pieces to consider. 

S.W.O.T Diagrams of each of the organizations can assist in developing the pieces of the puzzle when combining organizations. Identifying areas of weakness allow for additional partnerships to form strengthening the needed services. As healthcare organizations become larger and broader, niche services have the opportunity to accommodate certain patient populations. By increasing the patient satisfaction and leveraging technology, these services have the opportunity to be more efficient

Excite Health Partners is working with such a company right now.  By increasing patient engagement and satification, this organization excels in skill nursing services. As a result, they are purchasing service lines from healthcare organizations throughout the U.S.

Excite has also assisted a company by abstracting patient data. By scheduling the integration discussions in timely manner, Excite has helped to abstract data from three different EHR systems and able to populate all the data into our clients single EHR.

Whether it comes to strategic analysis, patient engagement, leveraging technology or just brute physical abstracting, Excite Health can be your Partner for your M&A.

Todd Klein

CIO, VP of EHR Services & Digital Solutions

INPATIENT CODING: DEFINING ‘PRESENT ON ADMISSION’

Posted by Samantha Serfass on July 24, 2019 in Blog, News

Inpatient Coding: Defining ‘Present on Admission’

In today’s rapidly developing pay-for-performance healthcare environment, collection, quality, and interpretation of present on admission (POA) indicators continues to play a key role in the inpatient coder’s responsibilities.

What is POA?

POA is defined as a condition that is present at the time the order for inpatient admission occurs. Conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery, are considered to be POA.

Coding options

Providers must report one of five indicators:

  • Y = yes (present at the time of inpatient admission)
  • N = no (not present at the time of inpatient admission)
  • U = unknown (documentation is insufficient to determine if condition was present at the time of admission)
  • W = clinically undetermined (provider is unable to clinically determine whether condition was present on admission)
  • 1 (on electronic claims) or blank (for paper claims) = exempt from POA reporting

The importance of documentation

Ideally, a physician works with hospital staff and coders to determine the best way to communicate POA information. POA indicators are assigned to principal and secondary diagnoses and external cause injury codes.  One recommendation is for physicians to simply put ‘POA’ in their notes next to their diagnosis. The Centers for Medicare and Medicaid Services (CMS) has suggested that the discharging physician clearly indicate in the discharge summary which of the conditions were or were not present on admission.

The Deficit Reduction Act of 2005 mandated that providers report POA indicators for all diagnoses submitted on Medicare inpatient acute care claims for discharges beginning October 1, 2007.  One year later, CMS announced that it intended to stop paying the costs of treating what it deemed to be preventable inpatient complications (Medicare No-Pay List).  This was a controversial move since the responsibility then fell to physicians and hospitals, not up to Medicare, to resolve documentation that is inconsistent, missing, conflicting, or unclear.

Like other coded data, the POA indicator is increasingly used for multiple purposes – reimbursement, clinical research, financial planning and quality of care evaluation. Successfully implementing POA reporting requires educating physicians and hospital staff on their roles in correct POA assignment.

If the coder encounters POA documentation that is unclear, they must query the provider. The physician is responsible for resolving the insufficiency.

Cynthia Alder-Smith, RHIT CCS

Auditor/ Educator Excite Health Partners

ADVISORY SERVICES: THE IMPORTANCE OF TECHNOLOGY AND STRATEGIC PLANS

Posted by Samantha Serfass on July 11, 2019 in Blog, News

Advisory Services: The Importance of Technology and Strategic Plans

Today, Advisory Services are becoming more prominent in the healthcare industry. Outside companies with experienced consultants offer organizations assistance with strategic initiatives and plans. Hospitals across the nation are creatively leveraging technology to offer more effective patient outcomes.

For example, Sentara Healthcare is working to advance the use of 3D printing. By utilizing the 3D printing technology, Sentara’s goal is to print an organ to allow doctors to assess the issues prior to surgery. University of Maryland Medical Center also is incorporating the latest technology into their medical advances – in April, the first organ delivery by drone was made to the hospital. Likewise, Hartford Hospital is leveraging advanced technology to assist with procedures. Hartford utilized 8 surgical robots to support heart, urological and gynecological surgeries and procedures.

Selecting the right outside help is key to utilizing the latest technology or developing a strategic plan/digital road map. Advisory consultants need to not only be knowledgeable of the latest technology but understand their impact in order to increase efficiency and patient outcomes. Understanding the benefits and impacts patient engagement have in an ACO model is an example of important aspects to consider when advising clients on initiatives and priorities.

Developing a strategic plan that supports a hospitals vision requires experienced consultants and fluid communication with the leadership of a hospital system.  Once a plan is finally developed, performing the system selection and portfolio management are paramount for patient and provider satisfaction.

The focus during Portfolio Management should on the core and strategic IT services needed by the healthcare system. This will help to support the IT Strategic plan over the next 3 to 5 years. The objective should be to reduce the number of applications allowing for a decrease in cost and increase in patient and user satisfaction.  

There are several different approaches for how a healthcare system can evaluate and select a vendor solution.  However, identifying the primary and secondary requirements is an important first step.  These requirements may include integration and storage capabilities, mobile device options, as well as features and functions within the application.  It’s vital to understand the strengths, weaknesses, opportunities and threats (SWOT) of each application within the healthcare system’s environment.

Through Excite’s Advisory Services, we can help your organization utilize the latest technology and develop a strategic plan to support the system. By evaluating current state environments, digital and automation initiatives, support models, project management offices and strategic plans, Excite works with you to develop each area to perform at their optimal level and provide guidance to your organization. 

Todd Klein

CIO, VP of EHR Services & Digital Solutions

CODER KNOWLEDGE: UV AWARENESS & SKIN CANCER

Posted by Samantha Serfass on June 25, 2019 in Blog, News

Coder Knowledge: UV Awareness & Skin Cancer

Next month is designated as UV Safety Awareness Month which comes as no surprise.  July is the month of summer vacations, trips to the beach, summer sports and outdoor yard work. 

Did You Know? 

Skin cancer is more and more common.  In fact, according to the American Cancer Society it has become the most frequently diagnosed form of cancer in the U.S.  The Skin Cancer Foundation notes that every year there are “more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon.”

Contributing factors

  1. Skin is the largest organ in the human body.
  2. The UV index is changing due to a diminished ozone layer.
  3. Patient awareness lags other, more publicized cancers.

Basal cell and squamous cell carcinomas are the most common forms of skin cancer, melanoma has the highest mortality rate. Skin cancer can be caused by too much exposure to ultraviolet (UV) rays from the sun and other sources, such as tanning beds and sun lamps. 

However, the good news is we can take highly preventative measures to decrease our risk.  During UV Safety Month, make it your practice to follow the index levels and associated protection recommendations. 

UV Index Recommended Protection
Extremely High (11+) Sunscreen, sunglasses, hat, shade, indoors from 10 a.m. until 4 p.m.
Very High (7-10) Sunscreen, sunglasses, hat, shade
High (6-7) Sunscreen, sunglasses, hat, shade
Medium (3-5) Sunscreen, sunglasses, hat
Low (0-2) Sunscreen, sunglasses

Coder Knowledge: Cell Type Matters

Clinical coding of skin cancers is based on two key factors: the type of cell involved and the anatomical site.  As mentioned above basal and squamous sell are the most common.  These types of skin cancers are often treated topically in the physician’s office and require minimal coding expertise.  However, melanoma is more invasive, and treatment typically includes a hospital encounter with radical wide excision, skin grafts, and lymph node excision.

Example Chapter 2 Index

        C44.11 Basal cell carcinoma of skin of eyelid

                  C44.111 Basal cell carcinoma of skin of unspecified eyelid

                   C44.112 Basal cell carcinoma of skin of right eyelid

                   C44.119 Basal cell carcinoma of skin of left eyelid

        C43.1   Malignant Melanoma skin of eyelid

                    C43.10 Malignant melanoma of unspecified eyelid

                    C43.11 Malignant melanoma of right eyelid

                    C43.12 Malignant melanoma of left eyelid

In ICD-10-CM, body sites are specific to site and type of skin cancer.  They require documentation of laterality for paired organs such as ears, eyes and upper and lower limbs. Physician documentation is key to specificity.

Denise Bell, CCS

Auditor/Educator

MANAGED SERVICES: REDUCING COST & INCREASING VALUE

Posted by Samantha Serfass on June 11, 2019 in Blog, News

Managed Services: Reducing Cost & Increasing Value

Today’s IT department is supporting so many initiatives:

  • Adapting to New Payment Models
  • Improved Provider & Patient Experience
  • Population Health
  • Clinical Integration
  • Performance Improvement

It’s difficult to staff projects to accommodate the demands, timeframe, and budget all while providing the expected quality of work from your organization. As the continued trend for IT department spend continues to reduce, finding solutions for highly qualified staff and accommodating the CFO becomes more challenging.  Staffing is typically around 50% of the IT budget or higher.  Today many hospital systems are leveraging Managed Services to reduce their spend by 30% or more depending on the hospital system.  

Managed Services allow the CIO and IT directors to assign local staff to the strategic projects while working with the user base to decrease tickets with the help of remote staff.   The entryway into the cost saving approach is to find the right partner.  Someone who is dedicated to proving better service then you currently have at lower cost.   Your partner should have no problems providing an SLA (Service Level Agreement) that will meet (or beat) your current IT response time.  Another cost saving approach is to also have your partner in Managed Services take responsibility for on-call / afterhours.  This can either make up for raises the hospital couldn’t afford or reduce the costs for on-call pay with employees.  

Eliminating on-call can be an employee satisfier, in any case employee satisfaction will increase by a allowing resources to get away from the routine tasks of working down tickets and moving to project which are more strategic.  Managed Services can increase resources at the beginning of the engagement to work all application models down to zero. Manage Service can readjust resources to maintain fresh tickets in the que.  Your partner manages the work effort and staffing based on your current and changing needs.  The beauty of Managed Services is employee and end-users are more satisfied. This can help decrease costs and the headaches of adjusting staff levels also is significantly reduced.

Excite Health Partners has the expertise and experience to assist with Managed Services. We can help you explore all the possibilities while tailoring a program that provides you with the best savings and value.

Todd Klein

CIO, VP of EHR Services & Digital Solutions

Recognizing The Symptoms: Coding NASH, The Silent Liver Disease

Posted by Samantha Serfass on May 15, 2019 in Blog, News

NASH – The Silent Liver Disease

Did you know that people can develop liver disease even if they do not drink alcohol?

A condition where fat accumulates in the liver is called nonalcoholic fatty liver disease (NAFLD).

Nonalcoholic steatohepatitis (NASH) is a type of NAFLD where the fat builds up in the liver and leads to inflammation and scarring (cirrhosis), which damages the liver and can become life-threatening.

NASH is called the silent liver disease because most people do not have or notice the signs or symptoms until they are in the more advanced stages. The more advance NASH becomes the more symptoms are noticed or develop. Sometimes the cause of NASH is never known.

 According to the American Liver Foundation, NASH is one of the leading causes of cirrhosis in adults in the United States – up to 25% of adults with NASH may have cirrhosis.

Years ago when a patient that did not use alcohol developed cirrhosis it was termed cryptogenic cirrhosis because the providers had no idea how the patient developed cirrhosis. Occasionally providers will still document it as cryptogenic cirrhosis when the cause has not been determined.

Who can develop NASH? Anyone can develop NASH. NASH is now the most common cause of liver disease in children who are obese. Yes, children are now being diagnosed with chronic liver disease which could lead to them needing a liver transplant.

Typically NASH is suspected when a provider orders routine blood work which returns with abdominal liver enzymes or an imaging test that shows a fatty liver. The only definitive way to accurately diagnosis NASH is doing a liver biopsy. The results will show if there is NASH and will also provide a grade and stage of the disease, inflammation (Grade 1 through 4) and bridging fibrosis (Stage 1 through 4). 

End stage liver disease is monitored regularly. The provider orders routine blood work and uses a Module For End Stage Liver Disease (MELD) Calculator to determine the patient’s MELD score. The MELD Score Range is 6-40 with 40 being severely ill.

SYMPTOMS (per Merck Manual):

  • Most patients do not have symptoms
  • Fatigue
  • Right upper quadrant abdominal discomfort
  • Hepatomegaly can develop
  • Splenomegaly may develop if advanced fibrosis is present
  • Patients who have cirrhosis due to NASH can be asymptomatic

RISK FACTORS (per Merck Manual):        

  • Diabetes
  • Obesity and/or metabolic syndrome
  • High cholesterol
  • High triglyceride levels
  • Hereditary
  • Certain medications

Non-alcoholic liver disease stages

  • Fatty Liver – Deposits of fat, liver can become enlarged
    • Liver Fibrosis – Scar tissue forms, cell injury
      • Cirrhosis – Liver becomes hard from scar tissue, liver unable to work properly

TREATMENT:

Until the disease progresses to end stage and requiring a liver transplant there really are not a lot of treatment options but there are somethings patients can do to manage their NASH. Below is a list of the common things that are recommended by providers. Each patient should go by the plan outlined by their own provider.

  • Weight loss
  • Exercise
  • Healthy Diet – Veggies, Fruits, Lean Protein or Plant Based Protein, Small Amount of Carbs (Best to see a Dietitian)
  • Avoid Alcohol Completely
  • See your provider regularly and stick with the program he or she outlines for you
  • Consistently high MELD score – liver transplant

ICD-10-CM:

Below are some of the ICD-10-CM Diagnosis codes that could potentially be assigned based on provider documentation.

  • Nonalcoholic steatohepatitis (NASH) – K75.81
  • Fatty liver, not elsewhere classified – K76.0
  • Other cirrhosis of liver – K74.69

The important thing to remember when assigning a code for steatohepatitis and/or cirrhosis is to not automatically assume it is alcohol related. It is important to read the record thoroughly and if in doubt query the provider for clarification of the type of steatohepatitis and/or cirrhosis.

Lorrie Strait, RHIT, CCS

Auditor/Educator