Today’s Tip: ICD-10 Anemia in CKD
When anemia NOS is present as a current condition, and the patient has underlying chronic kidney disease (CKD) or end-stage renal disease (ESRD), it is a fast track to the usage of D63.1, Anemia in chronic kidney disease (manifestation). This is assigned unless the anemia is specified as a different form and/or attributed to another condition. Much like the diabetes category, ICD-10-CM “In/With” convention assumes “due to.”
ICD-10-CM Official Guidelines for Coding and Reporting FY 2021 Section I. A. 15.
The word “with” or “in” should be interpreted to mean “associated with” or “due to” when it appears in a code title, the Alphabetic Index (either under a main term or subterm), or an instructional note in the Tabular List. The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular List. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated or when another guideline exists that specifically requires a documented linkage between two conditions (e.g., sepsis guideline for “acute organ dysfunction that is not clearly associated with the sepsis”).
For conditions not specifically linked by these relational terms in the classification or when a guideline requires that a linkage between two conditions be explicitly documented, provider documentation must link the conditions in order to code them as related. The word “with” in the Alphabetic Index is sequenced immediately following the main term or subterm, not in alphabetical order.
Anemia refers to the reduction of the total number of circulating red blood cells. It is diagnosed when there is the detection of decreased hemoglobin concentration, hematocrit, or red blood cell count. Anemia in chronic kidney disease specifically falls under the category of decreased red blood cell production.
In CKD or ESRD, kidney function is compromised to the point that blood cannot be filtered of wastes and fluid. The kidneys also produce less erythropoietin (EPO), a hormone that signals the bone marrow to produce additional red blood cells. Furthermore, in CKD patients the red blood cells are not able to survive as long in the bloodstream and suffer a premature death. Due to associated nutrient deficiencies in underlying CKD, red blood cells are not reproduced as frequently or with the same cellular integrity as in a healthy patient.
Education Disclaimer: This coding tip is intended to serve the general community and may not account for all differences in coding routines, duties, or individual client policies. The information and opinions presented here are based on the experience, training, and interpretation of the author. Although the information has been researched and reviewed for accuracy, the instructor does not accept any responsibility or liability with regard to errors, omissions, misuse, or misinterpretation. This information is intended as a guide; it should not be considered a legal or consulting opinion or advice.
Intellis is pleased to announce that Debra Bradford, RODC, SPHR, SHRM-SCP, has joined our team as Chief Human Resources Officer. Dee brings to Intellis superior business acumen and strategic planning experience aligning HR department policies and processes to meet our organizational goals. This position provides her with the opportunity to work directly with multiple health information sectors along with education, technology, and governmental agencies.
She also serves as an adjunct professor at Villanova University. She is the author of ‘OD Chatter’ a free workplace advice column, and the founder of several consulting companies since 1999 including ODL Business Partners, Inc. a Human Resources consulting firm specializing in organizational development and leadership training. he has been a featured speaker at SHRM Chapters in multiple states on the East Coast where she delivered continuing professional development training, and workshops in Leadership, Human Resources, and Organizational Development.
Her educational background includes a BS in Healthcare Management, a BS in Human Resources Management, both from Chestnut Hill College (Philadelphia, PA); and an MS in Organizational Development and Leadership from Philadelphia College of Osteopathic Medicine (Philadelphia, PA).
She has served as a member of the Board of Directors at several non-profit organizations and has spent over 15 years as a business consultant working directly with C-suite leaders, helping them find solutions for underperforming business metrics. A member of Sigma Beta Delta, Dee is an ‘out of the box’ thinker and friend to everyone she meets.
Always an old-fashioned country girl, Dee resides in Berks County, PA with her husband Chris and their pug Bentley. Her most rewarding accomplishment is developing HR and OD competencies in other professionals and helping organizations achieve their strategic goals.
Keeping up with the annual updates and guidelines is a challenge for coding professionals and facility leaders. Intellis overcomes the challenge by providing tailored IQ Education that prepares coders on the frontlines to ensure their facilities are always ready for new rules.
Are you ready for October 1?
For the year 2021, ICD-10-CM official guidelines reflect over 500 significant changes. The updates include 490 new codes, 47 revised codes, and 58 codes deemed invalid. In addition, the upcoming fiscal year ICD-10-PCS code set includes 544 new codes and the recently released FY 2021 ICD-10-PCS Official Guidelines for Coding and Reporting. Effective date: October 1, 2020.
Find out more!
Right now, Intellis is offering robust training to help organizations prepare for FY 2021 ICD-10-CM, ICD-10-PCS updates. The sessions are presented by Intellis VP of Education & Training Kim Felix, RHIA, CCS a nationally recognized Intellis IQ subject matter expert.
We’re committed to helping coding teams prepare, and we provide personal service to make sure your education experience goes smoothly.
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Partnership supports highly accurate patient matching and patient record management for providers as they implement new EHR platforms
At Intellis, we’re trusted industry experts offering customized and flexible revenue cycle management services for hospitals and health systems. We’re proud to enhance our efforts with a new partner. We’re teaming with Verato a leading provider of cloud-based identity resolution services. Together we’re enabling customers to leverage integrated technology and services. This ensures accurate matching of patient medical and financial records with the right patient.
Behind the numbers
A Pew Trust research analysis found that when healthcare organizations do not have the right capabilities in place for patient matching, the resulting errors have a significant impact on patient safety and healthcare costs:
- One in five hospital chief information officers links an instance of patient harm to a mismatch in patient records.
- Up to half of patient records are not accurately matched during transfers from one facility to another, such as from a rural hospital to an urban facility.
- Up to one in five patient records within the same health system are not accurately matched with patients.
Sometimes, these errors are due to typos made while inputting patient information during registration. Also, patient information changes, data formatting issues, and insurance fraud are culprits. Mismatched records are expensive to fix: One hospital spent $96 per patient record to resolve duplicate records in its system.
“The partnership between Intellis and Verato increases efficiency in EHR consolidation. Also, it aids clinicians at the point of care when the ability to access the right information quickly is critical to providing trusted care,” says Dan Cooke, President, Intellis. “We’re pleased to partner with Verato in providing state-of-the-art solutions for seamless integration and migration of EHRs. Our joint “services plus solutions” approach protects the integrity of patient data as well as patient safety.”
Our COVID-19 coding and CDI education and training webinars are AHIMA-Approved for CEUs. We are constantly focused on COVID-19 coding and CDI, and we’re quick to recognize and share critical changes as they become available. Our FREE education and training webinars are led by the Intellis IQ team of subject matter experts. The information presented is based on trusted healthcare sources including the American Health Information Management Association (AHIMA), the American Medical Association (AMA), the Centers for Disease Control and Prevention (CDC), and the Centers for Medicare & Medicaid Services (CMS). The education presented is monitored continuously to reflect the most current healthcare and industry updates.
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Each webinar includes a 1-hour education session presented by the Intellis IQ team of industry experts. Download the webinar overview or view below.
David brings 13 years of HIM experience in Outpatient Auditing and Coding to the Intellis IQ Team. Prior to joining Intellis, David served as an Outpatient Coding Quality Coordinator and Auditing Specialist for a large healthcare consulting company balancing the responsibilities of internal auditing and external audits and education for clients.
David’s proven track record of success in teaching is instrumental in performing new client onboarding and problem-focused audits. His passion and commitment to the HIM field are evident by his professional and academic accomplishments and RHIT and CCS credentials.
David’s drive for process improvement and mobilizing teams ensures that large scale projects or unique engagements are positioned with the support and resources necessary for success. Past projects include implementing transitions to EHR systems, charge mapping between departments, Trauma Level I coding management, revision of capture protocols for nursing and various ancillary services, development of functional Facility E&M models, along with robotic & computer-assisted orthopedic specialty billing solutions. David’s avid sense for guidelines interpretation and application to real-world client engagements. This activity has prompted clinical documentation improvement leading to organizational compliance and a reduction in denials.
COVID-19 has struck with stunning ferocity causing uncertainty across the healthcare landscape. Beyond patient care and staff safety demands, the crisis has evoked unprecedented health information challenges to medical coding and billing and clinical documentation integrity (CDI). Intellis’ immediate action continues to set the pace by providing three avenues for information and education from trusted healthcare sources and Intellis subject matter experts (SME). To date, nearly 1000 medical coders, HIM leaders, and CDI specialists along with 18 health organizations have benefited from Intellis’ commitment to sharing FREE COVID-19 educational resources.
One Site for Information
As the HIM industry grapples to respond and provide clear direction, ambiguity reverberated as national health organizations release evolving updates. Intellis CEO David Van Doren said, “At the outset, we recognized the huge impact of COVID-19 on health information management (HIM). With our distributed workforce, we were instantly positioned to assist providers. Further, we created our IQ Crisis Team to consolidate and share HIM information.” On the Intellis website (IntellisIQ.com), the team developed a single source where HIM professionals can obtain current COVID-19 directives and latest news from AHIMA, AMA, CDC, and CMS (intellisIQ.com/COVID-19). Each day, the website is updated as information becomes available. Also, Intellis prepared — and continually updates — Coding Tipsheets and FAQs. The Intellis IQ COVID-19 page has been visited nearly 2,500 times and the Tipsheets referenced over 1,700 times.
One Source for Online Training
To assist in disseminating timely HIM information, Intellis opened the IQ Center, the company’s education portal, to offer several FREE courses to ALL industry professionals. Intellis’ industry-recognized SMEs VP Education & Training Kim Felix, RHIA, CCS, VP of Clinical and Quality Services Allison Van Doren, RN BSN CCDS CDIP CRC, and Director of Education Jeanie Heck, BBA, CCS, CPC, CRC present coding- and CDI-related updates based on AHIMA and CMS information (education.intellisIQ.com).
One Team for COVID-19 Education
As the health crisis evolves, Intellis experts presented COVID-19 coding and CDI webinars based on AHIMA and CMS information to 18 health organizations. The one-hour sessions focused on ICD-10-CM, MS-DRG, and IP CDI updates for inpatient settings, and ICD-10-CM, CPT/HCPCS/Telemedicine, and OP CDI updates for outpatient settings. Each presentation was followed by a Q&A session. CoxHealth IP Coding Supervisor, Health Information Management Dianne Pierce, RHIT, said, “I would like to thank the Intellis educators for providing thorough, updated coding and clinical advice concerning the evolving COVID-19 pandemic. We had all of our IP and OP auditors and CDI Leadership attend at least one session and have included information we received in our policy which our coders are currently using.” Beth Israel Deaconess Medical Center (BIDMC), Director of Coding and Validation Susan B. Cohen, RHIA CDIP CCS, wrote, “Thank you so much for offering these webinars. They are so well done, and the staff really appreciate learning. Keep them coming!”
As the crisis continues, Intellis is committed to education sharing and contributing to the HIM knowledge-base. The COVID-19 online resource page, IQ Center courses, and webinars will continue to be updated as information evolves. Dates and times for updated webinars will be announced soon. Please contact info@intellisIQ.com for additional information.
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At Intellis, our team shares a deep-rooted passion for innovation, education, and a drive to solve complex HIM challenges. With experience, best practices, and agility, we combine advisory services with flexible end-to-end solutions to address revenue cycle management and data quality issues. Our expertise improves outcomes for both providers and patients. The Intellis IQ Suite includes revenue cycle management, health information management, clinical documentation integrity (CDI), health information technology, and education and training solutions. For more information, visit www.intellisiq.com.
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Kelly C. Vanek: 610.217.5011
Our COVID-19 resources and information page is here to keep you updated on the evolving pandemic. It includes information from public health organizations, HIM organizations, and our subject matter experts intended to share HIM best practices. For education presentations and resources regarding COVID-19, please visit the Intellis IQ Center, our HIM education portal.
Consider these questions about your team’s query compliance practices:
- Are you aware that the Office of Inspector General (OIG) is concerned with, and monitoring for, inappropriate query practice?
- Is your health system adhering to AHIMA’s Guidelines for Maintaining a Compliant
- Could use of templates be interfering with your ability to maintain an appropriate
- How can you monitor and maintain a highly compliant query process?
An Intellis Query Compliance Power Hour will help ensure your health system is on the right track. A Power Hour is an informative session taught by experienced presenters to address specific health information management concerns, provide up-to-date information for industry professionals, and promote best practices.
This Power Hour, focusing on appropriate query practice and compliance, is presented by Intellis Vice President of Clinical and Quality Services Allison Van Doren, RN BSN CCDS CDIP CRC.
The Intellis IQ team of experts is ready to join your staff for an information-packed Power Hour. We dive deep into the subject matter and offer concise informational programs and presentations on a variety of timely topics tailored to select audiences and desired results.
The Intellis IQ HCC Power Hour is a comprehensive session taught by experienced presenters to address Hierarchical Condition Categories (HCC). The purpose of HCC is to enable better health management along with accurate reimbursement. To achieve the goals, coding specialists need to stay up-to-date and informed on HCC best practices. Intellis offers expert instruction with qualified presenters:
Kim Felix RHIA, CCS — Vice President of Education
Jeanie Heck BBA, CCS, CPC, CRC — Director of Education.
For more information or to schedule a “POWER HOUR” for your team, please contact Intellis President Dan Cooke.
For our Intellis IQ podcast, CDI Specialist Paige Lowe RN, BSN, CCDS, CRC joins host Allison Van Doren, RN BSN CCDS CDIP CRC Vice President of Clinical and Quality Services. Together they discuss “What’s Best for CDI? The Pros and Cons of Working Remotely.” Using global research and real-life experience the pair presents the whole story from the onsite and remote work settings.
Listen and subscribe to the Intellis IQ Podcast at https://intellisiq.com/podcast/cdi-pros-and-cons-of-working-remotely/.
For more information, please download our white paper: “A Case for Remote CDI”
The ACDIS Symposium: Outpatient CDI conference is the only event dedicated to clinical documentation integrity (CDI) in the outpatient setting. The conference features innovative and informative sessions and speakers you can’t find anywhere else. If you need to know what works for OP-CDI, the Intellis Team will be at the heart of the event. So join us— booth 106.
Gain insight and best practices Intellis’ industry-recognized OP-CDI team
Meet VP of Clinical & Quality Services Allison Van Doren RN BSN CCDS CDIP CRC. Allison leads our clinical and quality team and is recognized industry-wide as an OP-CDI expert. Along with Allison meet VP of HIM Operations, Kristy Evans RHIT, CCS, CPC; CEO David Van Doren, RHIA, CCS, RAC-CT; and VP of Client Development Ryan Huxtable.
The conference features two days of education and networking dedicated to clinical documentation improvement (CDI) in the outpatient setting. Conference tracks address how to get started in the ambulatory setting, query techniques and nuances, metrics and analytics, staff training, and demonstrating ROI.
Our Team is looking forward to seeing you and helping you discover what’s best for OP-CDI. Join us at booth 106, November 14th and 15th at the Hyatt Regency in Austin, TX.