Steinhage Joins Intellis IQ Team
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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About Intellis
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.
Media Contact:
Cassidy Communications, Inc. for Intellis
Kelly C. Vanek: 610.217.5011
kvanek@cassidycommunications.com
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
Query Practice? - Could use of templates be interfering with your ability to maintain an appropriate
query practice? - 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.
Should organizations address stigmatizing language in medical records?
That is the question posed by Lisa A. Eramo, MA in her article “Choose Your Words Carefully” in a recent edition of For The Record. “Words matter. It’s not only what you write but also how you write it that affects others. This is true in a variety of settings, and health care is certainly no exception. In fact, a recent study conducted by researchers at Johns Hopkins University School of Medicine (Journal of General Internal Medicine, May 2018) found that the words providers document in patients’ medical records affect how other clinicians perceive and ultimately care for those patients—and not necessarily for the better.
‘I think sometimes we consider the medical record as a collection of objectively recorded data and plans, but when you step back, it becomes clear that you can really shape the narrative about a patient in very different ways, both implicitly and explicitly,” says Anna Goddu, MD, lead author and a medical student at Johns Hopkins University.’ ”
For real-world insight into how word usage and stigmatizing language in patient health records affect provider perception, Eramo tapped Intellis HCC experts Kim Felix, RHIA, CCS, vice president of education and training and Jeanie Heck, CCS, CPC, CRC, director of education. Kim addressed examples of stigmatizing language. Further, she supported creating an atmosphere where CDI specialist feel safe flagging stigmatizing language and alerting risk management or quality assurance. Jeanie addressed the need to maintain professionalism and emphasized mandatory education to ensure less experienced staff understand the importance of appropriate language.
The full article is available in For the Record.
Recently, our VP of Coding Operation Darina Kutish, RHIT, CCS provided expert insight to For The Record magazine’s feature “Of Viral Importance” written by Lisa A. Eramo, MA.
Of Viral Importance
Why Your Hospital’s Reputation Depends—at Least Partially—on Accurate Pneumonia Coding
These days, it takes seconds for patients to view mortality and readmissions data on the Centers for Medicare & Medicaid Services’ Hospital Compare website (www.medicare.gov/hospitalcompare). With a few clicks of the mouse, they can—and frequently do—draw conclusions about the quality of care that’s provided.
Pneumonia, which causes approximately 1 million hospital admissions annually, according to the Centers for Disease Control and Prevention, is one of several diagnoses listed on Hospital Compare. Coded data are what drives these publicly reported quality measures, making it imperative that organizations undertake a concerted effort to correctly capture diagnostic specificity and sequence conditions.
All cases with a principal diagnosis of pneumonia are included in the 30-day risk-standardized pneumonia readmission measure as well as the 30-day risk-standardized pneumonia mortality measure. Cases with a principal diagnosis of sepsis (with the exception of severe sepsis) and a secondary diagnosis of pneumonia coded as present on admission (POA) are also included in these measures when there is no additional secondary diagnosis of severe sepsis (ie, R65.20 [severe sepsis without septic shock] or R65.21 [severe sepsis with septic shock]) coded as POA.
“The bottom line is that all pneumonia codes are on the hook for mortality and readmissions,” says James P. Fee, MD, CCS, CCDS, CEO of Enjoin. “Aspiration pneumonia used to be the only one that was excluded, but now it’s also included.”
(For a complete list of ICD-10-CM codes as well as inclusion/exclusion criteria and risk adjustment for both pneumonia measures, visit the QualityNet website at www.qualitynet.org.)
Hospitals need to understand that these data drive consumer decisions about where to receive health care services, says Dee Mandley, RHIT, CCS, CCS-P, CDIP, lead educator at Peak Health Solutions. “Anyone can go on this site and compare hospitals based on pneumonia information, so you need to make sure that it’s coded correctly.”
In addition to quality measure implications, pneumonia coding affects reimbursement and length of stay. For example, unspecified pneumonia maps to diagnosis-related group (DRG) 195 (simple pneumonia and pleurisy without complication or comorbidity [CC] or major CC [MCC]) with a relative weight of 0.6868 and 2.6-day geometric length of stay. The more specific aspiration and certain specified bacterial pneumonias both map to DRG 179 (respiratory infections and inflammations without CC/MCC) with a relative weight of 0.9215 and 3.2-day geometric length of stay.
When reported as a secondary diagnosis, pneumonia carries an MCC status and can have a positive effect on the final Medicare severity DRG (MS-DRG) assignment, Mandley says. Pneumonia also carries a severity of illness rating of three and a risk of mortality rating of two, both of which have a positive effect on all patient refined DRG assignment, she adds.
Documentation Challenges
When it comes to accurate pneumonia coding, conflicting documentation is one of the biggest challenges for coders, says Darina Kutish, RHIT, CCS, vice president of coding operations at Intellis. “Some doctors will call it pneumonia, some will call it an infiltrate based on the X-ray, and some may say bronchitis. The documentation makes some of these cases very difficult to code.”
Coders must recognize clinical indicators of pneumonia and query when necessary, Kutish says. For example, symptoms such as fever, cough, shortness of breath, pleuritic chest pain, and respiratory distress can be clues that pneumonia is present. Other clues include a physical exam that shows rails, rhonchi, and abnormal breath sounds. The patient may also have an elevated white blood cell count and a chest X-ray showing consolidation, an infiltrate, and/or interstitial changes. Finally, the sputum culture may be positive for an organism.
“These are all good clinical indicators to back up the pneumonia. The sputum cultures do not need to be positive, but if they are, it can help support a query,” Kutish says.
According to Mandley, another challenge is identifying the principal diagnosis when the patient has multiple pulmonary conditions on admission such as respiratory failure, COPD, and pneumonia. Coders must think carefully when assigning pneumonia as the principal diagnosis because doing so means the case will potentially be included in the 30-day readmission and mortality measures. When in doubt, a query to the physician is necessary, Mandley says.
When multiple conditions are POA and all meet the definition of principal diagnosis, coders have the flexibility to choose the diagnosis that will yield the highest-weighted DRG, Kutish says. The principal diagnosis is defined in the Uniform Hospital Discharge Data Set as “that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.” For example, when pneumonia and acute respiratory failure are both POA and meet the definition of principal diagnosis, coders can report the pneumonia as the principal diagnosis with acute respiratory failure as a secondary MCC.
Scenario-Specific Pneumonia Coding Tips
Experts say pneumonia can present in many different ways; the clinical circumstances of each case will drive ICD-10-CM code assignment and sequencing. The following are several common scenarios with tips for compliant coding.
Unspecified Pneumonia
Coders should report ICD-10-CM code J18.9 when the cause of pneumonia is unknown. This can occur when sputum cultures are negative. Coders should also report J18.9 when physicians document one of the following conditions: community-acquired pneumonia, hospital-acquired pneumonia, or health care–acquired pneumonia, Mandley says.
Sputum cultures may be negative when patients receive antibiotics upon admission to the hospital and before cultures are taken or when the quality of the specimen is lacking, she adds. They may also be negative when patients are already on an antibiotic for another condition such as a urinary tract infection.
However, coders should always perform a thorough review of the record rather than default to an unspecified type, says Regina Jackson, CPC, CPMA, CPC-I, co-owner at EnR Coding Solutions. Doing so presents a more accurate clinical picture of severity of illness and risk of mortality, she says.
Pneumonia as a Manifestation of an Infectious Disease
When influenza causes pneumonia, coders should report a code from the ICD-10-CM J09.- through J11.- range. When the type of influenza is known—and physicians link the influenza with the pneumonia—report combination codes J09.- or J10.-. When the type of influenza is not known, report J11.-, says Elizabeth Hankins, CPC, CCS-P, CPMA, CPC-I, PMCC, co-owner and founder of EnR Coding Solutions.
Remember that patients can have more than one type of pneumonia simultaneously (eg, pneumonia due to influenza and pneumonia due to a bacterium). “You have to really carefully review the documentation on admission to see where the bulk of treatment is going,” Mandley says.
When coding tuberculosis that causes pneumonia, refer to the key term “pneumonia” in the alphabetic index and then the subterm “tuberculosis,” which directs coders to see “tuberculosis, pulmonary.” Thus, ICD-10-CM code A15.0 (tuberculosis of lung, including tuberculosis pneumonia) is appropriate, says Mary Frungillo-Tomak, CCS, CDIP, manager of inpatient coding, clinical documentation improvement (CDI) audit, and education at Atos.
Aspiration Pneumonia
Coders should report ICD-10-CM code J69.0 for aspiration pneumonia and be prepared to query physicians in the absence of explicit documentation when clinical indicators of aspiration pneumonia are present, according to Kutish. These include poststroke dysphagia and reflux disease as well as a swallowing study to assess the patient’s gag reflex or the presence of a nasogastric tube, she adds.
Bacterial Pneumonia
When there’s a positive sputum culture, physicians should link the specific organism causing the pneumonia so coders can choose the appropriate ICD-10-CM code for the bacterial pneumonia, Kutish says. “The doctor has to state the significance of that positive culture. If they don’t state that significance, then you cannot report the more specific code,” she explains.
The following is a sample statement that would allow coders to report ICD-10 code J15.5: “Patient has positive sputum culture for E coli and we’re treating them for E coli pneumonia.”
Mandley reminds coders to keep in mind that the type of bacterial organism can affect the final MS-DRG assignment. For example, gram-negative pneumonia maps to ICD-10-CM code J15.6, driving a respiratory infection DRG. Pneumonia due to Streptococcus pneumoniae maps to ICD-10-CM code J13, driving a lower-weighted simple pneumonia DRG.
Pneumonia That Causes Sepsis
When sepsis and pneumonia are both POA, coders should assign the sepsis as the principal diagnosis and the localized infection (pneumonia) as secondary per official coding guidelines, Frungillo-Tomak says.
These guidelines state: “If the reason for admission is both sepsis or severe sepsis and a localized infection, such as pneumonia or cellulitis, a code(s) for the underlying systemic infection should be assigned first and the code for the localized infection should be assigned as a secondary diagnosis. If the patient has severe sepsis, a code from subcategory R65.2 should also be assigned as a secondary diagnosis. If the patient is admitted with a localized infection, such as pneumonia, and sepsis/severe sepsis doesn’t develop until after admission, the localized infection should be assigned first, followed by the appropriate sepsis/severe sepsis codes.”
Pneumonia Due to Near Drowning
When a patient has pneumonia due to near drowning, coders should refer to the Excludes 1 note under ICD-10-CM code T75.1xx- (unspecified effects of drowning and nonfatal submersion) that instructs coders to code to the specified effects of the drowning (ie, pneumonia, J18.9), Kutish says.
Pneumonia With Acute Exacerbation of COPD
This situation requires the following codes: J44.0 (COPD with acute lower respiratory infection), J18.9 (pneumonia, unspecified organism), and J44.1 (COPD with acute exacerbation). Previously, J44.0 had a “use additional code” note to identify the infection, meaning coders were required to report the pneumonia code as a secondary diagnosis.
“Now there is a ‘code also’ note that does not denote sequencing. Therefore, you may sequence either one as the principal diagnosis depending on the circumstances of the admission,” Kutish says.
Tips to Promote Pneumonia Data Integrity
Experts share the following tips to ensure that coded data reflect pneumonia specificity:
• Provide coder education. Recruit a physician champion to educate coders about the types of pneumonia as well as causes, risk factors, signs, symptoms, complications, and treatment, Mandley says.
“Without knowledge of the disease, a coder is unable to analyze the clinical documentation in the medical record and recognize the need for a physician query to capture specificity of the diagnosis,” Frungillo-Tomak says. “It’s also necessary to compose a compliant query.”
• Provide physician education. A physician champion can educate physicians about pneumonia documentation requirements such as causative organisms, pneumonia type, and any associated conditions (eg, acute exacerbation of COPD and the presence of influenza), Mandley says.
“For inpatients, documentation of possible or probable diagnoses infers a strong clinical suspicion and can be coded as present,” she notes, adding it’s a good idea to incorporate documentation education into the orientation schedule for new residents and to post documentation tips and fliers in patient care areas.
• Use denials as teaching tools. Ask coders and CDI staff to review these cases so they understand why denials occur and how to prevent them proactively, Mandley says. For example, payers may assign a lower-weighted DRG if the POA indicator for the pneumonia is incorrect (ie, reported as Y when it should have been N).
Some payers may also deny pneumonia when the chest X-ray is negative, making it critical to document and code all of the patient’s other pneumonia symptoms, Kutish notes. “Get that bulletproof documentation up front so payers can’t deny payment,” she says.
• Analyze pneumonia queries. Do coders and CDI specialists frequently query one or two physicians? Or do queries tend to address the same documentation problem across the board? “A CDI program can provide tremendous data for analyzing coding and documentation patterns,” Mandley says.
• Develop clinical indicators. Mandley recommends involving medical staff in identifying specific clinical indicators that CDI and coding staff can use when assessing the presence of pneumonia.
• Promote collaboration between coding and CDI. Consider scheduling a recurring meeting so staff can discuss diagnoses that the organization may be struggling to report correctly, Frungillo-Tomak says.
She says these meetings are ideal opportunities to do the following:
— Exchange knowledge. CDI specialists can provide clinical education on pneumonia to coders, and coders can educate CDI staff on the application of pneumonia-related coding guidelines and Coding Clinic quarterly updates.
— Review and standardize physician queries to reflect specific types of pneumonia.
— Use a standardized dispute process to discuss cases for which coders and CDI specialists disagreed on final DRG assignment.
“I think it’s important for coders, CDI specialists, and physicians to work together to get that documentation so you get the most accurate payment for the hospital,” Kutish says.
— Lisa A. Eramo, MA, is a freelance writer and editor in Cranston, Rhode Island, who specializes in HIM, medical coding, and health care regulatory topics.
The For the Record feature “Of Viral Importance” was included with permission. Copyright © 2019.
During WellSpan Health’s Epic EHR conversion, the Intellis team consolidated five legacy EHRs, overcame significant interface match challenges, achieved over 99 percent accuracy, and delivered all key clinical data on day one. View the case study.
WellSpan Health is an integrated health care system headquartered in York, Pennsylvania. WellSpan works to ensure that inpatient, out-patient, home health, and physician services are accessible throughout the region. The health system includes:
- Providing care at six area hospitals
- Offering services at more than 130 outpatient locations
- Operating a regional home care organization
WellSpan launched “Project One,” to consolidate its five legacy EHRs and convert the entire system to the Epic EHR platform. At an estimated cost of $188.7 million over three years, the goal was to create uniformity, better connect providers with patients, and improve care coordination. WellSpan chose Intellis as a partner to support “Project One” by reducing costs, increasing accuracy, improving productivity, ensuring timely project completion, and successfully converting over 250,000 patient records to the Epic EHR platform. Contact us to learn more.
The health system expected delays, but they didn’t happen due to a ton of preparation work on the part the system’s workforce. WellSpan’s announcement of successful Epic EHR conversion go live: WellSpan Epic EHR goes live without a hitch | Healthcare IT News
“We recognized that we couldn’t function as one complete system, if we had multiple records and systems in place, We called it ‘Project One,’ not for its prioritization, but as it’s about one organization.”
— WellSpan Senior Vice President and CIO Hal Baker, MD
Intellis is pleased to announce the launch of the Intellis Intelligence Center, our innovative HIM online learning platform. We invite you to take a tour of the Intelligence Center and register to join our community of passionate educators and learners. As in introduction to online learning, we’re offering two 20-minute Coding Clinic Review courses FREE of charge. In 2018, the Intelligence Center will add dynamic training and support on a variety of topics for revenue cycle, clinical documentation improvement, and EHR professionals. We’re committed to education and leading the way in Health Information Management.