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Coding Quality Task Force

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Coding Quality Task Force Chart Review Orthopedic Chart September 22, 2006 Comorbidities Comorbidities are all conditions that coexist at the time of admission or ... – PowerPoint PPT presentation

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Title: Coding Quality Task Force


1
Coding Quality Task Force
  • Chart Review
  • Orthopedic Chart September 22, 2006

2
Diagnosis Typing
3
  • Comorbidities
  • Comorbidities are all conditions that coexist at
    the time of admission or
  • develop subsequently and demonstrate at least one
    of the following
  • significantly affects the treatment received
  • requires treatment beyond maintenance of the
    preexisting condition
  • increases the length of stay (LOS) by at least 24
    hours.
  • Consider the following in determining whether a
    condition qualifies as a comorbidity.
  • To support a determination of significance, there
    must be documented evidence in
  • the physicians documentation or discharge
    summary that the condition required at least one
  • of the following
  • clinical evaluation/consultation, excluding
    pre-operative anesthetic consults, where
  • new or amended course of treatment is
    recommended and instituted
  • therapeutic treatment/intervention with a code
    assignment of 50 or greater
  • from Section 1 of CCI
  • diagnostic intervention, inspection or biopsy
    with a code assignment from

4
  • Diagnosis Type (2).Post-admit Comorbidity
  • A Diagnosis Type (2) is a condition that arises
    post-admission,
  • has been assigned an ICD-10-CA code and
    satisfies the
  • requirements for determining comorbidity.
  • Reference Canadian Coding Standards ICD-10-CA
    and CCI 2006 page 10

5
CHART REVIEW
  • 72 year old female with osteoarthritis of the
    right knee.
  • Presents to hospital for elective total knee
    replacement
  • Original surgery, January 4th
  • January 5th, experienced pain in the right calf
    and DVT was investigated doppler negative
  • January 9th, pain persists with knee swelling

6
CHART REVIEW, continued
  • Continued pain, investigated and was clinically
    diagnosed with dislocation of the surgical knee
  • January 9th, patient had a closed reduction
  • January 11th, recurrent dislocation
  • January 11th, revision of the total knee
    replacement
  • January 24th, patient discharged to rehab

7
Hospital Dx Coding Selections
8
Hospital Dx Coding Selections
9
Hospital Dx Coding Selections
10
Calculating Dx Consensus
11
Diagnosis Consensus
12
Other Dx Codes Used, not making the cut
13
Lets recap
  • Admission January 4th
  • Initial OR January 4th
  • Pain began January 5th, ?DVT (-) findings
  • Clinical dx of dislocation, January 9th
  • Closed reduction, January 9th
  • Second dislocation, January 11th
  • Revision, January 11th

14
Recap continued.
  • Patient discharged January 24th to rehab
  • LOS 20 days
  • ALOS for TKA 5 - 8 days
  • Did the mechanical complication of the knee
    replacement lend to more resources being used?

15
Post Admit or Complication taking over case,
Canadian Coding Standard says.
  • If a post-admit comorbidity qualifies as the
    MRDx, it must be recorded as both the MRDx
  • and as a diagnosis Type (2)
  • Does the above Standard apply here??
  • Lets wait and see what CIHI coded

16
Osteoarthrits, primary or unspecified
17
Canadian Coding Standards, page 152
18
Query ID 5334Date Jul 09, 2002Patient Type
Inpatient
  • When a Doctor states that the patient has
    degeneration hip disease with no injury or trauma
    mentioned would you code M16.1 (primary) or M16.9
    (unspecified)?
  • This very question is before the World Health
    Organization this year. The ICD-10 Update
    Reference Committee is expected to debate whether
    "primary" and "unspecified" coxarthrosis are not
    virtually synonymous. There has been a
    recommendation to collapse these subcategories.
    Having given you the current international
    situation vis a vis this question, we are
    recommending that -- until this question has been
    decided by the international community -- you
    continue to use "primary coxarthrosis" when the
    physician clearly states that there is no
    underlying cause. If the physician simply states
    "osteoarthritis of the hip" and makes no further
    qualifying statement, then we recommend that you
    use "unspecified coxarthrosis".

19
  • Did the chart clearly stated that there was no
    underlying cause?
  • Chart does state
  • No injury
  • Pain, hips and other knee
  • Favouring?
  • Previous infection not documented?
  • Previous avascular necrosis?
  • Can not assume physician education
  • Lets wait and see what CIHI coded.

20
Anemia D62 or D64.9Query 20941
  • Question I am continuing to struggle with
    coding post-operative anemia. Our doctors will
    frequently document "post-operative anemia"
    following orthopedic procedures (mostly hip
    replacements), but they never specify the cause
    of the anemia. When the post-op anemia meets the
    criteria to be considered a diagnosis type 2, our
    facility has been using the code D64.9 Anemia,
    unspecified, with an additional external cause
    code of Y83.1 to identify the fact that the
    anemia was post-operative. In this case, we are
    assuming that "anemia" is a post-procedural sign,
    although it is not listed under post-procedural
    signs/symptoms on page 200 of the Coding
    Standards. Are we coding post-op anemia
    appropriately in this case?

21
Answer to Query 20941
  • First of all we would suggest that a diagnosis of
    postoperative anemia following hip replacement
    surgery, in the absence of any other stated
    cause, would be indicative of anemia due to acute
    blood loss and coded to D62 Acute posthemorrhagic
    anaemia. We do not currently have a coding
    standard on the coding of postoperative anemia
    therefore, you may wish to verify this with the
    physician. Hemorrhagic anemia is defined as
    anemia caused by the sudden and acute loss of
    blood. Since the physician specifically documents
    this as postoperative anemia you would also
    select Y83.1.

22
Answer to Query 20941
  • Secondly, the fact that the patient has acute
    posthemorrhagic anemia does not imply that there
    was a hemorrhage complicating the procedure but
    rather that the patient is suffering from anemia
    due to expected blood loss that occurred during
    the procedure. Every intervention would have a
    certain amount of expected blood loss, some
    interventions (i.e. hip replacments) being
    greater than others. T81.0 Haemorrhage and
    haematoma complicating a procedure, not elsewhere
    classified should only be selected when the
    physician identifies it as such. Some
    interventions, by their very nature, are
    associated with a large amount of blood loss that
    may sometimes result in posthemorrhagic anemia.

23
BUT..
  • If postoperative anemia is documented in the
    absence of indications that it is due to surgical
    blood loss, then you would default to D64.9
    Anemia, unspecified. Your physician is the best
    source for clarification of postoperative anemia
    as the situation and threshold for blood loss is
    different for every patient. This is why it is so
    difficult to make a standard on postoperative
    anemia. Note also that anemia is included in
    the listing on page 10 of the 2005 Coding
    Standards. These listings are not meant to be
    exhaustive.
  • ----------------------------------------------
    ------------------------------------
  • CIHI will be undating this query to remove the
    confusion
  • How did CIHI Code this chart..

24
CIHI Response to Diagnosis
25
  • DIAGNOSIS
  • DISCUSSION??

26
CCI CODES
27
CCI CODES
28
CCI CODES
29
Calculating Dx Consensus
30
CCI CONSENSUS
31
Other CCI Codes Used
32
Standards say for Revision.
  • A revision may be due to mechanical failure,
    dehiscence, poor functional outcome or any other
    complication of healing at the anatomy site(s)
    involved in the initial intervention.
  • It does not matter what the previous surgery was
    if a current problem at the old operative site
    exists,
  • Code the actual intervention that is now being
    performed and designate it with a status
    attribute of R for revision.
  • Standards, page 43

33
Components vs Compartments
  • Components hardware used excluding nail,
    screws, wires
  • Compartments area in which components are being
    implanted
  • Unicompartmental medial or lateral
  • Bicompartmental medial and lateral
  • Tricompartmental medial, lateral and
    patellofemoral

34
Compartments
35
Instructions in CCI under rubric 1.VG.53..
  • A partial knee replacement involves just a single
    compartment (medial or lateral) of the joint.
    More than one prosthetic component is typically
    used because the medial (or lateral) aspect of
    both the tibia and femur are replaced. Sometimes
    a plastic support bearing is also used to act as
    the meniscus joining the tibial tray and the
    femoral component -- three components but one
    compartment.

36
Revision Surgery, Jan 11th
  • Plastic Tibial articular surface replaced
  • Single component
  • Bicompartmental this single component is placed
    across both the medial and lateral compartments

37
Revision could be..
  • In the case of a revision arthroplasty, a single
    component may be removed and replaced. This is
    considered a revision of a total knee replacement
    (bicompartmental or tricompartmental) using a
    single component prosthetic device.

38
And
  • A total knee replacement always involves both the
    medial and the lateral compartments
    (bicompartmental, bycondylar) but may also
    involve the patellofemoral compartment
    (tricompartmental). When a bicompartmental knee
    replacement is performed, two prosthetic
    components will be used and when a
    tricompartmental knee replacement is performed,
    three prosthetic components will be used. All
    attributes are mandatory to support the Canadian
    Joint Replacement Registry CJRR reporting
    requirements.
  • We will let Dr. Naudie explain this further

39
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40
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41
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42
CIHI response to CCI Codes
43
  • INTERVENTION
  • DISCUSSION??

44
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45
  • A couple more neat websites
  • www.kneereplacementinfo.com/knee/
  • www.hipreplacementinfo.com/hip/

46
Coding Quality Task Force Committee100
volunteer
  • Deb Tetreault, Chair
  • Sandra Lariviere, Privacy Officer
  • Nancy Seers, Secretary
  • Diane Carrothers, Donations
  • Alison Temple, Membership Services
  • Agnes VanderVecht, Coding Support
  • Yvonne Peekhaus, Coding Support
  • Darlene Cambridge, Technical Support
  • Lynne Hopper, OHIMA Representative

47
Lets fill the donation tin
  • Your donation goes to pay the expenses to put on
    this Workshop. The remainder of the money goes
    to the Charity of Choice of the Physician doing
    the chart review.
  • Dr. Naudie has choosen the
  • Brain Tumor Foundation of Canada
  • Lets thank Dr. Naudie by showing your support to
    his charity
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