Jeff Perrine FNP C, MS

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Norman Benson
5 years ago
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practice None Avoiding unnecessary ER visits and hospitalizations Let ICD 10 and your EMR help guide

1 Jeff Perrine FNP C, MS Identify factors that lead to d long term care of patients Identify patient diagnoses as appropriate in ICD 10 Identify available programs to increase revenue in the primary care practice None Avoiding unnecessary ER visits and hospitalizations Let ICD 10 and your EMR help guide documentation Monitoring chronic conditions more closely to identify changes in a timely manner Participation in ACOs, MWV, CCM 1

2 International Classification of Diseases, 10th Revision, Clinical Modification (ICD 10 CM). The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), two departments within the U.S. Federal Government s Department of Health and Human Services (DHHS) provide guidelines for coding and reporting using ICD 10. Guidelines are further approved by the four organizations that make up the Cooperating Parties for the ICD 10 PCS: the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), CMS, and NCHS. Guidelines are published annually and cover from Oct 1 Sep year old Caucasian female presenting for an 8 day hx of productive cough, SOB, wheezing, and chills. The nurse puts the patient in an exam room, reconciles her medication list and takes vital signs. VS: T: 98.8F P:80 R:18 B/P:118/68 O2 sat: 98% RA Previous medical hx of HTN, CHF, CKD III, Hypercholesterolemia Current meds: lisinopril, furosemide, simvastatin 15 pack/year smoking hx quit 15 years ago Acute upper respiratory infections of unspecified site Benign essential hypertension (B/P 118/68) Established Patient Office Visit Level 3 (E/M 99213) 2

3 I13.0 Hypertensive heart and chronic kidney disease with heart failure The classification presumes a causal relationship between hypertension and heart involvement and between hypertension and kidney involvement, as the two conditions are linked by the term with in the Alphabetic Index. 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. 3

4 A combination code is a single code used to classify: Two diagnoses, or A diagnosis with an associated secondary process (manifestation) A diagnosis with an associated complication When the combination code lacks necessary specificity in describing the manifestation or complication, an additional code should be used as a secondary code. I13.0 Hypertensive heart and chronic kidney disease with heart failure N18.3 Chronic kidney disease, stage 3 (moderate) Stable with last creatinine 1.4 and appropriately on an ACE I I50.32 Chronic diastolic (congestive) heart failure Clinically euvolemic and well compensated All hypertension codes require an additional ICD 10 code if the patient is a current or former tobacco user. 4

5 I13.0 Hypertensive heart and chronic kidney disease with heart failure I50.32 Chronic diastolic (congestive) heart failure Stable with last creatinine 1.4 and appropriately on an ACE I N18.3 Chronic kidney disease, stage 3 (moderate) Clinically euvolemic and well compensated F Nicotine dependence in remission Has not smoked for 15 years and is congratulated E/M CC Problem Focused Hx 1 stable chronic illness, or 1 self limiting mild illness Low level decisionmaking: OTC meds, rest, diet, or minimal risk medical management (Azithromycin) E/M CC Detailed Hx 2 3 stable chronic illnesses, or 3+ self limiting problems Moderate level decisionmaking: Referrals requiring detailed discussion, minor surgical procedures, moderate risk medical management (warfarin) ACOs are groups of doctors, hospitals and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. The goal is to ensure that chronically ill patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. Centers for Medicare and Medicaid Services 5

6 When an ACO succeeds both in delivering highquality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program. However, ACO members are reimbursed for quality care of chronic conditions. Annual preventive visit Review of medical and social history related to health and education and counseling about preventive services Screenings, shots, and referrals for other care, if needed Height, weight, and blood pressure measurements A calculation of body mass index A review of potential risk for depression and patient level of safety Advanced directives May be conducted in conjunction with an office visit as long as documentation is separated into distinguishable parts. Monthly phone contact for patients suffering from multiple chronic conditions. Each call discusses: Current symptoms New concerns Nursing recommendations Pt understanding of regimen Med reconciliation Date of next contact Cigarette use, diet and exercise 6

7 Better tracking of chronic conditions Decreased ER use Maintains patients in the primary care practice and out of the hospital Benefit from shared savings Increased revenue from incentive programs Questions? 7

3/20/2017. CONNECTING THE LATEST GUIDANCE FY2017 FOR ICD-10 MATTERS Kyla D. Harrison, RN, BSN, HCS-D, COS-C Visiting Nurse Association of Kansas City

3/20/2017. CONNECTING THE LATEST GUIDANCE FY2017 FOR ICD-10 MATTERS Kyla D. Harrison, RN, BSN, HCS-D, COS-C Visiting Nurse Association of Kansas City CONNECTING THE LATEST GUIDANCE FY2017 FOR ICD-10 MATTERS Kyla D. Harrison, RN, BSN, HCS-D, COS-C Visiting Nurse Association of Kansas City Coding needs met in many different ways: 1. Fulltime Coders HCS-D