we need to answe all three qs . professor is expecting 2 paragraphs for the first q. keep in mind i am an international student pls
Chapter 2: Coding
Class Assignment 1
01/21/2020.
1.
The health information management (HIM) team at Anywhere University
Hospital (AUH) contracted with an auditing firm to perform full
assessment coding review. The results from this baseline assessment are
provided in four tables:
- Variation Log by Type of Error
- Variation Log by Coder
- Variation Log by MS-DRG
- MS-DRG Relationship Assessment
You
are the inpatient coding manager at AUH. Your director has asked you to
develop an ongoing review and monitoring schedule for the next year
based on the results from the outside review.
Include internal and
external reviews, coding in-services, physician workshops, and external
seminars/educational sessions that will be performed and or provided
for your staff. The schedule should be specific (include volumes and/or
percentages of charts to be reviewed). Keep in mind that on average it
takes 18 minutes to review one inpatient chart. Budget provides for
$15,000 for external reviews. The average cost for reviewing one
inpatient record by an external review team is $55.00 (fully loaded).
In
addition to preparing the schedule, outline how you will maintain
coding quality statistics and report them back to the HIM Director and
Compliance Committee at your facility.
How will you reward your staff members who show great improvements?
How will you reward and/or recognize that your staff has made improvements overall?
Your Coding Team consists of:
Coding Manager (you)
1 Data Quality Auditor
8 – Inpatient Coders (including Certified Coding Specialists, Registered Health Information technicians and administrators).
Results of the full assessment coding review for AUH
Two audits were performed:
1. Coding quality review by MS-DRG
2. MS-DRG Relationship Analysis
|
Variation Log by Type of Error |
% of errors |
|
Inaccurate sequencing or specificity principal diagnosis, affect MS-DRG |
17% |
|
Inaccurate sequencing or specificity principal diagnosis, non affect MS-DRG |
16% |
|
Omission CC, affect MS-DRG |
33% |
|
Omission CC, non affect MS-DRG |
2% |
|
Inaccurate principal procedure, affect MS-DRG |
3% |
|
Omission procedure, affect MS-DRG |
4% |
|
More specific coding of diagnosis or procedure, non affect MS-DRG |
12% |
|
Inaccurate coding |
5% |
|
Missed diagnosis or procedure code |
8% |
|
Variation Log by Coder |
||
|
Coder |
Error Rate |
Standard |
|
Coder 1 |
3% |
5% |
|
Coder 2 |
9% |
5% |
|
Coder 3 |
8% |
5% |
|
Coder 4 |
2% |
5% |
|
Coder 5 |
4% |
5% |
|
Coder 6 |
16% |
5% |
|
Coder 7 |
12% |
5% |
|
Coder 8 |
3% |
5% |
|
Variation Log by MS-DRG* |
||
|
MS-DRG |
Volume |
Error Rate |
|
470 |
420 |
2% |
|
313 |
233 |
14% |
|
392 |
232 |
1% |
|
291 |
232 |
17% |
|
247 |
220 |
3% |
|
292 |
216 |
5% |
|
871 |
213 |
12% |
|
641 |
209 |
0% |
|
194 |
195 |
3% |
|
293 |
193 |
1% |
|
885 |
188 |
3% |
|
312 |
177 |
0% |
|
191 |
175 |
7% |
|
287 |
173 |
2% |
|
310 |
171 |
15% |
|
689 |
157 |
11% |
|
603 |
143 |
2% |
|
379 |
137 |
3% |
|
192 |
131 |
9% |
|
683 |
116 |
11% |
|
189 |
114 |
1% |
|
069 |
110 |
2% |
|
190 |
92 |
12% |
|
193 |
87 |
10% |
|
690 |
76 |
4% |
|
065 |
76 |
5% |
|
195 |
72 |
2% |
|
066 |
52 |
2% |
|
064 |
41 |
5% |
|
906 |
35 |
2% |
*MS-DRG descriptions provided below
|
Variation Log by MS-DRG* Set |
||
|
MS-DRG Set |
Hospital % |
Nation % |
|
064 |
24.3% |
21.4% |
|
065 |
45.0% |
43.8% |
|
066 |
30.8% |
34.8% |
|
190 |
23.1% |
15.2% |
|
191 |
44.0% |
33.5% |
|
192 |
32.9% |
51.3% |
|
193 |
24.6% |
17.5% |
|
194 |
55.1% |
54.2% |
|
195 |
20.3% |
28.3% |
|
291 |
34.6% |
29.2% |
|
292 |
36.7% |
38.8% |
|
293 |
28.8% |
31.9% |
|
689 |
67.4% |
21.7% |
|
690 |
32.6% |
78.3% |
*MS-DRG descriptions provided below
|
MS-DRG |
MS-DRG Title (FY 2018) |
|
064 |
Intracranial hemorrhage or cerebral infarction w MCC |
|
065 |
Intracranial hemorrhage or cerebral infarction w CC |
|
066 |
Intracranial hemorrhage or cerebral infarction w/o CC/MCC |
|
069 |
Transient ischemia |
|
189 |
Pulmonary edema & respiratory failure |
|
190 |
Chronic obstructive pulmonary disease w MCC |
|
191 |
Chronic obstructive pulmonary disease w CC |
|
192 |
Chronic obstructive pulmonary disease w/o CC/MCC |
|
193 |
Simple pneumonia & pleurisy w MCC |
|
194 |
Simple pneumonia & pleurisy w CC |
|
195 |
Simple pneumonia & pleurisy w/o CC/MCC |
|
247 |
Perc cardiovasc proc w drug-eluting stent w/o MCC |
|
287 |
Circulatory disorders except AMI, w card cath w/o MCC |
|
291 |
Heart failure & shock w MCC |
|
292 |
Heart failure & shock w CC |
|
293 |
Heart failure & shock w/o CC/MCC |
|
310 |
Cardiac arrhythmia & conduction disorders w/o CC/MCC |
|
312 |
Syncope & collapse |
|
313 |
Chest pain |
|
379 |
G.I. hemorrhage w/o CC/MCC |
|
392 |
Esophagitis, gastroent & misc digest disorders w/o MCC |
|
470 |
Major joint replacement or reattachment of lower extremity w/o MCC |
|
603 |
Cellulitis w/o MCC |
|
641 |
Nutritional & misc metabolic disorders w/o MCC |
|
683 |
Renal failure w CC |
|
689 |
Kidney & urinary tract infections w/ MCC |
|
690 |
Kidney & urinary tract infections w/o MCC |
|
871 |
Septicemia w/o MV 96+ hours w MCC |
|
885 |
Psychoses |
|
906 |
Hand procedures for injuries |
2.
Compare the hospital figures to the state average and the peer
facilities. Why are an individual hospital’s figures above or below the
state average? One potential explanation could be coding or billing
errors. Brainstorm other possible explanations for why a facility’s CMI
is higher or lower than the state or its peers?
|
Table 5. Overall CMI—Years 1–3 |
|||
|
Facility |
Year 1 |
Year 2 |
Year 3 |
|
Hospital A |
1.8694 |
1.9017 |
2.1473 |
|
Hospital B |
1.9662 |
2.0554 |
2.0267 |
|
Hospital C |
1.6440 |
1.6873 |
1.7010 |
|
Hospital D |
1.8454 |
1.7021 |
1.6250 |
|
State Average |
1.4480 |
1.4778 |
1.4953 |
3.
What is ICD-10? What is ICD-10-CM? Is this classification system
important for the future of healthcare reimbursement? Why or why not?
Begin your research with the National Center for Health Statistics Web site at: http://www.cdc.gov/nchs/
