Back to the basics Coding Documentation Coverage 09152017 Disclaimer The information provided is the experience of the HSHS St Vincent Hospital and Edwards Lifesciences has not independently evaluated these data Outcomes are dependent upon a number of facility and surgeon fact ID: 930473
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Slide1
Principles of Reimbursement
“Back to the basics” – Coding Documentation, Coverage
09/15/2017
Slide2Disclaimer
The information provided is the experience of the
HSHS St. Vincent Hospital
, and Edwards Lifesciences has not independently evaluated these data. Outcomes are dependent upon a number of facility and surgeon factors which are outside Edwards’ control. These data should not be considered promises or guarantees by Edwards that the outcomes presented here will be achieved by an individual facility. Patti Runge and Chris Brabant are paid consultants to Edwards Lifesciences
2
Slide3Introduction and b
ackground
History of the program
Documentation processEngagement3Objectives
Slide4The Journey
Slide5TAVR Team Concept
5
Collaborative treatment decision
Optimal patient centric careDedication across medical specialtiesHSHS SVGPrevea Health
HSHS SJSPrairie Heart Institute
Interventional
Cardiologist
Cardiologist
Surgeon
Valve Clinic
Coordinator
Cardiac
CATH Lab
and
O.R. Staff
Anesthesiologist
Referring
Cardiologist
Imaging Specialists
TAVR
Heart Team
Slide6Springfield
Slide7TAVR Preparation
Slide8Collective Effort
Provider team
Cardiac Surgeons
CardiologistsAPNP and PA-COperational groupValve ClinicCardiovascular Lab Cardiac Surgical ORCardiac Short StayCVICU
Coding and Documentation
8
Slide99
St. Vincent Hospital
TAVR Metrics
Slide10Engage your Clinical Documentation Integrity Specialists / CDIS from the start
A strong working relationship between your Clinical Documentation Team and Coding Team is crucial
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Keys to Documentation Success
Slide11Met with our CTS Nurse Practitioners regularly for the first few months to discuss key documentation tips
Share Top MCC lists with Providers
Attended weekly TAVR discussions with CTS team
Each CDIS has attended discussions to become familiar with both the TAVR team and TAVR program11
Starting Line
Slide1212
TAVR Review Process
Slide1313
Clinical Validation
Slide1414
Congestive Heart Failure
Slide1515
Diastolic Congestive Heart Failure
Diastolic heart failure occurs when the left ventricle
loses
its ability to relax normally because the muscle has become stiff. The heart can’t properly fill with blood during the resting period between each beat.
Causes include hypertension, faulty heart valves, cardiomyopathy, arrhythmias, and chronic diseases such as diabetes and chronic kidney disease.
Treatment includes diuretics, beta blockers, ACE inhibitors, ARB’s along with diet and lifestyle changes.
Slide16Preserved Ventricular Function, Preserved Systolic Function and HFpEF are all synonymous with Diastolic CHF and can be coded as such
Low EF, Reduced Systolic Function, and HFrEF can be coded to Systolic CHF
Decompensated or exacerbated equals Acute
Clinical Indicators to look for in Acute CHF:Chest X-ray: Pleural effusion, pulmonary edema, interstitial fluid present?Are there additional Chest X-rays ordered? Abnormal breath sounds, SOB, orthopnea, decreased activity level documented?Increased Oxygen needs above baseline?Have their home CHF meds been restarted?Any additional IV diuretics or IV BP meds being given?
Weight, lower extremity edema increased?If none of the above indicators are present and Acute Heart Failure is documented, it is important that you query to validate the diagnosis
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Documentation of Congestive Heart Failure
Slide17CLINICAL INDICATORS: 86 year old man with severe symptomatic aortic
stenosis admitted for
scheduled transcatheter aortic
valve replacement. Acute on chronic diastolic heart failure has been documented. Weight remained stable, chest X-ray and lungs were clear, no edema was present, and no diuretics were given.
Please clarify the acuity of the heart failure:
A. Acute on Chronic Diastolic Heart Failure
B. Chronic Diastolic Heart Failure
C. No clinically significant abnormality
D. Other (please specify)
E. Decline Query (please explain)
Your
response serves as your authenticated entry to the Legal Medical Record.
Thank you;
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Clinical Validation Query
Slide18MCC
Code
MCC
Code
Acute on Chronic Diastolic
Congestive Heart Failure
I50.33
Acute Diastolic
Heart Failure
I50.31
Acute on chronic combined Diastolic/Systolic
Congestive Heart Failure
I50.43
Acute on Chronic
Post-Procedural Respiratory Failure
J95.822
End
Stage
Renal Disease
N18.6
Acute/Subacute
Infective Endocarditis
I33.0
Acute
on Chronic Systolic Heart Failure
I50.23
Acute Pulmonary Edema
J81.0
Acute Respiratory Failure with Hypoxia
J96.01
Acute Respiratory Failure with Hypercapnia
J96.02
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Top 10 MCC List
Slide19Staying Engaged
Continued presence at weekly TAVR discussions
Ongoing Provider Education
Standardized Query formatVerbal Queries are a great way to keep lines of communication open
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Slide2020
Thank You
Patti Runge RN BSN
Chris
Brabant FACHE
Clinical Documentation Specialist, Facilitator Executive Director, Heart Lung &
Patti.Runge@hshs.org
920-431-3279 Vascular Center Prevea Health
christopher.brabant@hshs.org
920 884 5967
Edwards, Edwards Lifesciences are
trademarks of Edwards Lifesciences Corporation. All other trademarks are the property of their respective owners.
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