onditions in the Newborn Nursery J Douglas Campbell MD Physician Advisor Clinical Documentation Integrity Wolfson Childrens Hospital BCBS Commercial payers Staywell Medicaid Why ID: 1036098
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1. Documentation of commonconditions in theNewborn NurseryJ. Douglas Campbell MDPhysician AdvisorClinical Documentation IntegrityWolfson Children’s Hospital
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4. BCBS ( Commercial payers)Staywell (Medicaid)$
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7. Why not getpaid forwhat you do?If you dothe work…
8. Use the right wordsto getthe right reimbursement
9. Ankyloglossia
10. Single live newborn with ankyloglossiaROM – 1 SOI - 1BCBS - improved reimbursementMedicaid (Staywell) no changeAnkyloglossiaMinimum Documentation Required: Lactation nurse to assess feeding secondary to anklyoglossiaFollow up ankyloglossia with pediatrician / ENT
11. It’s all about the hip
12. Single live newborn with congenital hip dysplasiaROM – 1SOI - 1BCBS - improved reimbursementMedicaid (Staywell) – no changeMinimum Documentation Required - Presumed (suspected/probable/likely) developmental dysplasia of the hip (DDH) will require follow-up hip ultrasound.
13. Single live newborn with Breech presentationROM – 2SOI - 1BCBS –$ improved reimbursementMedicaid (Staywell) $improved Minimum Documentation Required: Breech presentation – will require follow-up ultrasound
14. LGA / SGASize matters
15. LGA (not associated with IDM)Single live newborn with LGAROM – 1SOI - 1BCBS – no changeMedicaid (Staywell) – no changeInfants whose weight exceeds the 90th percentile for gestational age are classified as LGAMinimum Documentation Required: Infant is LGA
16. SGA (not associated with IDM)Single live newborn withSGAROM – 2SOI - 1BCBS – improved reimbursementMedicaid (Staywell) – improved Minimum Documentation Required:Infant is SGAInfants whose birthweight is below the 10th percentile, when plotted against gestational age on a standard growth curve, are considered small for gestational age (SGA)
17. Hypoglycemia (not associated with IDM) Single live newborn with Hypoglycemia ROM – 2SOI - 1BCBS – improved reimbursementMedicaid (Staywell) - improvedDefinition – blood glucose < 40 mg/dl & treated with GluTose gel or IV glucose NOT treated with only formula or breast feeding
18. < 40 mg/dl
19. And the word HYPOGLYCEMIANot - Low blood sugar Not - Low serum glucoseMinimum Documentation Required:Hypoglycemia
20. Affects the Newborn
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22. NEONATAL EFFECTS — IDMs are at increased risk for mortality and morbidity compared with neonates born to a nondiabetic motherNeonatal complications in infant’s of diabetic mothers include:●Congenital anomalies – 5%●Prematurity – 36%●Microsomia – see in 20% of IDM vs. 10% in non-IDM●Macrosomia, which increases the risk of birth injury (eg, brachial plexus injury) – 34%●Respiratory distress – 33%●Metabolic complications including hypoglycemia and hypocalcemia●Hematologic complications including polycythemia and hyperviscosity●Hyperbilirubinemia – 25%●Cardiomyopathy
23. Despite the propensity for abnormalities associated with maternal diabetes, many IDM’s are born without any complications or abnormalities
24. Single live newborn that is“Infant of diabetic mother”ROM - 1SOI - 1BCBS - no change Medicaid (Staywell) – no changeInfant of Diabetic MotherNo complications / associated entitiesMinimal Documentation Required :Infant of diabetic mother with gestational / Non-gestational diabetes (Type I or Type II)
25. When there is a condition associated with the maternal diabetes…………
26. Syndrome of Infant of a Diabetic Mother IDM with a condition which felt to be secondary to (or associated with)maternal diabetes.LGA / SGAHypoglycemiaHyperbilirubinemiaPolycythemiaTransient tachypnea of newborn
27. Syndrome of infant of diabetic motherSingle live newborn with “Syndrome of infant of diabetic mother”ROM - 2SOI - 1BCBS – improved reimbursementMedicaid (Staywell) - improvedLet’s l k at documentation:
28. Documentation for Syndrome ofInfant of a Diabetic MotherDocument the maternal diabetes as: a. gestational b. non-gestational (Type I or II)2. The entity felt to be associated with maternal diabetes3. Linkage utilizing the words: secondary, due to or with 4. Use the words syndrome of IDM
29. Infant large for gestation age secondary to syndrome of infant of a diabetic mother with gestational diabetes2. Infant small for gestation age due to syndrome of infant of a diabetic mother with Type I diabetes3. Infant with hypoglycemia secondary to syndrome of infant of a diabetic mother with Type II diabetes4. Infant with polycythemia with syndrome of infant of a diabetic mother with gestational diabetesSecondary to > due to >> with
30. ABO incompatibilityABO isoimmunization
31. ABO IsoimmunizationMother Blood group O – newborn type A or BSome Group O moms have anti-A, anti-B IgG antibodiesCan result in hemolysis in fetus/newbornMore common and more severe in African AmericansCan occur with first pregnancy Less severe than Rh incompatibility 55/1000 live births
32. Laboratory testingCoombsHemoglobin Reticulocyte countBilirubin Coombs positive
33. ABO Isoimmunization Single live newborn with ABO iso-immunizationROM – 2SOI - 1 BCBS – improved reimbursementMedicaid (Staywell) - improved Minimum Documentation Required:ABO isoimmunization Single live newbornROM – 1SOI – 1BCBS - $ XMedicaid (Staywell) - $ Y
34. Prematurity
35. < 37 completed weeks gestation Minimum Documentation Required :Premature / Preterm
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37. Why leave iton the tree?Why leave it on the table?