Principles of Reimbursement - PowerPoint Presentation

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Principles of Reimbursement

“Back to the basics” – Coding Documentation, Coverage

09/15/2017

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 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

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Introduction and b

ackground

History of the program

Documentation processEngagement3Objectives

The Journey

TAVR Team Concept

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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

Springfield

TAVR Preparation

Collective Effort

Provider team

Cardiac Surgeons

CardiologistsAPNP and PA-COperational groupValve ClinicCardiovascular Lab Cardiac Surgical ORCardiac Short StayCVICU

Coding and Documentation

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St. Vincent Hospital

TAVR Metrics

Engage 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

Met 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

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TAVR Review Process

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Clinical Validation

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Congestive Heart Failure

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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.

Preserved 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

CLINICAL 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

MCC

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

Staying 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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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.

PP-

-US-2344 v1.021

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