TRANSITION TO ICD-10 CODING IN LONG TERM CARE. Jane Ryan, MHA, RHIA May 24, 2016

Transcription

1 TRANSITION TO ICD-10 CODING IN LONG TERM CARE Jane Ryan, MHA, RHIA May 24, 2016

2 OUTLINE Description of Allied Services Integrated Health System Difficulties in Coding for Long Term Care Preparation/Education Activities Prior to 10/01/2015 Implementation Day Review by Outside Agency Education, Education, Education

3 Allied Services Integrated Health System Inpatient Rehab 4 Facilities Outpatient Rehab 13 Facilities Skilled Nursing 1 Facility Transitional Rehab 2 Facilities Assisted Living 1 Facility Home Health, In-Home Care, Community Services

4 Difficulties in Coding for LTC Diagnoses obtained from hospital records. Diagnoses for medications must be determined. The reason for admission to the hospital may not be the same as the reason for admission for skilled nursing care. Diagnoses may be added during the stay.

5 Difficulties in Coding for LTC EXAMPLES

6 Preparation/Education ICD-10 Committee Committee began meeting in Members Members were selected based upon knowledge and expertise in tools needed to implement ICD-10.

7 Education Coders attended 1-day to 3-day training courses and utilized on-line courses. John Heinz (3 coders) Allied Rehab/Skilled Nursing (3 coders) Home Health (3 coders for 3 facilities)

8 Activities Prior to 10/01/2015 Coders in the inpatient facilities are trained in inpatient and outpatient rehab coding, long term care coding, and transitional rehab unit coding. A long-awaited encoder was installed. Facilities were prioritized and codes converted for patients/residents/clients who were expected to be discharged after 10/01/2015.

9 Activities (continued) Skilled Nursing Center Residents Computer System PointClickCare (PCC) Codes are assigned on admission and upon return from a hospitalization.

10 Activities (continued) Some diagnoses need to be added after a physician visit, laboratory test, imaging test, etc. Some long-term residents had diagnoses which could be resolved (pneumonia, UTI, etc.) Resolved diagnoses in PCC are able to be retrieved if necessary.

11 Activities (continued) RNACs played a pivotal role in determining which diagnoses were no longer being treated and could be resolved. Form was developed to communicate with coders.

12 Activities (continued) DIAGNOSIS CHANGE UPDATE AND/OR RESOLVE DIAGNOSES Unit FAX to 4313 Onset Date Resident Diagnosis Change THIS IS NOT PART OF THE PERMANENT RECORD

13 Activities (continued) 325+ charts were reviewed by six RNACs. We continue to use the form. RNACs assist in evaluating inconsistency in codes and determination of whether the condition still exists.

14 Activities (continued) PointClickCare allowed us to convert codes to ICD-10 prior to 10/01/2015 without the codes appearing on the face sheet or within the medical record.

15 Implementation Day At midnight on 10/01/2015, switch was made to show converted codes. New face sheets with ICD-10 codes were printed for all residents by unit clerks and placed on the hard-copy chart.

16 Implementation Day Difficulties In ICD-9, specificity is lacking. Codes had to be re-evaluated after conversion to determine if diagnoses could be further specified.

17 Review by Outside Agency In April, charts were reviewed to determine if appropriate coding is being utilized. The review enhanced our education.

18 Education, Education, Education The learning process continues. Helpful Hints Be certain to review the Tabular List for Excludes and Includes Notes Example follows.

19 Education, Education, Education What does your facility want to capture? Example follows.

20 Education, Education, Education How is primary diagnosis determined? Example follows.

21 Education, Education, Education Use Coding Clinic. Use Faye Brown resources. An encoder is helpful, but is not 100% accurate. USE THE BOOK!!!!!! Obtain AHIMA credentials.

22 Questions?

23 Contact Information Jane Ryan, MHA, RHIA Allied Services Integrated Health System 475 Morgan Highway Scranton, PA