coding NGT
Hello fellow pedi CDIS. I have been going back and forth with my HIM manager about the new update for 2017 in coding NGT placement. In the past coding the NGT changes a APR-DRG to "Mod procedure unrelated to PDX" and yielded a higher weight and SOI, no matter what. Today, I was instructed not to code the NGT placement because it causes issues with reimbursement. If a child is admitted for initiation of NGT placement for FTT/malnutrition, we are not to code it.
Have any of you had this issue with the new update for 2017. I am thinking that maybe my 3M is not updated.
Your thoughts , thanks in advance for your help.
Steph
Comments
I will keep you updated if I find anything out.
Jackie
Jackie
There are no coding guidelines precluding sites from coding various procedures performed by an RN, PT, etc. In my view, the record is more complete if such procedure are coded, but within reason and with an accounting for the time and effort and contribution to the data base taken to code such procedures. (Generally would not code IV lines, but would code PICC, as one example).
Paul Evans, RHIA. CCDS
My guess is K92.9.
Claudine
@lostwater - totally agree! the coding of the NGT placement or PICC line placed by our nurses is extremely important for capture of patients for research project, but because they were performed by 'a nurse', no coding. it doesn't even affect our reimbursement- medical necessity from Interqual or Milliman doesn't ask who placed it, just that they have it and use it.
@jackietouch- regrettably the coders will not code a PICC line placed by a clinical nurse, only APN or physician. basically, any procedure done by a 'nurse' is not captured. ugh!
The amount of information a coder must abstract, such as source of admission, dates of consults, etc. is considerable and takes much time - as well as simply coding the chart. There are UHDDS definitions mandating that certain procedures that are required to be coded. (See Coding Guidelines)
This leaves hundreds of other procedures a coder 'could' code; but, the reality is, this won't happen. However, If a procedure impacted an APR DRG assignment, one may argue that impacts issues such as ROM and even reimbursement as some parties pay on APR. So, I'd make my case to the coding manager, but I'd bring a strong rationale and justification to the table. I am speaking from experience as I have had some ask that we even code Chest Films! Bear in mind much work is captured not by hard coding, but via the charge description master process. My opinion is a PICC line is coded or not based on policy, but based upon whom placed the PICC. Having said that, it is doubtful coders would or should code every possible procedure that would be good to have for research; it is not logical. Again, check with your CDM for a listing of other procedures performed onsite, but not coded with PCS, but with CPT. These will have Revenue Codes and are further broken down by CPT, and can be used for research.
Paul
Does your organization have a policy on which procedures should be coded in IP settings? If not, you probably should discuss with your Coding Manager whether it will be beneficial to create one. Traditionally only invasive procedures are captured in the IP settings, but sometimes other procedures can be included, if they are required for additional data collection.
The issue that bothers me here is that your organization suppresses the code for a documented procedure for purely financial reason. Not assigning the code when the procedure is clearly documented contradicts AHIMA Standards of Ethical Coding:
Coding professionals shall not: 5.3. Misrepresent the patient's clinical picture through intentional incorrect coding or omission of diagnosis or procedure codes, or the addition of diagnosis or procedure codes unsupported by health record documentation, to inappropriately increase reimbursement, justify medical necessity, improve publicly reported data, or qualify for insurance policy coverage benefitshttp://bok.ahima.org/CodingStandards