Mortality Reviews
Does anyone have a good template/guideline/form to use for mortality reviews? If someone has one they would like to share, I would be grateful! Thanks so much!-Vicki
Vicki S. Davis, RN CDS
Clinical Documentation Improvement Manager
Health Information Management Department
Alamance Regional Medical Center
Office (336) 586-3765
Ascom Mobile (336) 586-4191
Fax (336) 538-7428
vdavis2@armc.com
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens
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Vicki S. Davis, RN CDS
Clinical Documentation Improvement Manager
Health Information Management Department
Alamance Regional Medical Center
Office (336) 586-3765
Ascom Mobile (336) 586-4191
Fax (336) 538-7428
vdavis2@armc.com
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens
______________________________________________________________________
Notice: The information contained in this message (Including attachments) is covered by the Electronic Communications Privacy Act, 18 U.S.C. 2510-2521, is confidential and may be legally protected from disclosure. If you are not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any retention, dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify the Sender immediately by replying to the message and deleting it from your computer. ______________________________________________________________________
Comments
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
Robert
Robert S. Hodges, BSN, MSN, RN, CCDS
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
P: 989-497-2500 x13101
F: 989-321-4912
E: Robert.Hodges2@va.gov
"Patriotism is easy to understand in America; it means looking out for
yourself by looking out for your country" Calvin Coolidge
t, DRG, SOI/ROM scores, Pdx, mcc/cc's, secondary dx's, DNR/Palliative stat=
us (and if we are still coding it in the top 9 for the quality measures), =
and whether the case was reviewed by a CDS or not.
All of this work to find out what we already know-the SOI/ROM scores are u=
sually 4/4 when CDS was involved. Is anyone shocked??????????? Lol.
We are getting ready to start reviewing all charts before coding drops the=
bill when the SOI/ROM scores are less than 4/4. I started a spreadsheet =
to help me track the info, but it seems awkward and cumbersome. I attache=
d a sample of the spreadsheet without any specific patient identifiers. A=
nyone have any suggestions for improvement?
Thanks so much-V
Vicki S. Davis, RN CDS
Clinical Documentation Improvement Manager
Health Information Management Department
Alamance Regional Medical Center
Office (336) 586-3765
Ascom Mobile (336) 586-4191
Fax (336) 538-7428
vdavis2@armc.com
"The difference between the right word and the almost right word is the di=
fference between lightning and the lightning bug."- Samuel "Mark Twain" Cl=
emens
One thought I had looking at it quickly, it might be worthwhile to add 2 columns where you would put in the # of cc's and the # of mcc's (in addition to listing them out as you've done).
Additionally, are you posing retrospective queries to capture additional diagnosis? or suggestions to coding to add additional diagnosis that you feel are documented but not coded? Fields to capture those activities (and the outcomes, MD answered, coder agreed, what & number of additional diagnosis...)
If you (or anyone else) are members to UHC, they have full detail available about their mortality models so you can know exactly what does / does not impact mortality for any particular DRG.
Don
The problem we ended up having is that every time I reported back to our director and MD liaison, they wanted additional data. Generally it was demographic data that was already in our electronic system (Midas) but I had not included it in my report. Also, when you begin doing these reviews, things just start coming up. I hope other hospitals don't have this issue but I don't think administration was aware that we have many death charts without d/c summaries (!!!). So then of course they wanted to know how many and which Dr's etc. It just kept growing.... This is why I ended up working with IT to create a formal registry. This way when they want to then look at any additional info (ethnicity, consults, ICD-9's, etc), I (meaning a data analyst does it for me) can pull out whatever they request. I can also pull out a pre-built Face Sheet with the review data as well as pertinent demographics and all the ICD-9 codes and print that. This only became important because our death records are highly scrutinized by MD's. They are looking at their own quality data at this point via CRIMSON and the first thing they generally want to focus on is the death charts. This is why we decided it was super important to ensure that the coding was accurate and any opportunities to improve their SOI/ROM has been handled. I'm sure not every hospital is dealing with this same issue, but that's our context.
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
Vicki S. Davis, RN CDS
Clinical Documentation Improvement Manager
Health Information Management Department
Alamance Regional Medical Center
Office (336) 586-3765
Ascom Mobile (336) 586-4191
Fax (336) 538-7428
vdavis2@armc.com
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens
physician review and documentation of opportunities to improve
processes/outcomes. It is based on info collected by the CDS and coders,
including DNR status, comfort care, SOI/ROM scores, secondary dx, etc
but then prompts the reviewing physician to add comments as appropriate
(see highlighted fields). Mortality review is a standing agenda item at
our monthly core measure team meetings.
Bonnie Zahn, RHIA, CHP, CHDA
Director, Health Information Management
Underwood-Memorial Hospital
509 N. Broad Street
Woodbury, New Jersey 08096
Phone: (856) 853-2112
Fax: (856) 251-0997
E-Mail: zahnb@umhospital.org
What I noticed is the tendency to choose the main diagnosis and drop the bill.
I am unfamiliar with how outpt/ED is billed but have noticed many 'rebills' when the information requesting additional diagnoses was relayed to coding.
Charlene Thiry, RN, BSN, CPC, CCDS
CDI Consultant
Phone: 913-796-5944
charlene.thiry@TrustHCS.com
www.TrustHCS.com
Read our blog: http://www.trusthcs.com/blog/
Amy Fenton, R.N.
Clinical Documentation Specialist
Bronson Hospital
Quality and Safety
601 John Street
Box 59
Kalamazoo, MI 49007
Phone 269-341-8442
Fax 269-341-8330
As for the payment part, I also am not overly familiar with OP billing but it is my basic understanding that payment is based off of the CPT codes rather than the I-10 diagnostic codes. This is why OP CDI is so different than IP.
If I am incorrect and metrics like O:E or financial reimbursement would be impacted by my reviews, I want to include OP encounters in this process. But it they won't be impacted, I will punt these reviews to quality for identification of any quality improvement opportunities and continue to only review IP.
Thanks for your input!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
Also remember that since mortality is a "30 day all cause" make sure you have their discharge status correct, since discharging to hospice will exclude them from coming back into your data if they die within 30 days of discharge.
Liz
Juli
Juli Bovard RN CCDS
Certified Clinical Documentation Specialist
Clinical Effectiveness/Clinical Quality
Rapid City Regional Hospital
755-8426 (work)
786-2677 (cell)
"No Limit to Better......"
[CCDS_pin_1inch]
If they were admitted as an acute inpatient then yes we would review the case. Admin has flip flopped a couple of times and has now removed out-patient from our population.
Vanessa Falkoff RN
Clinical Documentation Improvement Coordinator
University Medical Center of Southern Nevada
1800 W Charleston Blvd
Las Vegas, NV
vanessa.falkoff@umcsn.com
office 702-383-7322
Compassion * Accountability * Respect * Integrity
No, we exclude from the population of reviews.
On Thu, Feb 18, 2016 at 3:58 PM, CDI Talk wrote:
> We do not include Hospice at our institution!
Debbie Smith, RN, CCDS, CCS
UT Southwestern Medical Center at Dallas-
William P Clements and Zale Lipshy University Hospitals
6201 Harry Hines Blvd.
Dallas, TX 75390
214-645-5217
Deborahw.smith@utsouthwestern.edu
Sent from my iPad
What I have been able to discern, in some quality models, if a patient qualifies for Inpatient Hospice Services, an order is written for same, and the service is reported as Hospice, these patients are not included in the Mortality Outcomes data and are not tabulated as an expired outcome for acute inpatient admission. Your site is required to have a license for a hospice designation.
Paul
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421
evanspx@sutterhealth.org
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I've been conducting mortality reviews on all inpatients (including hospice) since 2010.
Kerry Seekircher, RN, BS, CCDS, CDIP