acute blood loss anemia

MD has beautiful documentation:acute upper GI bleed, acute gastric ulcer and anemia d/t GI bleeding. My question is: does he have to document "anemia d/t acute blood loss"? I was told he does and then I listened to an ACDIS conference tape and it was stated that it doesn't have to be word for word. As long as the bleed was documented and that it was acute would be sufficient. Does anyone have any comments regarding this? Thank you.

Comments

  • edited April 2016
    If you look in the index of the ICD-9-CM code book it takes you:
    Anemia
    Blood loss
    Acute

    Or in the encoder:
    Bleeding
    GI
    Ulcer
    acute
    blood loss anemia?
    Yes - acute

    I would ask for the specificity of acute blood loss anemia.

    Charlene

  • edited April 2016
    I would clarify as it could be an acute or chronic blood loss anemia. Kim

  • edited April 2016
    It doesn't have to be word for word. The MD has said acute GI bleed and
    anemia due to GI bleeding. The two have been linked.

    Karen Beal, RN, BSN, CCRN
    Clinical Documentation Improvement Specialist
    Huntington Hospital
    100 W. California Blvd.
    Pasadena, CA 91109
    626-397-2024
    Fax 626-397-2904
    karen.beal@huntingtonhospital.com
  • edited April 2016
    Are you saying that the documentation is sufficient to code the blood loss anemia?




    Malinda


  • edited April 2016
    Coding Clinic 4Q 1993 states:
    If the physician clearly documents the anemia is due to acute blood loss,
    code 285.1 Acute posthemorrhagic anemia should be assigned. Anemia due to
    chronic blood loss is coded to 280.0 Secondary to blood loss (chronic).
    The physician should always be queried if there is a lack of sufficient
    documentation. Never assume cause and effect relationship.


    Stacy Vaughn, RHIT, CCS
    Data Support Specialist/DRG Assurance
    Aurora Baycare Medical Center
    2845 Greenbrier Rd
    Green Bay, WI 54311
    Phone: (920) 288-8655
    Fax: (920) 288-3052

  • We ask our physicians to document either:
    ABLA (acute blood loss anemia); or
    Acute anemia d/t blood loss; or
    Anemia d/t acute blood loss
    We just make sure the word "acute" is documented in relationship to the anemia/blood loss
  • Malinda,

    The documentation is sufficient. The MD did say acute upper GI bleed,
    acute gastric ulcer and anemia d/t GI bleeding.
    I ran this past the coding supervisor. She said you have enough for
    acute blood loss anemia. (the blood loss is due to GI bleed, and the
    patient has acute UGI bleed and acute gastric ulcer taking care of the
    acute portion).

    Karen
  • edited April 2016
    THANKS

    Chris Lamboley, RN, BSN
    Utilization Review Supervisor
    Illinois Valley Community Hospital
    925 West St.
    Peru, Il. 61354
    815.780.3294
    Fax: 815.780.3640
    chris.lamboley@ivch.org


  • edited April 2016
    I wouldn't have queried if they hadn't said anemia unless there were other clinical indicators as I generally like to see a 20% drop to indicate need for a query. But since the MD had documented Anemia, I would query for specificity/type.

    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

  • I'd reference any 'significant' amount of blood listed as lost during the procedure in a query.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

  • Hi,
    If the Docs say anemia, then we would query for type.
    If not, then we would query for significance of a drop of 2gm or more.

    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


    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 8:57 AM
    To: Vanessa Falkoff
    Subject: RE:[cdi_talk] Acute blood loss anemia

    I'd reference any 'significant' amount of blood listed as lost during the procedure in a query.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

    [cid:image001.jpg@01CE983E.025F5700]

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 8:48 AM
    To: Evans, Paul
    Subject: RE:[cdi_talk] Acute blood loss anemia

    Thank you

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 11:47 AM
    To: Slavin, Cindy
    Subject: RE:[cdi_talk] Acute blood loss anemia

    Yes. I would query for acute blood loss. I had one of our Vascular surgeons tell me that anything 2gm loss or more after should be considered as possibly an acute blood loss. Our coders query our OB/GYN's for this post delivery.

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 11:41 AM
    To: Melissa Windau
    Subject: [cdi_talk] Acute blood loss anemia

    Patient with hgb 11.7 to 9.5 post delivery..physician writes anemia, patient is being supplemented with PO iron..is discharged with PO iron...
    Would you query for acute blood loss?

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 11:23 AM
    To: Slavin, Cindy
    Subject: [cdi_talk] Excisional Debridement (Bovie)


    Below is a CC that clearly states the Bovie can be used as a cutting tool for excision. This might help the coder understand the different uses of the Bovie. Coders love Coding Clinics....



    It is addressing a question for I-10 but the same concept applies to I-9.

    [cid:image006.png@01D09924.CE8B6A60]





    Do you code excisional debridement done with a Bovie to excisional or nonexcisional?


    Sharon Salinas, CCS
    Health Information Management
    Barlow Respiratory Hospital
    2000 Stadium Way, Los Angeles CA 90026
    Tel: 213-250-4200 ext 3336
    FAX: 213-202-6490
    ssalinas@barlow2000.org






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    CONFIDENTIALITY NOTICE: This communication and its attachments may contain confidential or privileged information intended solely for the use of the individual or entity to whom it is addressed. If you are not an intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it (or any portion of the contents) or the attachments is strictly prohibited. If you have received this communication in error, please contact the sender and immediately destroy all copies of the communication and attachments. Thank you.
  • I'd also verify that there wasn't a dilutional component due to fluid administration, but yes, go for ABLA.

    Renee

    Linda Renee Brown, RN, MA, CCDS, CCS, CDIP
    Director, Clinical Documentation
    Tanner Health System
  • edited April 2016
    My 2 cents is I realize the type of anemia should be specified but it looks dilutional. If she had an epidural, she could have had 2 liters of fluid. I wonder if she was on iron before the delivery. I do not query for drop of Hgb 2 gm if patient has had IV fluid.

    Laura

  • RE: ABLA:

    That is why I'd review the record to see precisely 'how much' blood is documented as lost during the episode of care.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

  • edited April 2016
    Hi all, I came in late. Was there a transfusion of PRBC?
     

  • edited April 2016
    I only query with transfusion of blood products myself. You have to have the correct Intensity of Service.

    Mary L. Snook RN-BC
    Clinical Documentation Improvement Specialist
    Fairfield Medical Center
    740-689-4443



  • edited April 2016
    I believe even without PRBC’s you can support ABLA. If the condition is being monitored (repeat labs) and/or the patient is symptomatic (hypotension, tachycardia, etc), I think a query is indicated. I do think you have to be careful to account for dilution/fluid shifts, especially in surgical patients which is why I like to see the hgb a couple days after surgery.
    In this particular case, the physician has already identified the patient as having anemia so I am more comfortable querying for specificity of the condition even without a 20% drop. The diagnosis has already been made, you are simply asking for the underlying cause of the condition.

    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

  • What if the patient refuses transfusion based on Religious Grounds? Still has the condition, but refuses transfusion. A condition is reportable if it is ‘clinically evaluated”



    Actually, per the UHDDS Definition, treatment is (transfusion) not ‘required’ – although, many would acknowledge that direct treatment of any condition being considered surely strengthens the argument to code said condition.


    Conditions may be reported if:

    UHDDS Definition


    Meets the criteria for a secondary diagnosis if the physician documents the condition, evaluates the condition, or monitors the condition in some fashion that meets the criteria set forth in Coding Clinic such that the condition qualifies in terms of any of the following:



    · Clinical Evaluation

    · Therapeutic Treatment

    · Further evaluation by diagnostic studies, procedures or consultation

    · Extended LOS

    · Increased nursing care and/or other monitoring


    Clinical evaluation means the medical staff is aware of the condition and is evaluating it in terms of evaluation, testing, consultations, and clinical observation of the patient’s condition and/or the existence of the condition affect the types or choices of treatment rendered to the patient.


    A physical examination and a history is a ‘routine’ part of every hospital admission. The mere existence of any condition does not mean the condition is always reportable.

    Per Faye Brown, 2006, “Codes should not be assigned for conditions that do not meet UHDDS criteria for reporting. For example, diagnostic reports often mention such conditions such as hiatal hernia, atelectasis, and right bundle branch block with no further mention to indicate any relevance to the care given. Assigning a code is inappropriate for reporting purposes unless the physician provides documentation to support the condition’s significance for the episode of care”

    The mention of mild or asymptomatic MVP, as an example does not “usually” meet the definition of a reportable condition. In addition, some coders feel it is appropriate to report MVP merely because the record may state something such as: “Echo showed mild MVP”. However, this is NOT a diagnostic statement and this practice is contradicted by Coding Clinic.

    Some Examples, with Credit to the publication, “Faye Brown”

    Example 1: A low potassium level finding treated with intravenous or oral potassium is clinically significant and should be brought to the attention of the physician if no diagnosis has been documented.

    Example 2: A hematocrit of 28 %, even though asymptomatic and not treated, may have been evaluated by the physician with serial hematocrit. Because this is outside the range of normal laboratory values and has been further evaluated, it is significant enough to ask the physician whether an associated diagnosis should be documented.

    Example 3: A routine preoperative chest X-ray on an elderly patient reveals collapse of the vertebral body. The patient was asymptomatic and no further evaluation or treatment was carried out. This is a common finding in elderly patients and is probably insignificant for this episode.

    Example 4: In the absence of a cardiac problem, an isolated electrocardiographic finding of bundle branch block is ordinarily not significant, whereas a finding of a Mobitz II block may have important implications for the patient's care and would warrant asking the physician whether it should be reported for this admission.

    Example 5: Incidental findings on X-ray such as asymptomatic hiatal hernia or diverticulosis should not be reported unless further evaluation or treatment is carried out.

    Codes from section 790-796, Nonspecific abnormal findings, should be assigned only when the physician has not been able to arrive at a diagnosis based on an abnormal finding, but considers it clinically significant enough to list in the final diagnostic statement.

    Example 6: The physician lists an abnormal sedimentation rate, 790.1, on the face sheet and has been unable to make a definitive diagnosis during the hospitalization.

    Example 7: An abnormal pap smear of cervix, 795.0, is listed in the final diagnostic statement.

    Sources:

    http://www.medicinenet.com/mitral_valve_prolapse/page2.htm

    http://en.wikipedia.org/wiki/Mitral_valve

    Merck Manual, 16th Edition





    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

  • edited April 2016
    Interqual and Milliman require transfusion of blood products for the diagnosis to certify inpatient treatment for the stay in the hospital.

  • edited April 2016
    My opinion: interqual and milliman are irrevalent for CDI. These books are not diagnostic. They are about medical necessity. So a patient may have ABLA but not need IP admission because it is not severe enough to require transfusion and can be treated and monitored as an outpatient. But this does not mean that a patient who already is an inpatient can’t have ABLA without requiring transfusion.

    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

  • Well stated Katy and I totally agree!



    Mark

    MARK LEBLANC, RN, MBA, CCDS

    DIRECTOR CDI SERVICES



    952-353-3505

    m.leblanc@thewilshiregroup.net







    IMPORTANT WARNING: This message is intended for the use of the person or entity to which it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this information is strictly prohibited. Thank you for your cooperation.



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 3:09 PM
    To: m.leblanc@thewilshiregroup.net
    Subject: RE: [cdi_talk] Acute blood loss anemia



    My opinion: interqual and milliman are irrevalent for CDI. These books are not diagnostic. They are about medical necessity. So a patient may have ABLA but not need IP admission because it is not severe enough to require transfusion and can be treated and monitored as an outpatient. But this does not mean that a patient who already is an inpatient can’t have ABLA without requiring transfusion.



    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



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 2:08 PM
    To: Kathryn Good
    Subject: RE: [cdi_talk] Acute blood loss anemia



    Interqual and Milliman require transfusion of blood products for the diagnosis to certify inpatient treatment for the stay in the hospital.



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 3:59 PM
    To: Mary Snook
    Subject: RE: [cdi_talk] Acute blood loss anemia



    I believe even without PRBC’s you can support ABLA. If the condition is being monitored (repeat labs) and/or the patient is symptomatic (hypotension, tachycardia, etc), I think a query is indicated. I do think you have to be careful to account for dilution/fluid shifts, especially in surgical patients which is why I like to see the hgb a couple days after surgery.

    In this particular case, the physician has already identified the patient as having anemia so I am more comfortable querying for specificity of the condition even without a 20% drop. The diagnosis has already been made, you are simply asking for the underlying cause of the condition.



    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



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 1:37 PM
    To: Kathryn Good
    Subject: RE: [cdi_talk] Acute blood loss anemia



    I only query with transfusion of blood products myself. You have to have the correct Intensity of Service.



    Mary L. Snook RN-BC

    Clinical Documentation Improvement Specialist

    Fairfield Medical Center

    740-689-4443







    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 2:52 PM
    To: Mary Snook
    Subject: Re: [cdi_talk] Acute blood loss anemia



    Hi all, I came in late. Was there a transfusion of PRBC?





    _____

    From: "CDI Talk"
    To: gwojo@wowway.com
    Sent: Thursday, May 28, 2015 12:00:23 PM
    Subject: RE:[cdi_talk] Acute blood loss anemia





    RE: ABLA:



    That is why I’d review the record to see precisely ‘how much’ blood is documented as lost during the episode of care.



    Paul Evans, RHIA, CCS, CCS-P, CCDS



    Manager, Regional Clinical Documentation & Coding Integrity

    Sutter West Bay

    633 Folsom St., 7th Floor, Office 7-044

    San Francisco, CA 94107

    Cell: 415.412.9421



    evanspx@sutterhealth.org







    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 9:50 AM
    To: Evans, Paul
    Subject: RE:[cdi_talk] Acute blood loss anemia



    My 2 cents is I realize the type of anemia should be specified but it looks dilutional. If she had an epidural, she could have had 2 liters of fluid. I wonder if she was on iron before the delivery. I do not query for drop of Hgb 2 gm if patient has had IV fluid.



    Laura



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 12:01 PM
    To: Ringland, Laura
    Subject: RE:[cdi_talk] Acute blood loss anemia



    Hi,

    If the Docs say anemia, then we would query for type.

    If not, then we would query for significance of a drop of 2gm or more.



    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







    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 8:57 AM
    To: Vanessa Falkoff
    Subject: RE:[cdi_talk] Acute blood loss anemia



    I’d reference any ‘significant’ amount of blood listed as lost during the procedure in a query.



    Paul Evans, RHIA, CCS, CCS-P, CCDS



    Manager, Regional Clinical Documentation & Coding Integrity

    Sutter West Bay

    633 Folsom St., 7th Floor, Office 7-044

    San Francisco, CA 94107

    Cell: 415.412.9421



    evanspx@sutterhealth.org







    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 8:48 AM
    To: Evans, Paul
    Subject: RE:[cdi_talk] Acute blood loss anemia



    Thank you



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 11:47 AM
    To: Slavin, Cindy
    Subject: RE:[cdi_talk] Acute blood loss anemia



    Yes. I would query for acute blood loss. I had one of our Vascular surgeons tell me that anything 2gm loss or more after should be considered as possibly an acute blood loss. Our coders query our OB/GYN’s for this post delivery.



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 11:41 AM
    To: Melissa Windau
    Subject: [cdi_talk] Acute blood loss anemia



    Patient with hgb 11.7 to 9.5 post delivery..physician writes anemia, patient is being supplemented with PO iron..is discharged with PO iron…

    Would you query for acute blood loss?



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 11:23 AM
    To: Slavin, Cindy
    Subject: [cdi_talk] Excisional Debridement (Bovie)



    Below is a CC that clearly states the Bovie can be used as a cutting tool for excision. This might help the coder understand the different uses of the Bovie. Coders love Coding Clinics….



    It is addressing a question for I-10 but the same concept applies to I-9.







    Do you code excisional debridement done with a Bovie to excisional or nonexcisional?





    Sharon Salinas, CCS

    Health Information Management

    Barlow Respiratory Hospital

    2000 Stadium Way, Los Angeles CA 90026

    Tel: 213-250-4200 ext 3336

    FAX: 213-202-6490

    ssalinas@barlow2000.org




    ­­


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  • UHDDS criteria for reporting secondary diagnoses does not require transfusion of blood products. I don’t think this was a question of qualifying for inpatient care.

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 4:08 PM
    To: Fisher, Donna L.
    Subject: RE: [cdi_talk] Acute blood loss anemia

    Interqual and Milliman require transfusion of blood products for the diagnosis to certify inpatient treatment for the stay in the hospital.

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 3:59 PM
    To: Mary Snook
    Subject: RE: [cdi_talk] Acute blood loss anemia

    I believe even without PRBC’s you can support ABLA. If the condition is being monitored (repeat labs) and/or the patient is symptomatic (hypotension, tachycardia, etc), I think a query is indicated. I do think you have to be careful to account for dilution/fluid shifts, especially in surgical patients which is why I like to see the hgb a couple days after surgery.
    In this particular case, the physician has already identified the patient as having anemia so I am more comfortable querying for specificity of the condition even without a 20% drop. The diagnosis has already been made, you are simply asking for the underlying cause of the condition.

    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

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 1:37 PM
    To: Kathryn Good
    Subject: RE: [cdi_talk] Acute blood loss anemia

    I only query with transfusion of blood products myself. You have to have the correct Intensity of Service.

    Mary L. Snook RN-BC
    Clinical Documentation Improvement Specialist
    Fairfield Medical Center
    740-689-4443



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 2:52 PM
    To: Mary Snook
    Subject: Re: [cdi_talk] Acute blood loss anemia

    Hi all, I came in late. Was there a transfusion of PRBC?


    ________________________________
    From: "CDI Talk"
    To: gwojo@wowway.com
    Sent: Thursday, May 28, 2015 12:00:23 PM
    Subject: RE:[cdi_talk] Acute blood loss anemia


    RE: ABLA:

    That is why I’d review the record to see precisely ‘how much’ blood is documented as lost during the episode of care.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

    [cid:image001.jpg@01CE983E.025F5700]

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 9:50 AM
    To: Evans, Paul
    Subject: RE:[cdi_talk] Acute blood loss anemia

    My 2 cents is I realize the type of anemia should be specified but it looks dilutional. If she had an epidural, she could have had 2 liters of fluid. I wonder if she was on iron before the delivery. I do not query for drop of Hgb 2 gm if patient has had IV fluid.

    Laura

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 12:01 PM
    To: Ringland, Laura
    Subject: RE:[cdi_talk] Acute blood loss anemia

    Hi,
    If the Docs say anemia, then we would query for type.
    If not, then we would query for significance of a drop of 2gm or more.

    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



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 8:57 AM
    To: Vanessa Falkoff
    Subject: RE:[cdi_talk] Acute blood loss anemia

    I’d reference any ‘significant’ amount of blood listed as lost during the procedure in a query.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

    [cid:image001.jpg@01CE983E.025F5700]

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 8:48 AM
    To: Evans, Paul
    Subject: RE:[cdi_talk] Acute blood loss anemia

    Thank you

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 11:47 AM
    To: Slavin, Cindy
    Subject: RE:[cdi_talk] Acute blood loss anemia

    Yes. I would query for acute blood loss. I had one of our Vascular surgeons tell me that anything 2gm loss or more after should be considered as possibly an acute blood loss. Our coders query our OB/GYN’s for this post delivery.

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 11:41 AM
    To: Melissa Windau
    Subject: [cdi_talk] Acute blood loss anemia

    Patient with hgb 11.7 to 9.5 post delivery..physician writes anemia, patient is being supplemented with PO iron..is discharged with PO iron…
    Would you query for acute blood loss?

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 11:23 AM
    To: Slavin, Cindy
    Subject: [cdi_talk] Excisional Debridement (Bovie)


    Below is a CC that clearly states the Bovie can be used as a cutting tool for excision. This might help the coder understand the different uses of the Bovie. Coders love Coding Clinics….



    It is addressing a question for I-10 but the same concept applies to I-9.

    [cid:image003.png@01D09961.35533F70]





    Do you code excisional debridement done with a Bovie to excisional or nonexcisional?


    Sharon Salinas, CCS
    Health Information Management
    Barlow Respiratory Hospital
    2000 Stadium Way, Los Angeles CA 90026
    Tel: 213-250-4200 ext 3336
    FAX: 213-202-6490
    ssalinas@barlow2000.org


    ­­



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    CONFIDENTIALITY NOTICE: This communication and its attachments may contain confidential or privileged information intended solely for the use of the individual or entity to whom it is addressed. If you are not an intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it (or any portion of the contents) or the attachments is strictly prohibited. If you have received this communication in error, please contact the sender and immediately destroy all copies of the communication and attachments. Thank you.



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    People you know. Care you trust.

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  • That would be pertinent to meet Medical Necessity if the patient were being admitted FOR anemia. This is not the case w/ a pt that has a reportable form of anemia that is being coded as a secondary condition.

    If any condition is reportable as per the Official Guidelines, it should be coded, regardless.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

    [cid:image002.jpg@01D09948.16F53C90]

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 1:08 PM
    To: Evans, Paul
    Subject: RE: [cdi_talk] Acute blood loss anemia

    Interqual and Milliman require transfusion of blood products for the diagnosis to certify inpatient treatment for the stay in the hospital.

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 3:59 PM
    To: Mary Snook
    Subject: RE: [cdi_talk] Acute blood loss anemia

    I believe even without PRBC’s you can support ABLA. If the condition is being monitored (repeat labs) and/or the patient is symptomatic (hypotension, tachycardia, etc), I think a query is indicated. I do think you have to be careful to account for dilution/fluid shifts, especially in surgical patients which is why I like to see the hgb a couple days after surgery.
    In this particular case, the physician has already identified the patient as having anemia so I am more comfortable querying for specificity of the condition even without a 20% drop. The diagnosis has already been made, you are simply asking for the underlying cause of the condition.

    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

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 1:37 PM
    To: Kathryn Good
    Subject: RE: [cdi_talk] Acute blood loss anemia

    I only query with transfusion of blood products myself. You have to have the correct Intensity of Service.

    Mary L. Snook RN-BC
    Clinical Documentation Improvement Specialist
    Fairfield Medical Center
    740-689-4443



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 2:52 PM
    To: Mary Snook
    Subject: Re: [cdi_talk] Acute blood loss anemia

    Hi all, I came in late. Was there a transfusion of PRBC?


    ________________________________
    From: "CDI Talk"
    To: gwojo@wowway.com
    Sent: Thursday, May 28, 2015 12:00:23 PM
    Subject: RE:[cdi_talk] Acute blood loss anemia


    RE: ABLA:

    That is why I’d review the record to see precisely ‘how much’ blood is documented as lost during the episode of care.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

    [cid:image002.jpg@01D09948.16F53C90]

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 9:50 AM
    To: Evans, Paul
    Subject: RE:[cdi_talk] Acute blood loss anemia

    My 2 cents is I realize the type of anemia should be specified but it looks dilutional. If she had an epidural, she could have had 2 liters of fluid. I wonder if she was on iron before the delivery. I do not query for drop of Hgb 2 gm if patient has had IV fluid.

    Laura

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 12:01 PM
    To: Ringland, Laura
    Subject: RE:[cdi_talk] Acute blood loss anemia

    Hi,
    If the Docs say anemia, then we would query for type.
    If not, then we would query for significance of a drop of 2gm or more.

    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



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 8:57 AM
    To: Vanessa Falkoff
    Subject: RE:[cdi_talk] Acute blood loss anemia

    I’d reference any ‘significant’ amount of blood listed as lost during the procedure in a query.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

    [cid:image002.jpg@01D09948.16F53C90]

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 8:48 AM
    To: Evans, Paul
    Subject: RE:[cdi_talk] Acute blood loss anemia

    Thank you

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 11:47 AM
    To: Slavin, Cindy
    Subject: RE:[cdi_talk] Acute blood loss anemia

    Yes. I would query for acute blood loss. I had one of our Vascular surgeons tell me that anything 2gm loss or more after should be considered as possibly an acute blood loss. Our coders query our OB/GYN’s for this post delivery.

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 11:41 AM
    To: Melissa Windau
    Subject: [cdi_talk] Acute blood loss anemia

    Patient with hgb 11.7 to 9.5 post delivery..physician writes anemia, patient is being supplemented with PO iron..is discharged with PO iron…
    Would you query for acute blood loss?

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 11:23 AM
    To: Slavin, Cindy
    Subject: [cdi_talk] Excisional Debridement (Bovie)


    Below is a CC that clearly states the Bovie can be used as a cutting tool for excision. This might help the coder understand the different uses of the Bovie. Coders love Coding Clinics….



    It is addressing a question for I-10 but the same concept applies to I-9.

    [cid:image005.png@01D09948.16F53C90]





    Do you code excisional debridement done with a Bovie to excisional or nonexcisional?


    Sharon Salinas, CCS
    Health Information Management
    Barlow Respiratory Hospital
    2000 Stadium Way, Los Angeles CA 90026
    Tel: 213-250-4200 ext 3336
    FAX: 213-202-6490
    ssalinas@barlow2000.org


    ­­



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  • I agree Katie. Not relevant for CDI.

    Kathleen Benson RN, BSN, CCDS
    Supervisor, Clinical Documentation Integrity
    UWHealth University of Wisconsin Hospital
    Office Location: University Crossing, 749 University Row, Suite 200
    Mailing Location: 600 Highland Avenue, Mail Code 9920
    Madison, WI 53792-9475
    608-516-5638
    kbenson@uwhealth.org
    [cid:image004.png@01D0995A.84497F60]



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 3:09 PM
    To: Benson Kathleen
    Subject: RE: [cdi_talk] Acute blood loss anemia

    My opinion: interqual and milliman are irrevalent for CDI. These books are not diagnostic. They are about medical necessity. So a patient may have ABLA but not need IP admission because it is not severe enough to require transfusion and can be treated and monitored as an outpatient. But this does not mean that a patient who already is an inpatient can’t have ABLA without requiring transfusion.

    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

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 2:08 PM
    To: Kathryn Good
    Subject: RE: [cdi_talk] Acute blood loss anemia

    Interqual and Milliman require transfusion of blood products for the diagnosis to certify inpatient treatment for the stay in the hospital.

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 3:59 PM
    To: Mary Snook
    Subject: RE: [cdi_talk] Acute blood loss anemia

    I believe even without PRBC’s you can support ABLA. If the condition is being monitored (repeat labs) and/or the patient is symptomatic (hypotension, tachycardia, etc), I think a query is indicated. I do think you have to be careful to account for dilution/fluid shifts, especially in surgical patients which is why I like to see the hgb a couple days after surgery.
    In this particular case, the physician has already identified the patient as having anemia so I am more comfortable querying for specificity of the condition even without a 20% drop. The diagnosis has already been made, you are simply asking for the underlying cause of the condition.

    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

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 1:37 PM
    To: Kathryn Good
    Subject: RE: [cdi_talk] Acute blood loss anemia

    I only query with transfusion of blood products myself. You have to have the correct Intensity of Service.

    Mary L. Snook RN-BC
    Clinical Documentation Improvement Specialist
    Fairfield Medical Center
    740-689-4443



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 2:52 PM
    To: Mary Snook
    Subject: Re: [cdi_talk] Acute blood loss anemia

    Hi all, I came in late. Was there a transfusion of PRBC?


    ________________________________
    From: "CDI Talk"
    To: gwojo@wowway.com
    Sent: Thursday, May 28, 2015 12:00:23 PM
    Subject: RE:[cdi_talk] Acute blood loss anemia


    RE: ABLA:

    That is why I’d review the record to see precisely ‘how much’ blood is documented as lost during the episode of care.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

    [cid:image001.jpg@01CE983E.025F5700]

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 9:50 AM
    To: Evans, Paul
    Subject: RE:[cdi_talk] Acute blood loss anemia

    My 2 cents is I realize the type of anemia should be specified but it looks dilutional. If she had an epidural, she could have had 2 liters of fluid. I wonder if she was on iron before the delivery. I do not query for drop of Hgb 2 gm if patient has had IV fluid.

    Laura

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 12:01 PM
    To: Ringland, Laura
    Subject: RE:[cdi_talk] Acute blood loss anemia

    Hi,
    If the Docs say anemia, then we would query for type.
    If not, then we would query for significance of a drop of 2gm or more.

    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



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 8:57 AM
    To: Vanessa Falkoff
    Subject: RE:[cdi_talk] Acute blood loss anemia

    I’d reference any ‘significant’ amount of blood listed as lost during the procedure in a query.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

    [cid:image001.jpg@01CE983E.025F5700]

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 8:48 AM
    To: Evans, Paul
    Subject: RE:[cdi_talk] Acute blood loss anemia

    Thank you

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 11:47 AM
    To: Slavin, Cindy
    Subject: RE:[cdi_talk] Acute blood loss anemia

    Yes. I would query for acute blood loss. I had one of our Vascular surgeons tell me that anything 2gm loss or more after should be considered as possibly an acute blood loss. Our coders query our OB/GYN’s for this post delivery.

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 11:41 AM
    To: Melissa Windau
    Subject: [cdi_talk] Acute blood loss anemia

    Patient with hgb 11.7 to 9.5 post delivery..physician writes anemia, patient is being supplemented with PO iron..is discharged with PO iron…
    Would you query for acute blood loss?

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 11:23 AM
    To: Slavin, Cindy
    Subject: [cdi_talk] Excisional Debridement (Bovie)


    Below is a CC that clearly states the Bovie can be used as a cutting tool for excision. This might help the coder understand the different uses of the Bovie. Coders love Coding Clinics….



    It is addressing a question for I-10 but the same concept applies to I-9.

    [cid:image007.png@01D0995A.84497F60]





    Do you code excisional debridement done with a Bovie to excisional or nonexcisional?


    Sharon Salinas, CCS
    Health Information Management
    Barlow Respiratory Hospital
    2000 Stadium Way, Los Angeles CA 90026
    Tel: 213-250-4200 ext 3336
    FAX: 213-202-6490
    ssalinas@barlow2000.org


    ­­



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    CONFIDENTIALITY NOTICE: This communication and its attachments may contain confidential or privileged information intended solely for the use of the individual or entity to whom it is addressed. If you are not an intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it (or any portion of the contents) or the attachments is strictly prohibited. If you have received this communication in error, please contact the sender and immediately destroy all copies of the communication and attachments. Thank you.



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    Fairfield Medical Center
    People you know. Care you trust.

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  • Agree!

    Sharon Salinas, CCS
    Health Information Management
    Barlow Respiratory Hospital
    2000 Stadium Way, Los Angeles CA 90026
    Tel: 213-250-4200 ext 3336
    FAX: 213-202-6490
    ssalinas@barlow2000.org

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 1:09 PM
    To: Salinas, Sharon
    Subject: RE: [cdi_talk] Acute blood loss anemia

    My opinion: interqual and milliman are irrevalent for CDI. These books are not diagnostic. They are about medical necessity. So a patient may have ABLA but not need IP admission because it is not severe enough to require transfusion and can be treated and monitored as an outpatient. But this does not mean that a patient who already is an inpatient can’t have ABLA without requiring transfusion.

    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

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 2:08 PM
    To: Kathryn Good
    Subject: RE: [cdi_talk] Acute blood loss anemia

    Interqual and Milliman require transfusion of blood products for the diagnosis to certify inpatient treatment for the stay in the hospital.

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 3:59 PM
    To: Mary Snook
    Subject: RE: [cdi_talk] Acute blood loss anemia

    I believe even without PRBC’s you can support ABLA. If the condition is being monitored (repeat labs) and/or the patient is symptomatic (hypotension, tachycardia, etc), I think a query is indicated. I do think you have to be careful to account for dilution/fluid shifts, especially in surgical patients which is why I like to see the hgb a couple days after surgery.
    In this particular case, the physician has already identified the patient as having anemia so I am more comfortable querying for specificity of the condition even without a 20% drop. The diagnosis has already been made, you are simply asking for the underlying cause of the condition.

    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

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 1:37 PM
    To: Kathryn Good
    Subject: RE: [cdi_talk] Acute blood loss anemia

    I only query with transfusion of blood products myself. You have to have the correct Intensity of Service.

    Mary L. Snook RN-BC
    Clinical Documentation Improvement Specialist
    Fairfield Medical Center
    740-689-4443



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 2:52 PM
    To: Mary Snook
    Subject: Re: [cdi_talk] Acute blood loss anemia

    Hi all, I came in late. Was there a transfusion of PRBC?


    ________________________________
    From: "CDI Talk"
    To: gwojo@wowway.com
    Sent: Thursday, May 28, 2015 12:00:23 PM
    Subject: RE:[cdi_talk] Acute blood loss anemia


    RE: ABLA:

    That is why I’d review the record to see precisely ‘how much’ blood is documented as lost during the episode of care.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

    [cid:image001.jpg@01CE983E.025F5700]

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 9:50 AM
    To: Evans, Paul
    Subject: RE:[cdi_talk] Acute blood loss anemia

    My 2 cents is I realize the type of anemia should be specified but it looks dilutional. If she had an epidural, she could have had 2 liters of fluid. I wonder if she was on iron before the delivery. I do not query for drop of Hgb 2 gm if patient has had IV fluid.

    Laura

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 12:01 PM
    To: Ringland, Laura
    Subject: RE:[cdi_talk] Acute blood loss anemia

    Hi,
    If the Docs say anemia, then we would query for type.
    If not, then we would query for significance of a drop of 2gm or more.

    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



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 8:57 AM
    To: Vanessa Falkoff
    Subject: RE:[cdi_talk] Acute blood loss anemia

    I’d reference any ‘significant’ amount of blood listed as lost during the procedure in a query.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

    [cid:image001.jpg@01CE983E.025F5700]

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 8:48 AM
    To: Evans, Paul
    Subject: RE:[cdi_talk] Acute blood loss anemia

    Thank you

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 11:47 AM
    To: Slavin, Cindy
    Subject: RE:[cdi_talk] Acute blood loss anemia

    Yes. I would query for acute blood loss. I had one of our Vascular surgeons tell me that anything 2gm loss or more after should be considered as possibly an acute blood loss. Our coders query our OB/GYN’s for this post delivery.

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 11:41 AM
    To: Melissa Windau
    Subject: [cdi_talk] Acute blood loss anemia

    Patient with hgb 11.7 to 9.5 post delivery..physician writes anemia, patient is being supplemented with PO iron..is discharged with PO iron…
    Would you query for acute blood loss?

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 11:23 AM
    To: Slavin, Cindy
    Subject: [cdi_talk] Excisional Debridement (Bovie)


    Below is a CC that clearly states the Bovie can be used as a cutting tool for excision. This might help the coder understand the different uses of the Bovie. Coders love Coding Clinics….



    It is addressing a question for I-10 but the same concept applies to I-9.

    [cid:image003.png@01D0994A.DD12F0A0]





    Do you code excisional debridement done with a Bovie to excisional or nonexcisional?


    Sharon Salinas, CCS
    Health Information Management
    Barlow Respiratory Hospital
    2000 Stadium Way, Los Angeles CA 90026
    Tel: 213-250-4200 ext 3336
    FAX: 213-202-6490
    ssalinas@barlow2000.org


    ­­



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  • Thank you! What was the EBL and IVF in? Just trying to get the entire clinical picture!

    ----- Original Message -----

    From: "CDI Talk"
    To: gwojo@wowway.com
    Sent: Thursday, May 28, 2015 3:33:21 PM
    Subject: RE: [cdi_talk] Acute blood loss anemia



    Agree!

     


    Sharon Salinas, CCS

    Health Information Management

    Barlow Respiratory Hospital

    2000 Stadium Way, Los Angeles CA 90026

    Tel: 213-250-4200 ext 3336

    FAX: 213-202-6490

    ssalinas@barlow2000.org


     


    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, May 28, 2015 1:09 PM
    To: Salinas, Sharon
    Subject: RE: [cdi_talk] Acute blood loss anemia


     

    My opinion: interqual and milliman are irrevalent for CDI. These books are not diagnostic. They are about medical necessity. So a patient may have ABLA but not need IP admission because it is not severe enough to require transfusion and can be treated and monitored as an outpatient . But this does not mean that a patient who already is an inpatient can’t have ABLA without requiring transfusion.  

     


    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


     


    From: CDI Talk [ mailto:cdi_talk@hcprotalk.com ]
    Sent: Thursday, May 28, 2015 2:08 PM
    To: Kathryn Good
    Subject: RE: [cdi_talk] Acute blood loss anemia


     

    Interqual and Milliman require transfusion of blood products for the diagnosis to certify inpatient treatment for the stay in the hospital.

     


    From: CDI Talk [ mailto:cdi_talk@hcprotalk.com ]
    Sent: Thursday, May 28, 2015 3:59 PM
    To: Mary Snook
    Subject: RE: [cdi_talk] Acute blood loss anemia


     

    I believe even without PRBC’s you can support ABLA. If the condition is being monitored (repeat labs) and/or the patient is symptomatic (hypotension, tachycardia, etc), I think a query is indicated. I do think you have to be careful to account for dilution/fluid shifts, especially in surgical patients which is why I like to see the hgb a couple days after surgery.

    In this particular case, the physician has already identified the patient as having anemia so I am more comfortable querying for specificity of the condition even without a 20% drop. The diagnosis has already been made, you are simply asking for the underlying cause of the condition.

     


    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


     


    From: CDI Talk [ mailto:cdi_talk@hcprotalk.com ]
    Sent: Thursday, May 28, 2015 1:37 PM
    To: Kathryn Good
    Subject: RE: [cdi_talk] Acute blood loss anemia


     

    I only query with transfusion of blood products myself. You have to have the correct Intensity of Service.

     

    Mary L. Snook RN-BC

    Clinical Documentation Improvement Specialist

    Fairfield Medical Center

    740-689-4443

     

     

     


    From: CDI Talk [ mailto:cdi_talk@hcprotalk.com ]
    Sent: Thursday, May 28, 2015 2:52 PM
    To: Mary Snook
    Subject: Re: [cdi_talk] Acute blood loss anemia


     


    Hi all, I came in late. Was there a transfusion of PRBC?


     


     



    From: "CDI Talk" < cdi_talk@hcprotalk.com >
    To: gwojo@wowway.com
    Sent: Thursday, May 28, 2015 12:00:23 PM
    Subject: RE:[cdi_talk] Acute blood loss anemia


     




    RE: ABLA:

     

    That is why I’d review the record to see precisely ‘how much’ blood is documented as lost during the episode of care.

     


    Paul Evans, RHIA, CCS, CCS-P, CCDS

     

    Manager, Regional Clinical Documentation & Coding Integrity

    Sutter West Bay

    633 Folsom St., 7th Floor,  Office 7-044

    San Francisco, CA  94107

    Cell:  415.412.9421

     

    evanspx@sutterhealth.org

     




     


    From: CDI Talk [ mailto:cdi_talk@hcprotalk.com ]
    Sent: Thursday, May 28, 2015 9:50 AM
    To: Evans, Paul
    Subject: RE:[cdi_talk] Acute blood loss anemia


     

    My 2 cents is I realize the type of anemia should be specified but it looks dilutional.   If she had an epidural, she could have had 2 liters of fluid.  I wonder if she was on iron before the delivery.   I do not query for drop of Hgb 2 gm if patient has had IV fluid. 

     

    Laura

     


    From: CDI Talk [ mailto:cdi_talk@hcprotalk.com ]
    Sent: Thursday, May 28, 2015 12:01 PM
    To: Ringland, Laura
    Subject: RE:[cdi_talk] Acute blood loss anemia


     

    Hi,

    If the Docs  say anemia, then we would query for type.

    If not, then we would query for significance of a drop of 2gm or more.

     

    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

     

     

     


    From: CDI Talk [ mailto:cdi_talk@hcprotalk.com ]
    Sent: Thursday, May 28, 2015 8:57 AM
    To: Vanessa Falkoff
    Subject: RE:[cdi_talk] Acute blood loss anemia


     

    I’d reference any ‘significant’ amount of  blood listed as lost during the procedure in a query.

     


    Paul Evans, RHIA, CCS, CCS-P, CCDS

     

    Manager, Regional Clinical Documentation & Coding Integrity

    Sutter West Bay

    633 Folsom St., 7th Floor,  Office 7-044

    San Francisco, CA  94107

    Cell:  415.412.9421

     

    evanspx@sutterhealth.org

     




     


    From: CDI Talk [ mailto:cdi_talk@hcprotalk.com ]
    Sent: Thursday, May 28, 2015 8:48 AM
    To: Evans, Paul
    Subject: RE:[cdi_talk] Acute blood loss anemia


     

    Thank you

     


    From: CDI Talk [ mailto:cdi_talk@hcprotalk.com ]
    Sent: Thursday, May 28, 2015 11:47 AM
    To: Slavin, Cindy
    Subject: RE:[cdi_talk] Acute blood loss anemia


     

    Yes. I would query for acute blood loss. I had one of our Vascular surgeons tell me that anything 2gm loss or more after should be considered as possibly an acute blood loss. Our coders query our OB/GYN’s for this post delivery.

     


    From: CDI Talk [ mailto:cdi_talk@hcprotalk.com ]
    Sent: Thursday, May 28, 2015 11:41 AM
    To: Melissa Windau
    Subject: [cdi_talk] Acute blood loss anemia


     

    Patient with hgb 11.7 to 9.5 post delivery..physician writes anemia, patient is being supplemented with PO iron..is discharged with PO iron…

    Would you query for acute blood loss?

     


    From: CDI Talk [ mailto:cdi_talk@hcprotalk.com ]
    Sent: Thursday, May 28, 2015 11:23 AM
    To: Slavin, Cindy
    Subject: [cdi_talk] Excisional Debridement (Bovie)


     

    Below is a CC that clearly states the Bovie can be used as a cutting tool for excision. This might help the coder understand the different uses of the Bovie.  Coders love Coding Clinics….

     

    It is addressing a question for I-10 but the same concept applies to I-9.



     

     

    Do you code excisional debridement done with a Bovie to excisional or nonexcisional?

     

     

    Sharon Salinas, CCS

    Health Information Management

    Barlow Respiratory Hospital

    2000 Stadium Way, Los Angeles CA 90026

    Tel: 213-250-4200 ext 3336

    FAX: 213-202-6490

    ssalinas@barlow2000.org

     


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    Fairfield Medical Center
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