HCAP

cselukecseluke
edited May 2016 in CDI Talk Archive
I have a question for the group about how you handle your healthcare
associated pneumonia cases. Our hospitalist service documents many cases
of HCAP. Per the ATS 2005, guidelines, the antibiotic coverage is
usually targeted for MRSA and gram negative pathogens. Unfortunately
many of the cases code to "simple" pneumonia because they never document
suspected pathogens or they say they are "covering" for e.g. Pseudomonas
or MRSA.



If they document, for instance, "treating a suspected gram negative/MRSA
pneumonia", can both pneumonias be coded? Does the wording matter? If
they say "treating a suspected gram negative OR MRSA pnemonia", does the
coding differ? What about "treating a suspected gram negative AND MRSA
pneumonia'?



Cathy Seluke, RN, BSN, ACM, CCDS
Supervisor Clinical Documentation Compliance
MaineGeneral Medical Center
Augusta and Waterville, Maine
(207) 872-1796
Cathy.Seluke@mainegeneral.org

Comments

  • robert.hodges2robert.hodges2
    edited May 2016
    I ALWAYS query on pneumonia specificity.


    Per coding rules, as I understand them, if a slash or the word "or" is
    used between two diagnoses neither can be coded. We actually have a
    "slash use" query here for that very reason.


    Hope this helps


    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
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  • cselukecseluke
    edited May 2016
    Thanks, Robert. How do you word your query when the antibiotic coverage
    is for BOTH gram negs and MRSA?



    Cathy Seluke, RN, BSN, ACM, CCDS
    Supervisor Clinical Documentation Compliance
    MaineGeneral Medical Center
    Augusta and Waterville, Maine
    (207) 872-1796
    Cathy.Seluke@mainegeneral.org




  • robert.hodges2robert.hodges2
    PHYSICIAN QUERY FORM













    CONFIDENTIAL

    THIS FORM WILL NOT BECOME PART OF THE PERMANENT RECORD

     

    ALEDA E. LUTZ VAMC/655

     

    SLASH

  • ssalinasssalinas
    edited May 2016
    I am curious regarding your statement of not being able to use diagnoses
    with a slash (/). I am not aware of any coding rule or coding
    convention that addresses slashes. Generally I see no reason they
    cannot be coded when a statement is made that they are being treated. I
    guess I consider the slash as a comma or the phrase 'and/or'. I would
    code both if they had a '/', 'or' or 'and' between them.

    I'm also interested in others thoughts on this.

    Thanks,

    Sharon Salinas, CCS
    Barlow Respiratory Hospital
    213-250-4200 Extension 3336
  • sharon.colesharon.cole
    edited May 2016
    I've always understood that if a physician documented "versus" or "or" you could not code, but if they said "and" you could code either choice. For example: TIA vs CVA - you have to know which it is and must query. If they say sepsis due to UTI and PNA you do not need to query. If they say sepsis due to PNA or UTI (and just for grins and giggles say the patient also has a chronic indwelling foley that caused the UTI) you would have to query for what exactly caused or probably caused the sepsis as it can change the DRG.

    Sharon Cole, RN, CCDS
    Providence Health Center
    Case Management Dept
    254.751.4256
    Sharon.cole@phn-waco.org
  • mdomineseymdominesey
    edited May 2016
    I've always interpreted slashes as "OR" or "Versus" as well. My understanding is that when you have an "OR", a query is necessitated because one or the other is being "ruled out". I have always asked "what is the most likely" and remind them that "probable,", "possible", "rule out" are acceptable terms to use in the documentation. If one sees a symptom followed by a "OR" or "Versus" with a list of diagnoses, then the guidelines tell us that we are to code the symptom as primary until a more concrete diagnosis is made.

    Kindest Regards,

    Mark


    Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP
    Clinical Documentation Excellence
    Sr. Clinical Documentation Improvement Specialist
    Sibley Memorial Hospital
    Information Technology
    5255 Loughboro Rd NW
    Washington DC, 20016-2695
    W: 202.660.6782
    F: 202.537.4477
    mdominesey@sibley.org
    http://www.sibley.org
  • sharon.cooper@owensborohealth.orgsharon.cooper@owensborohealth.org
    edited May 2016
    I agree Sharon.


    Sharon Cooper, RN-BC, CCS, CCDS, CDIP
    AHIMA-Approved ICD-10-CM/PCS Trainer

    Owensboro Medical Health System
    Manager Clinical Documentation & Appeals
    P.O. Box 20007
    Owensboro, KY 42304-0007
    (270) 688-1277 Office
    (270) 316-9088 Cell
    (270) 688-2737 Fax
    sharon.cooper@omhs.org

    TEAM = Together Everyone Accomplishes More!
  • catladyrncatladyrn
    This is what the Official Guidelines state:

    "In those rare instances when two or more contrasting or comparative diagnoses are documented as “either/or” (or similar terminology), they are coded as if the diagnoses were confirmed and the diagnoses are sequenced according to the circumstances of the admission."

    I suspect the confusion may be exist due to the coding of diagnoses and symptoms. We should query when the physician states, symptom due to either X or Y. Coding guidelines state that the symptom must be coded first, but the alternate diagnoses can be coded, as well. We query because we don't want a symptom code as PDx.

    Just my $0.02.

    Renee

    Linda Renee Brown, RN, CCRN, CCDS, CDIP
  • mdomineseymdominesey
    edited May 2016
    Great clarification Renee, thanks!

    As CDI specialists we should help get the chart to where it is best coded. i.e. concurrent query for specificity and clarity, but if the chart gets to the coder with the either/or still there, then they will code the conditions.

    I would try to get the chart more concrete while the patient is in the hospital in order to lessen the exposure to audit take backs and prepayment denials.

    Kindest Regards,

    Mark


    Mark N. Dominesey, RN, BSN, MBA, CCDS
    Sr. Clinical Documentation Improvement Specialist
    Sibley Memorial Hospital
    Information Technology
    5255 Loughboro Rd NW
    Washington DC, 20016-2695
    W: 202.660.6782
    http://www.sibley.org
    mdominesey@sibley.org
  • robert.hodges2robert.hodges2
    edited May 2016
    I do love the discussion here. Thanks all for sharing your knowledge and expertise yet again :)

    Robert
     
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