Thanks for input
Thank you so much to all of you who responded to my questions about
mortality review. I gained some valuable insight from what you posted.
Katy, I too am confused about palliative care code V66.7 and whether its
presence on the coding summary excludes cases from certain mortality
measures. I have not been able to find a valid reference that tells me
what the real deal is. I'm planning to talk to my quality department to
see if they can help me out.
Paul, the first case I reviewed yesterday was almost a carbon copy of
the one you posted. An elderly female presented with a massive ICH. The
CT scan showed brain herniation. All that was documented by the
attending was "massive ICH, unresponsiveness." Case as coded ROM 1 SOI
1. Adding coma and brain compression+ ROM 4 SOI 4. Excellent example.
Thank you again for your willingness to share your expertise. I read
these posts every day and have learned so much from so many of you.
Cathy Seluke, RN, BSN, ACM, CCDS
Supervisor Clinical Documentation Compliance
MaineGeneral Medical Center
Augusta and Waterville, Maine
(207) 872-1796
Cathy.Seluke@mainegeneral.org
mortality review. I gained some valuable insight from what you posted.
Katy, I too am confused about palliative care code V66.7 and whether its
presence on the coding summary excludes cases from certain mortality
measures. I have not been able to find a valid reference that tells me
what the real deal is. I'm planning to talk to my quality department to
see if they can help me out.
Paul, the first case I reviewed yesterday was almost a carbon copy of
the one you posted. An elderly female presented with a massive ICH. The
CT scan showed brain herniation. All that was documented by the
attending was "massive ICH, unresponsiveness." Case as coded ROM 1 SOI
1. Adding coma and brain compression+ ROM 4 SOI 4. Excellent example.
Thank you again for your willingness to share your expertise. I read
these posts every day and have learned so much from so many of you.
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
It is gratifying to learn you were successful with your "carbon case". (We have one today with the same scenario, patient with a 'massive midline shift' due to ICH, 3% hypertonic Saline with goal sodium 140-150 and burr holes to evacuate).
It seems somewhat common to use the term midline shift rather than edema or hernia of the brain. Our radiologist termed this a hernia.
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation & Coding Integrity
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org
Wish we could use words like "massive" and "mid-line shift" to reflect the severity of illness and risk of mortality... the letters "CVA" just doesn't do a condition justice sometimes! Just Like the term "extremis"- we still need a code for that one! (Google it... you know you want to...J)
Have a good weekend!!!!!!!!-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 difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens