PEPPER

katysuegood@gmail.comkatysuegood@gmail.com
in CDI Talk Archive
For those of you who monitor PEPPER data, how do you feel about the single CC/MCC rate that has been tracked for a while now?

From a CDI perspective do you feel that a robust program results in a lower single CC/MCC rate or????

Thanks!

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

Comments

  • catladyrncatladyrn
    I just think it reminds you to review those records to see if there are any additional CCs/MCCs that could have been captured, and also if the single CC/MCC is strong enough to withstand audit. We don't focus our program on capturing CCs and MCCs but we don't want to leave them on the table, either. We are a low outlier for that target area, which could mean we're doing great, but to me it means I have to review records to make sure we're not over-reporting diagnoses that are inappropriate. Doing an audit of records based on a PEPPER usually reaps lots of information--some of which I wasn't necessarily looking for--and helps not only my team but can help other departments as well. I use findings to shape education for my team and our providers.

    I'd like to see more emphasis on quality metrics such as SOI/ROM in PEPPER, but I can't complain considering it's free.

    Renee

    Linda Renee Brown, RN, MA, CCDS, CCS, CDIP
    Director, Clinical Documentation
    Tanner Health System
  • dbeiseldentondbeiseldenton
    What I have noticed -personal opinion- is that with a robust CDI program it hasn't lower the CC/MCC rate but has provided more documentation to support the diagnosis for the CC/MCC. Sometimes even with great documentation, the payor still denies it or throws it out.
  • Unknown
    edited March 2016
    I do think it flattens out the older your program is, and the longer the education has been on going on.
    Thanks
    Jamie
    Baptist Health
    Jacksonville, Florida

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    I feel some of the diagnoses captured as single CC/MCC can be dubious, such as acute blood loss anemia, atelectasis, etc, following surgery and 'acute respiratory failure' after cardiothoracic procedures, such as MV repair/CABG. I believe CDI teams and coding teams should approach the single cc/mcc cases w/ caution, and retrospectively audit the cases.

    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

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited March 2016
    I am responsible for monitoring PEPPER and I audit outliers quarterly. We are low in Single CC/MCC's and we are always a high outlier for Medical CC/MCC capture. The 'suggested interventions for low outliers' is to audit cases that are NCC's to see is CC/MCC's are being missed. However, since our overall capture rate is so high, I have not been concerned about the low Single CC/MCC rate. Just want to make sure I am not missing something here.

    Thanks!

    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

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    One limitation of the PEPPER data is that it reports all care into one comparative data base w/o any stratification. So, we have a certified stroke center of excellence, and we perform interventional procedures for ICH, such as stents and clippings. Reviewing the PEPPER data, we are a high-outlier for strokes. But, this only reflects our reality. The PEPPER compares our data to all other facilities, regardless of the size and sophistication of other sites.


    It has some value, and it is free, but the rates visa vie the comparative data base limit usefulness as one can't use 'peer to peer' data.


    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



  • katysuegood@gmail.comkatysuegood@gmail.com
    edited March 2016
    Absolutely agree! We are a high outlier in sepsis, pna, and medical CC/MCC every single quarter. We know that is just the way it is but I am still expected to audit ;-)

    At this point PEPPER doesn’t add much value for us for these areas (UR monitors the one/two day lengths of stay and other care coord issues) because the data basically always looks the same for us.

    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

  • sharon.cooper@owensborohealth.orgsharon.cooper@owensborohealth.org
    edited March 2016
    Katy,

    Our data resembles yours & typically looks the same each quarter, but we also continue to audit a percentage of the high & low outliers. We send the results of our audit to our Corporate Compliance Officer (which are essentially the same every time).

    Sharon

    Sharon Cooper, RN-BC, CCS, CDIP, CCDS, CHTS-CP
    AHIMA-Approved ICD-10-CM/PCS Trainer/Ambassador
    Manager Clinical Documentation/Appeals

    Owensboro Health Regional Hospital
    P.O. Box 20007
    Owensboro, KY 42304-0007
    Office: 270-417-4612
    Cell: 270-316-9088
    Fax: 1-270-417-4609


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