"coverage"

lsipos@monument.healthlsipos@monument.health
edited March 2016 in CDI Talk Archive
Good morning.

Long story short.. Patient admitted with Pneumonia, trach and on vent tx back from rehab, resp failure....
Provider has documented (verbatim):

"Broad-spectrum antibiotics for healthcare acquired pneumonia: Vancomycin, Zosyn, Cipro(dual coverage for Pseudomonas) pending cultures"

I THINK there is a coding clinic that references "COVERAGE" for related to a diagnosis such as this, but was wondering if anyone knows where/what it is as I cannot locate it? I only have the H&P to go off of right now and am waiting to see what the provider says today on his PN. No sputum cx back yet. Does anyone know of the coding clinic as I don't think I can use "coverage for" like I can for treating for, suspicion, probable etc.

Help... my instinct is that likely this man doesn't have a simple pneumonia (no sepsis indicators).

TIA

Juli

Comments

  • lsipos@monument.healthlsipos@monument.health
    edited March 2016
    ...but I am not the doctor obviously and though I want to use the pseudomonas I want to make sure there isn't a coding clinic referencing it!

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, January 14, 2016 9:28 AM
    To: Bovard, Juli
    Subject: [cdi_talk] "coverage"

  • Unknown
    edited March 2016
    I'd go with clarifying, since he wrote double coverage for Pseudomonas, if, after a day or two, it seems that either the organism is re-covered on a culture, the sputum seems to be green with a smell of grapes around the room that, despite negative culture, Pseudomonas is what I'm thinking the patient has and I'm reducing the number of antibiotics for coverage. If the doc can't say that, it's pneumonia unspecified. I'm praying for the cultures!

    Robert S. Gold, MD
    CEO, DCBA, Inc
    4611 Brierwood Place
    Atlanta, GA 30360
    (770) 216-9691 (Office)
    (404) 580-0204 (Cell)

  • mulled2mulled2
    edited March 2016
    Query for complex/gr neg PNA

  • lsipos@monument.healthlsipos@monument.health
    edited March 2016
    I understand that, was just wondering if someone had the coding clinic relative to "coverage for". I have spoken to the provider now and he wants to know if there is something that says coders cant code from that. Yes, I have educated etc... spoken with him. He is not an outlier and just wants to understand... so, I am looking for the coding clinic.

    Juli

  • Unknown
    edited March 2016
    Coverage for is not the same as. The suggested words are only appropriate on discharge and not during the patient stay. Coverage could include all of the organisms the doc is covering with all of the other antibiotics. If he concludes that it was probably pseudomonas at the end pf the stay, then he should be encouraged to say "despite negative cultures, this was probably pseudomonas pneumonia" and that would cover all bases. If he can't ethically say that, then it's pneumonia unspecified.

    Robert S. Gold, MD
    CEO, DCBA, Inc
    4611 Brierwood Place
    Atlanta, GA 30360
    (770) 216-9691 (Office)
    (404) 580-0204 (Cell)

  • lsipos@monument.healthlsipos@monument.health
    edited March 2016
    Thank you Dr. Gold. :)

    Juli

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    Hi, Juli

    My software reference is not my favorite, but I did just run a check in the index, and I can't find anything about this scenario in Coding Clinic - someone with more robust search feature may find something helpful?

    From my practice, I typically don't query for a more precise type of PNA when the antibiotic usage is so broad as to include gram - and gram + : I think the differentials are too broad.

    In the rare situation that we see the staff reacting to a valid C&S and then adjust coverage based on the C&S and we see pharmacy notes speaking to 'peak and through', then we consider a query. I am aware of all of the issues with obtaining a valid C&S in a timely fashion.

    IMO (and, yes, just my opinion), all we really know in such cases is that the patient has some type of Bacterial PNA, but we don't' know if it is gram neg or gram positive.

    We have a lot of positive response to our queries for Aspiration, but that is a different matter.

    PE

    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

  • jmontyjmonty
    edited March 2016
    The 2016 CDI pocket guide, page 120, states, " The terms "coverage" or "coverage for" certain organisms are not adequate documentation for coding purposes; the suspected organism(s) must be specifically mentioned as a possible cause. Hope this helps.



    Julie Monty
    RN, CCDS
    HIM Dept.
    (518) 314-3476
    JMonty@cvph.org
    The University of Vermont Health Network
    Champlain Valley Physicians Hospital
    UVMHealth.org/CVPH


  • lsipos@monument.healthlsipos@monument.health
    edited March 2016
    Thanks Julie. I don't have the 2016 copy yet but will look in the 2014. We did order the 2016!

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, January 14, 2016 10:13 AM
    To: Bovard, Juli
    Subject: RE:[cdi_talk] "coverage"

    The 2016 CDI pocket guide, page 120, states, " The terms "coverage" or "coverage for" certain organisms are not adequate documentation for coding purposes; the suspected organism(s) must be specifically mentioned as a possible cause. Hope this helps.



    Julie Monty
    RN, CCDS
    HIM Dept.
    (518) 314-3476
    JMonty@cvph.org
    The University of Vermont Health Network
    Champlain Valley Physicians Hospital
    UVMHealth.org/CVPH



  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    Regarding gram negative pneumonia, ideally the Coordination and Maintenance Committee would change the coding index to delete this as a reportable disease, if, clinically, it is not appropriate to classify someone as having 'gram negative' pneumonia.

    IMO, if this is available as a choice, it will be reported.



    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

  • jmontyjmonty
    edited March 2016
    Your welcome Juli. The pocket guide did not reference any coding clinic so I don't know for sure if there is one out there. When I read your question it rang a bell... The pocket guide was the only place that I found it. It was right in the section about pneumonia.

  • Unknown
    edited March 2016
    Paul - check out the stuff I've written. The ICD code has a specific intent. It's still a good code - just is advised on how to use it inappropriately a number of years ago.

    Robert S. Gold, MD
    CEO, DCBA, Inc
    4611 Brierwood Place
    Atlanta, GA 30360
    (770) 216-9691 (Office)
    (404) 580-0204 (Cell)


  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    Dr. G.


    Thank you - I will find your article(s). As a practical approach, again, I can't recall any of the physicians on my staff classifying any pneumonia simply as 'gram negative'.

    In that very, very rare instance they have faith in the validity of C&S (and it is available in a timely manner), they will sometimes state the precise infective agent...this is not the norm. Current practice seems to be to used broad-based drugs to cover several types of pneumonia - in my view, this is not precise enough to code anything other than "pneumonia, w/o specification"


    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

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