RE: cdi_talk digest: February 18, 2016
Could you go for atn since needed dialysis, ?
Sent from my Verizon Wireless 4G LTE smartphone
-------- Original message --------
From: CDI Talk digest
Date: 2/19/2016 12:00 AM (GMT-05:00)
To: cdi_talk digest recipients
Subject: cdi_talk digest: February 18, 2016
CDI_TALK Digest for Thursday, February 18, 2016.
1. Rhabdomyolysis
2. mortality reviews
3. RE: mortality reviews
4. RE: Rhabdomyolysis
5. RE: mortality reviews
6. RE: Rhabdomyolysis
7. Re: mortality reviews
8. PCS is KILLING me!!
9. RE: Rhabdomyolysis
10. RE: Rhabdomyolysis
11. Re: mortality reviews
12. RE: Rhabdomyolysis
13. RE: Rhabdomyolysis
14. RE: PCS is KILLING me!!
15. RE: mortality reviews
16. Query Question
17. RE: cdi_talk digest: February 17, 2016
18. RE: PCS is KILLING me!!
19. re: Query Question
20. RE: cdi_talk digest: February 17, 2016
21. RE: mortality reviews
----------------------------------------------------------------------
Subject: Rhabdomyolysis
From: Angie Guiler
Date: Thu, 18 Feb 2016 20:55:11 +0000
X-Message-Number: 1
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
----------------------------------------------------------------------
Subject: mortality reviews
From: "Seekircher, Kerry"
Date: Thu, 18 Feb 2016 15:57:51 -0500
X-Message-Number: 2
For those of you conducting mortality reviews, do you also review pts who are admitted and expire in hospice?
Thanks,
Kerry
Kerry Seekircher, RN, BS, CCDS, CDIP
________________________________
Note:
This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.
Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.
----------------------------------------------------------------------
Subject: RE: mortality reviews
From:
Date: Thu, 18 Feb 2016 20:58:47 +0000
X-Message-Number: 3
We do not include Hospice at our institution!
Juli
Juli Bovard RN CCDS
Certified Clinical Documentation Specialist
Clinical Effectiveness/Clinical Quality
Rapid City Regional Hospital
755-8426 (work)
786-2677 (cell)
"No Limit to Better......"
[CCDS_pin_1inch]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 1:58 PM
To: Bovard, Juli
Subject: [cdi_talk] mortality reviews
For those of you conducting mortality reviews, do you also review pts who are admitted and expire in hospice?
Thanks,
Kerry
Kerry Seekircher, RN, BS, CCDS, CDIP
________________________________
Note:
This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.
Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
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If you would like to be removed from CDI Talk, please send a blank email to
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Regional Health is an integrated health care system with the purpose of helping patients and communities live well.
Note: The information contained in this message, including any attachments, may be privileged, confidential, or protected from disclosure under state or federal laws . If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly prohibited. If you have received this communication in error, please notify the Sender immediately by a "reply to sender only" message and destroy all electronic or paper copies of the communication, including any attachments.
----------------------------------------------------------------------
Subject: RE: Rhabdomyolysis
From:
Date: Thu, 18 Feb 2016 21:00:18 +0000
X-Message-Number: 4
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Subject: RE: mortality reviews
From:
Date: Thu, 18 Feb 2016 21:03:11 +0000
X-Message-Number: 5
Hi Kerry,
If they were admitted as an acute inpatient then yes we would review the case. Admin has flip flopped a couple of times and has now removed out-patient from our population.
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, February 18, 2016 12:58 PM
To: Vanessa Falkoff
Subject: [cdi_talk] mortality reviews
For those of you conducting mortality reviews, do you also review pts who are admitted and expire in hospice?
Thanks,
Kerry
Kerry Seekircher, RN, BS, CCDS, CDIP
________________________________
Note:
This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.
Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
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---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Subject: RE: Rhabdomyolysis
From: Angie Guiler
Date: Thu, 18 Feb 2016 21:09:53 +0000
X-Message-Number: 6
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: angie.guiler@bergerhealth.com
If you would like to be removed from CDI Talk, please send a blank email to
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---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Subject: Re: mortality reviews
From: Steven Robinson
Date: Thu, 18 Feb 2016 16:19:13 -0500
X-Message-Number: 7
No, we exclude from the population of reviews.
On Thu, Feb 18, 2016 at 3:58 PM, CDI Talk wrote:
> We do not include Hospice at our institution!
>
>
>
> Juli
>
> *Juli Bovard RN CCDS*
>
> *Certified Clinical Documentation Specialist*
>
> *Clinical Effectiveness/Clinical Quality*
>
> *Rapid City Regional Hospital*
>
> *755-8426 (work)*
>
> *786-2677 (cell)*
>
> *"No Limit to Better......"*
>
> *[image: CCDS_pin_1inch]*
>
>
>
>
>
>
>
> *From:* CDI Talk [mailto:cdi_talk@hcprotalk.com]
> *Sent:* Thursday, February 18, 2016 1:58 PM
> *To:* Bovard, Juli
> *Subject:* [cdi_talk] mortality reviews
>
>
>
> For those of you conducting mortality reviews, do you also review pts who
> are admitted and expire in hospice?
>
> Thanks,
>
> Kerry
>
>
>
> *Kerry Seekircher, RN, BS, CCDS, CDIP*
>
>
>
>
>
>
>
>
> ------------------------------
>
> Note:
> This message is for the named person's use only. It may contain
> confidential, proprietary or legally privileged information. No
> confidentiality or privilege is waived or lost by any mistransmission. If
> you receive this message in error, please immediately delete it and all
> copies of it from your system, destroy any hard copies of it and notify the
> sender. You must not, directly or indirectly, use, disclose, distribute,
> print, or copy any part of this message if you are not the intended
> recipient. This organization and any of its subsidiaries each reserve the
> right to monitor all e-mail communications through its networks.
>
> Any views expressed in this message are those of the individual sender,
> except where the message states otherwise and the sender is authorized to
> state them to be the views of any such entity.
>
>
>
> ---
>
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
>
>
> You are receiving this message as a member of CDI Talk as: jbovard@regionalhealth.com
>
> If you would like to be removed from CDI Talk, please send a blank email to
>
> leave-cdi_talk-12940160.55ea2c13b419eb7deb7e5125c36e4234@hcprotalk.com
>
> ---
>
> Copyright 2013
>
> HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
>
> ------------------------------
> Regional Health is an integrated health care system with the purpose of
> helping patients and communities live well.
>
> Note: The information contained in this message, including any
> attachments, may be privileged, confidential, or protected from disclosure
> under state or federal laws . If the reader of this message is not the
> intended recipient, or an employee or agent responsible for delivering this
> message to the intended recipient, you are hereby notified that any
> dissemination, distribution, or copying of this communication is strictly
> prohibited. If you have received this communication in error, please notify
> the Sender immediately by a "reply to sender only" message and destroy all
> electronic or paper copies of the communication, including any attachments.
>
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: slrobinson329@gmail.com
> If you would like to be removed from CDI Talk, please send a blank email to leave-cdi_talk-20337088.e489c6968e2eaa3346b0bd0a944f339d@hcprotalk.com
> ---
> Copyright 2013
> HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
>
>
--
Steve Robinson
slrobinson329@gmail.com
404-694-0778
----------------------------------------------------------------------
Subject: PCS is KILLING me!!
From: Kathryn Good
Date: Thu, 18 Feb 2016 21:22:05 +0000
X-Message-Number: 8
Whew!
Trauma undergoes an closed reduction and external fixation procedure. Coding told me they did not have enough information to code the procedure. They want queries for the approach, device specificity, location...
This is what I see:
[cid:image002.png@01D16A57.0ACAD8E0]
Then from post-op xray....
[cid:image004.png@01D16A4F.33DAC130]
I go here:
[cid:image003.png@01D16A4F.33DAC130]
Without a query.
But do we need to code the placement of the fixation decide separately? And if so, do you think the approach is clear or are queries needed?
We are getting quite a few requests for queries on PCS stuff that is actually in there its just not in 'coding language'. I am trying to be diligent about making sure queries are needed. But it is time consuming and PCS is definitely NOT my forte ;-)
Thanks!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
----------------------------------------------------------------------
Subject: RE: Rhabdomyolysis
From:
Date: Thu, 18 Feb 2016 21:26:52 +0000
X-Message-Number: 9
I found a couple of references and this is what all seem to say:
The third quarter of 2002 Coding Clinic clarifies the proper code assignment of acute renal failure due to rhabdo. This advice supersedes the Coding Clinic advice found in the 2nd Quarter 2001 in which the guidance was to assign the rhabdo, ICD-9 code 728.89 as principal diagnosis with acute renal failure, ICD-9 584.9, as secondary diagnosis. Instead, the acute renal failure is to be assigned as principal diagnosis with rhabdo as secondary, provided the documentation and circumstances of admission support the same. Keep in mind that acute renal failure is an "unspecified code." If the physician documented a more specific diagnosis such as acute tubular necrosis, a specified acute renal failure, this diagnosis would be sequenced as principal diagnosis.
http://health-information.advanceweb.com/Article/Coding-QA-Aug-30-2005.aspx
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, February 18, 2016 1:10 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: angie.guiler@bergerhealth.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-20325672.4ff02ea37fab4b038fabf4550c231787@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Subject: RE: Rhabdomyolysis
From: Angie Guiler
Date: Thu, 18 Feb 2016 21:36:12 +0000
X-Message-Number: 10
Looking at the coding clinic for rhabodmyolysis it appears there was 2003/4th quarter update, is that just an update to the code? Making the coding clinic you provided below still active?
Thank you again, apologize for the multiple questions.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:27 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
I found a couple of references and this is what all seem to say:
The third quarter of 2002 Coding Clinic clarifies the proper code assignment of acute renal failure due to rhabdo. This advice supersedes the Coding Clinic advice found in the 2nd Quarter 2001 in which the guidance was to assign the rhabdo, ICD-9 code 728.89 as principal diagnosis with acute renal failure, ICD-9 584.9, as secondary diagnosis. Instead, the acute renal failure is to be assigned as principal diagnosis with rhabdo as secondary, provided the documentation and circumstances of admission support the same. Keep in mind that acute renal failure is an "unspecified code." If the physician documented a more specific diagnosis such as acute tubular necrosis, a specified acute renal failure, this diagnosis would be sequenced as principal diagnosis.
http://health-information.advanceweb.com/Article/Coding-QA-Aug-30-2005.aspx
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, February 18, 2016 1:10 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: angie.guiler@bergerhealth.com
If you would like to be removed from CDI Talk, please send a blank email to
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
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CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
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----------------------------------------------------------------------
Subject: Re: mortality reviews
From: Debbie Smith
Date: Thu, 18 Feb 2016 15:37:38 -0600
X-Message-Number: 11
Mortality reviews were just added to our workflow and if they were admitted as an acute inpatient we are asked to review them.
Debbie Smith, RN, CCDS, CCS
UT Southwestern Medical Center at Dallas-
William P Clements and Zale Lipshy University Hospitals
6201 Harry Hines Blvd.
Dallas, TX 75390
214-645-5217
Deborahw.smith@utsouthwestern.edu
Sent from my iPad
> On Feb 18, 2016, at 3:03 PM, CDI Talk wrote:
>
> Hi Kerry,
>
> If they were admitted as an acute inpatient then yes we would review the case. Admin has flip flopped a couple of times and has now removed out-patient from our population.
>
> 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, February 18, 2016 12:58 PM
> To: Vanessa Falkoff
> Subject: [cdi_talk] mortality reviews
>
> For those of you conducting mortality reviews, do you also review pts who are admitted and expire in hospice?
> Thanks,
> Kerry
>
> Kerry Seekircher, RN, BS, CCDS, CDIP
>
>
>
>
> Note:
> This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.
>
> Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.
>
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
> If you would like to be removed from CDI Talk, please send a blank email to
> leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
> ---
> Copyright 2013
> HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: dsmith12h@aol.com
> If you would like to be removed from CDI Talk, please send a blank email to
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> ---
> Copyright 2013
> HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Subject: RE: Rhabdomyolysis
From:
Date: Thu, 18 Feb 2016 21:51:05 +0000
X-Message-Number: 12
This article is from 2015
For patients with AKI due to rhabdomyolysis, coders should sequence AKI as the principal diagnosis, according to Coding Clinic, Third Quarter 2002, p. 28
http://blr.hcpro.com/content.cfm?content_id=319012
V
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 1:36 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
Looking at the coding clinic for rhabodmyolysis it appears there was 2003/4th quarter update, is that just an update to the code? Making the coding clinic you provided below still active?
Thank you again, apologize for the multiple questions.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:27 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
I found a couple of references and this is what all seem to say:
The third quarter of 2002 Coding Clinic clarifies the proper code assignment of acute renal failure due to rhabdo. This advice supersedes the Coding Clinic advice found in the 2nd Quarter 2001 in which the guidance was to assign the rhabdo, ICD-9 code 728.89 as principal diagnosis with acute renal failure, ICD-9 584.9, as secondary diagnosis. Instead, the acute renal failure is to be assigned as principal diagnosis with rhabdo as secondary, provided the documentation and circumstances of admission support the same. Keep in mind that acute renal failure is an "unspecified code." If the physician documented a more specific diagnosis such as acute tubular necrosis, a specified acute renal failure, this diagnosis would be sequenced as principal diagnosis.
http://health-information.advanceweb.com/Article/Coding-QA-Aug-30-2005.aspx
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, February 18, 2016 1:10 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
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---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
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----------------------------------------------------------------------
Subject: RE: Rhabdomyolysis
From: Angie Guiler
Date: Thu, 18 Feb 2016 21:52:31 +0000
X-Message-Number: 13
Perfect. Thank you:)
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:51 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
This article is from 2015
For patients with AKI due to rhabdomyolysis, coders should sequence AKI as the principal diagnosis, according to Coding Clinic, Third Quarter 2002, p. 28
http://blr.hcpro.com/content.cfm?content_id=319012
V
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 1:36 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
Looking at the coding clinic for rhabodmyolysis it appears there was 2003/4th quarter update, is that just an update to the code? Making the coding clinic you provided below still active?
Thank you again, apologize for the multiple questions.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:27 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
I found a couple of references and this is what all seem to say:
The third quarter of 2002 Coding Clinic clarifies the proper code assignment of acute renal failure due to rhabdo. This advice supersedes the Coding Clinic advice found in the 2nd Quarter 2001 in which the guidance was to assign the rhabdo, ICD-9 code 728.89 as principal diagnosis with acute renal failure, ICD-9 584.9, as secondary diagnosis. Instead, the acute renal failure is to be assigned as principal diagnosis with rhabdo as secondary, provided the documentation and circumstances of admission support the same. Keep in mind that acute renal failure is an "unspecified code." If the physician documented a more specific diagnosis such as acute tubular necrosis, a specified acute renal failure, this diagnosis would be sequenced as principal diagnosis.
http://health-information.advanceweb.com/Article/Coding-QA-Aug-30-2005.aspx
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, February 18, 2016 1:10 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
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Copyright 2013
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----------------------------------------------------------------------
Subject: RE: PCS is KILLING me!!
From: "Lueck, Cheree RN"
Date: Thu, 18 Feb 2016 15:00:16 -0700
X-Message-Number: 14
Katy,
The ex fix device is not coded separately, as it is included in the closed reduction. You account for it in the device character. The report stated "the external fixator was tightened down...", so I'm not sure a query is required for the device, as it seems fairly clear what device was used to keep the fracture reduced.
Also, the fracture is open, but they do not state that they made a separate or deepened the incision to reduce the fracture. They clearly have stated that they performed a closed reduction (external approach) of the fracture & then irrigated the wound or "open part" and eventually go on to close and dress this wound.
The body part seems fairly clear as well in the axial images as to where the pins of the exfix are placed. I would code this out the same way that you did if I were looking at this. I personally, would not send a query out on this case, as it seems very clear what they did.
I'm curious as to what "coding language" they would like the surgeon to use. (externally reposition? , exfix device?, L ankle joint???)
Those are my thoughts.
Cheree
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 2:22 PM
To: Lueck, Cheree RN
Subject: [cdi_talk] PCS is KILLING me!!
Whew!
Trauma undergoes an closed reduction and external fixation procedure. Coding told me they did not have enough information to code the procedure. They want queries for the approach, device specificity, location...
This is what I see:
[cid:image002.png@01D16A5A.F4B923F0]
Then from post-op xray....
[cid:image004.png@01D16A5A.F4B923F0]
I go here:
[cid:image005.png@01D16A5A.F4B923F0]
Without a query.
But do we need to code the placement of the fixation decide separately? And if so, do you think the approach is clear or are queries needed?
We are getting quite a few requests for queries on PCS stuff that is actually in there its just not in 'coding language'. I am trying to be diligent about making sure queries are needed. But it is time consuming and PCS is definitely NOT my forte ;-)
Thanks!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
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Copyright 2013
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The Denver Health email system has made the following annotations
---------------------------------------------------------------------CONFIDENTIALITY NOTICE - This e-mail transmission, and any documents, files or previous e-mail messages attached to it may contain information that is confidential or legally privileged. If you are not the intended recipient, or a person responsible for delivering it to the intended recipient, you are hereby notified that you must not read this transmission and that any disclosure, copying, printing, distribution or use of any of the information contained in or attached to this transmission is STRICTLY PROHIBITED. If you have received this transmission in error, please immediately notify the sender by telephone or return e-mail and delete the original transmission and its attachments without reading or saving in any manner. Thank you.
----------------------------------------------------------------------
Subject: RE: mortality reviews
From: "Evans, Paul"
Date: Thu, 18 Feb 2016 14:00:34 -0800
X-Message-Number: 15
Kerry
What I have been able to discern, in some quality models, if a patient qualifies for Inpatient Hospice Services, an order is written for same, and the service is reported as Hospice, these patients are not included in the Mortality Outcomes data and are not tabulated as an expired outcome for acute inpatient admission. Your site is required to have a license for a hospice designation.
Paul
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation
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@01D16A54.BC524380]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 1:38 PM
To: Evans, Paul
Subject: Re: [cdi_talk] mortality reviews
Mortality reviews were just added to our workflow and if they were admitted as an acute inpatient we are asked to review them.
Debbie Smith, RN, CCDS, CCS
UT Southwestern Medical Center at Dallas-
William P Clements and Zale Lipshy University Hospitals
6201 Harry Hines Blvd.
Dallas, TX 75390
214-645-5217
Deborahw.smith@utsouthwestern.edu
Sent from my iPad
On Feb 18, 2016, at 3:03 PM, CDI Talk wrote:
Hi Kerry,
If they were admitted as an acute inpatient then yes we would review the case. Admin has flip flopped a couple of times and has now removed out-patient from our population.
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, February 18, 2016 12:58 PM
To: Vanessa Falkoff
Subject: [cdi_talk] mortality reviews
For those of you conducting mortality reviews, do you also review pts who are admitted and expire in hospice?
Thanks,
Kerry
Kerry Seekircher, RN, BS, CCDS, CDIP
________________________________
Note:
This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.
Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.
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----------------------------------------------------------------------
Subject: Query Question
From: "Hudson, Cynthia"
Date: Thu, 18 Feb 2016 22:10:49 +0000
X-Message-Number: 16
We are being asked to audit queries for compliance. I am being told that there is a difference in auditing queries for compliance from a Children's hospital versus Adult facility. I thought that the basic query guidelines pertained to everyone with clinical indicators present in order to query.
Am I wrong in my thinking? Also, does anyone know what the productivity standards for auditing charts are for children as compared to adults?
Thanks,
Syndi
Syndi Hudson, RN, CCDS,CCM
CHRISTUS Santa Rosa New Braunfels
CDI Specialist
cynthia.hudson@christushealth.org
830-643-6116 (Office)
830-643-5139 (Fax)
[CCDS_pin_1inch]
"We are His hands". Isaiah 64:8
CONFIDENTIALITY NOTICE: Confidential information, such as identifiable patient health information or business information, is subject to protection under state and federal law. If you are not the intended recipient of this message, you may not disclose, print, copy or disseminate this information. If you have received this in error, please reply and notify the sender (only) and delete the message. Unauthorized interception of this e-mail is a violation of federal criminal law.
----------------------------------------------------------------------
Subject: RE: cdi_talk digest: February 17, 2016
From: rmhosler
Date: Thu, 18 Feb 2016 18:49:16 -0500
X-Message-Number: 17
What about cardiorenal syndrome?
Sent from my Verizon Wireless 4G LTE smartphone
-------- Original message --------
From: CDI Talk digest
Date: 2/18/2016 12:00 AM (GMT-05:00)
To: cdi_talk digest recipients
Subject: cdi_talk digest: February 17, 2016
CDI_TALK Digest for Wednesday, February 17, 2016.
1. RE: Pdx selection: sepsis
2. Outpatient CDI?
3. RE: Outpatient CDI?
4. RE: Outpatient CDI?
5. RE: Outpatient CDI?
6. RE: Outpatient CDI?
7. RE: Outpatient CDI?
8. RE: Outpatient CDI?
9. RE: Outpatient CDI?
10. RE: Outpatient CDI?
11. RE: Outpatient CDI?
12. Re: Outpatient CDI?
13. Re: Outpatient CDI?
----------------------------------------------------------------------
Subject: RE: Pdx selection: sepsis
From: Mary Snook
Date: Wed, 17 Feb 2016 07:56:08 -0500
X-Message-Number: 1
I would code the Sepsis as primary.�� That is what brought the patient in to the hospital.
Mary L. Snook RN-BC
Clinical Documentation Improvement Specialist
Fairfield Medical Center
740-689-4443
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, February 16, 2016 10:53 AM
To: Mary Snook
Subject: RE:[cdi_talk] Pdx selection: sepsis
Hi Katy,
I would still stick with the sepsis as the acute issue that caused this admit.
Have a great week!
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: Monday, February 15, 2016 1:02 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Pdx selection: sepsis
I have a patient with underlying CHF with end-stage cardiomyopathy,�� ESRD, diabetes, liver disease, malnutrition with numerous stage 3/4 decubes, with hx of numerous hospitalizations and surgeries that came in with shock. This was immediately thought to be cardiogenic but possibly some component of septic shock as well. No source was identified until 5 days in when we had a positive c-diff culture. The entire time he was on antibiotics however ultimately treatment was deemed medical future because of his multiple organ failures and underlying chronic illnesses (not assoc with sepsis).
I had sepsis sequenced as primary per guidelines until I got to the DCS. It states:
�������� Antibiotics were given for possible infection and several cultures were positive, however, Mr. Benally's primary clinical issue was his end stage cardiomyopathy plus end stage renal and hepatic disease.�� After antibiotic therapy, on 1/30/2016, after multiple family conferences, pressor and inotrope support were removed as he had failed to wean and there were no interventions that were reasonably to be offered for end stage multi system organ failure.
Would you stick with sepsis as pdx or does this change the Pdx selection in your opinion?
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
���������������������������� ---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
���������������������������� ---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
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--
Fairfield Medical Center
People you know. Care you trust.
"Confidentiality Notice: This email message, including any attachments is
for the sole use of the intended recipient(s) and may contain confidential
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distribution is prohibited. If you are not the intended recipient, please
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message."
----------------------------------------------------------------------
Subject: Outpatient CDI?
From: "Katherine Rushlau"
Date: Wed, 17 Feb 2016 10:10:24 -0500
X-Message-Number: 2
Hi CDI Talkers!
ACDIS is considering publishing a book on outpatient CDI and I need your feedback! Do you think the book is a good idea/why, and, if so, what are some topics etc. you'd like to see in an outpatient book?
Please feel free to comment here or contact me directly! I appreciate the help!
Katherine Rushlau | Editor
Association of Clinical Documentation Improvement Specialists
75 Sylvan Street, Suite A-101 |�� Danvers, MA 01923
(p) 978-223-1721 ext. 3270 | (f) 781-639-7857
krushlau@hcpro.com
----------------------------------------------------------------------
Subject: RE: Outpatient CDI?
From: "Bourque, Suzonne"
Date: Wed, 17 Feb 2016 15:56:07 +0000
X-Message-Number: 3
I think it's a good idea as our facility is possibly looking at expanding CDI into the OP arena.�� It would be good to have a resource to help us expand to OP, what metrics to capture, what to watch for, education tips, etc.
Suzonne Bourque, RHIA, CCS, CCDS
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Wednesday, February 17, 2016 9:10 AM
To: Bourque, Suzonne
Subject: [cdi_talk] Outpatient CDI?
Hi CDI Talkers!
ACDIS is considering publishing a book on outpatient CDI and I need your feedback! Do you think the book is a good idea/why, and, if so, what are some topics etc. you'd like to see in an outpatient book?
Please feel free to comment here or contact me directly! I appreciate the help!
Katherine Rushlau | Editor
Association of Clinical Documentation Improvement Specialists
75 Sylvan Street, Suite A-101 |�� Danvers, MA 01923
(p) 978-223-1721 ext. 3270 | (f) 781-639-7857
krushlau@hcpro.com
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: sbourque@wkhs.com
If you would like to be removed from CDI Talk, please send a blank email to
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---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Subject: RE: Outpatient CDI?
From: "Debby Dallen, BSN, RN , CCDS"
Date: Wed, 17 Feb 2016 11:11:41 -0500
X-Message-Number: 4
I am not involved in outpatient CDI but my facility has hired staff for Ambulatory CDI. I think it would be wonderful to have a resource those involved in CDI in the Outpatient area.
I will be meeting with the new CDI educator for this unit and provide her with as much information as possible but I am sure there are some differences between inpatient and outpatient.��
Our goal is to ensure we are as consistent as possible when we educate our physicians.
Excellent idea!!
Deborah A Dallen, BSN, RN, CCDS
Supervisor
Clinical Documentation Improvement
Einstein Medical Center
Health Information Management
Phila PA 19141
215-456-8902
dallend@einstein.edu
>>> CDI Talk 2/17/2016 10:56 AM >>>
I think it's a good idea as our facility is possibly looking at expanding CDI into the OP arena.�� It would be good to have a resource to help us expand to OP, what metrics to capture, what to watch for, education tips, etc.
Suzonne Bourque, RHIA, CCS, CCDS
-----Original Messa
Sent from my Verizon Wireless 4G LTE smartphone
-------- Original message --------
From: CDI Talk digest
Date: 2/19/2016 12:00 AM (GMT-05:00)
To: cdi_talk digest recipients
Subject: cdi_talk digest: February 18, 2016
CDI_TALK Digest for Thursday, February 18, 2016.
1. Rhabdomyolysis
2. mortality reviews
3. RE: mortality reviews
4. RE: Rhabdomyolysis
5. RE: mortality reviews
6. RE: Rhabdomyolysis
7. Re: mortality reviews
8. PCS is KILLING me!!
9. RE: Rhabdomyolysis
10. RE: Rhabdomyolysis
11. Re: mortality reviews
12. RE: Rhabdomyolysis
13. RE: Rhabdomyolysis
14. RE: PCS is KILLING me!!
15. RE: mortality reviews
16. Query Question
17. RE: cdi_talk digest: February 17, 2016
18. RE: PCS is KILLING me!!
19. re: Query Question
20. RE: cdi_talk digest: February 17, 2016
21. RE: mortality reviews
----------------------------------------------------------------------
Subject: Rhabdomyolysis
From: Angie Guiler
Date: Thu, 18 Feb 2016 20:55:11 +0000
X-Message-Number: 1
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
----------------------------------------------------------------------
Subject: mortality reviews
From: "Seekircher, Kerry"
Date: Thu, 18 Feb 2016 15:57:51 -0500
X-Message-Number: 2
For those of you conducting mortality reviews, do you also review pts who are admitted and expire in hospice?
Thanks,
Kerry
Kerry Seekircher, RN, BS, CCDS, CDIP
________________________________
Note:
This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.
Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.
----------------------------------------------------------------------
Subject: RE: mortality reviews
From:
Date: Thu, 18 Feb 2016 20:58:47 +0000
X-Message-Number: 3
We do not include Hospice at our institution!
Juli
Juli Bovard RN CCDS
Certified Clinical Documentation Specialist
Clinical Effectiveness/Clinical Quality
Rapid City Regional Hospital
755-8426 (work)
786-2677 (cell)
"No Limit to Better......"
[CCDS_pin_1inch]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 1:58 PM
To: Bovard, Juli
Subject: [cdi_talk] mortality reviews
For those of you conducting mortality reviews, do you also review pts who are admitted and expire in hospice?
Thanks,
Kerry
Kerry Seekircher, RN, BS, CCDS, CDIP
________________________________
Note:
This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.
Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: jbovard@regionalhealth.com
If you would like to be removed from CDI Talk, please send a blank email to
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Regional Health is an integrated health care system with the purpose of helping patients and communities live well.
Note: The information contained in this message, including any attachments, may be privileged, confidential, or protected from disclosure under state or federal laws . If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly prohibited. If you have received this communication in error, please notify the Sender immediately by a "reply to sender only" message and destroy all electronic or paper copies of the communication, including any attachments.
----------------------------------------------------------------------
Subject: RE: Rhabdomyolysis
From:
Date: Thu, 18 Feb 2016 21:00:18 +0000
X-Message-Number: 4
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Subject: RE: mortality reviews
From:
Date: Thu, 18 Feb 2016 21:03:11 +0000
X-Message-Number: 5
Hi Kerry,
If they were admitted as an acute inpatient then yes we would review the case. Admin has flip flopped a couple of times and has now removed out-patient from our population.
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, February 18, 2016 12:58 PM
To: Vanessa Falkoff
Subject: [cdi_talk] mortality reviews
For those of you conducting mortality reviews, do you also review pts who are admitted and expire in hospice?
Thanks,
Kerry
Kerry Seekircher, RN, BS, CCDS, CDIP
________________________________
Note:
This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.
Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
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---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Subject: RE: Rhabdomyolysis
From: Angie Guiler
Date: Thu, 18 Feb 2016 21:09:53 +0000
X-Message-Number: 6
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: angie.guiler@bergerhealth.com
If you would like to be removed from CDI Talk, please send a blank email to
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Subject: Re: mortality reviews
From: Steven Robinson
Date: Thu, 18 Feb 2016 16:19:13 -0500
X-Message-Number: 7
No, we exclude from the population of reviews.
On Thu, Feb 18, 2016 at 3:58 PM, CDI Talk wrote:
> We do not include Hospice at our institution!
>
>
>
> Juli
>
> *Juli Bovard RN CCDS*
>
> *Certified Clinical Documentation Specialist*
>
> *Clinical Effectiveness/Clinical Quality*
>
> *Rapid City Regional Hospital*
>
> *755-8426 (work)*
>
> *786-2677 (cell)*
>
> *"No Limit to Better......"*
>
> *[image: CCDS_pin_1inch]*
>
>
>
>
>
>
>
> *From:* CDI Talk [mailto:cdi_talk@hcprotalk.com]
> *Sent:* Thursday, February 18, 2016 1:58 PM
> *To:* Bovard, Juli
> *Subject:* [cdi_talk] mortality reviews
>
>
>
> For those of you conducting mortality reviews, do you also review pts who
> are admitted and expire in hospice?
>
> Thanks,
>
> Kerry
>
>
>
> *Kerry Seekircher, RN, BS, CCDS, CDIP*
>
>
>
>
>
>
>
>
> ------------------------------
>
> Note:
> This message is for the named person's use only. It may contain
> confidential, proprietary or legally privileged information. No
> confidentiality or privilege is waived or lost by any mistransmission. If
> you receive this message in error, please immediately delete it and all
> copies of it from your system, destroy any hard copies of it and notify the
> sender. You must not, directly or indirectly, use, disclose, distribute,
> print, or copy any part of this message if you are not the intended
> recipient. This organization and any of its subsidiaries each reserve the
> right to monitor all e-mail communications through its networks.
>
> Any views expressed in this message are those of the individual sender,
> except where the message states otherwise and the sender is authorized to
> state them to be the views of any such entity.
>
>
>
> ---
>
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
>
>
> You are receiving this message as a member of CDI Talk as: jbovard@regionalhealth.com
>
> If you would like to be removed from CDI Talk, please send a blank email to
>
> leave-cdi_talk-12940160.55ea2c13b419eb7deb7e5125c36e4234@hcprotalk.com
>
> ---
>
> Copyright 2013
>
> HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
>
> ------------------------------
> Regional Health is an integrated health care system with the purpose of
> helping patients and communities live well.
>
> Note: The information contained in this message, including any
> attachments, may be privileged, confidential, or protected from disclosure
> under state or federal laws . If the reader of this message is not the
> intended recipient, or an employee or agent responsible for delivering this
> message to the intended recipient, you are hereby notified that any
> dissemination, distribution, or copying of this communication is strictly
> prohibited. If you have received this communication in error, please notify
> the Sender immediately by a "reply to sender only" message and destroy all
> electronic or paper copies of the communication, including any attachments.
>
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: slrobinson329@gmail.com
> If you would like to be removed from CDI Talk, please send a blank email to leave-cdi_talk-20337088.e489c6968e2eaa3346b0bd0a944f339d@hcprotalk.com
> ---
> Copyright 2013
> HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
>
>
--
Steve Robinson
slrobinson329@gmail.com
404-694-0778
----------------------------------------------------------------------
Subject: PCS is KILLING me!!
From: Kathryn Good
Date: Thu, 18 Feb 2016 21:22:05 +0000
X-Message-Number: 8
Whew!
Trauma undergoes an closed reduction and external fixation procedure. Coding told me they did not have enough information to code the procedure. They want queries for the approach, device specificity, location...
This is what I see:
[cid:image002.png@01D16A57.0ACAD8E0]
Then from post-op xray....
[cid:image004.png@01D16A4F.33DAC130]
I go here:
[cid:image003.png@01D16A4F.33DAC130]
Without a query.
But do we need to code the placement of the fixation decide separately? And if so, do you think the approach is clear or are queries needed?
We are getting quite a few requests for queries on PCS stuff that is actually in there its just not in 'coding language'. I am trying to be diligent about making sure queries are needed. But it is time consuming and PCS is definitely NOT my forte ;-)
Thanks!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
----------------------------------------------------------------------
Subject: RE: Rhabdomyolysis
From:
Date: Thu, 18 Feb 2016 21:26:52 +0000
X-Message-Number: 9
I found a couple of references and this is what all seem to say:
The third quarter of 2002 Coding Clinic clarifies the proper code assignment of acute renal failure due to rhabdo. This advice supersedes the Coding Clinic advice found in the 2nd Quarter 2001 in which the guidance was to assign the rhabdo, ICD-9 code 728.89 as principal diagnosis with acute renal failure, ICD-9 584.9, as secondary diagnosis. Instead, the acute renal failure is to be assigned as principal diagnosis with rhabdo as secondary, provided the documentation and circumstances of admission support the same. Keep in mind that acute renal failure is an "unspecified code." If the physician documented a more specific diagnosis such as acute tubular necrosis, a specified acute renal failure, this diagnosis would be sequenced as principal diagnosis.
http://health-information.advanceweb.com/Article/Coding-QA-Aug-30-2005.aspx
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, February 18, 2016 1:10 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
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----------------------------------------------------------------------
Subject: RE: Rhabdomyolysis
From: Angie Guiler
Date: Thu, 18 Feb 2016 21:36:12 +0000
X-Message-Number: 10
Looking at the coding clinic for rhabodmyolysis it appears there was 2003/4th quarter update, is that just an update to the code? Making the coding clinic you provided below still active?
Thank you again, apologize for the multiple questions.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:27 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
I found a couple of references and this is what all seem to say:
The third quarter of 2002 Coding Clinic clarifies the proper code assignment of acute renal failure due to rhabdo. This advice supersedes the Coding Clinic advice found in the 2nd Quarter 2001 in which the guidance was to assign the rhabdo, ICD-9 code 728.89 as principal diagnosis with acute renal failure, ICD-9 584.9, as secondary diagnosis. Instead, the acute renal failure is to be assigned as principal diagnosis with rhabdo as secondary, provided the documentation and circumstances of admission support the same. Keep in mind that acute renal failure is an "unspecified code." If the physician documented a more specific diagnosis such as acute tubular necrosis, a specified acute renal failure, this diagnosis would be sequenced as principal diagnosis.
http://health-information.advanceweb.com/Article/Coding-QA-Aug-30-2005.aspx
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, February 18, 2016 1:10 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
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HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
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----------------------------------------------------------------------
Subject: Re: mortality reviews
From: Debbie Smith
Date: Thu, 18 Feb 2016 15:37:38 -0600
X-Message-Number: 11
Mortality reviews were just added to our workflow and if they were admitted as an acute inpatient we are asked to review them.
Debbie Smith, RN, CCDS, CCS
UT Southwestern Medical Center at Dallas-
William P Clements and Zale Lipshy University Hospitals
6201 Harry Hines Blvd.
Dallas, TX 75390
214-645-5217
Deborahw.smith@utsouthwestern.edu
Sent from my iPad
> On Feb 18, 2016, at 3:03 PM, CDI Talk wrote:
>
> Hi Kerry,
>
> If they were admitted as an acute inpatient then yes we would review the case. Admin has flip flopped a couple of times and has now removed out-patient from our population.
>
> 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, February 18, 2016 12:58 PM
> To: Vanessa Falkoff
> Subject: [cdi_talk] mortality reviews
>
> For those of you conducting mortality reviews, do you also review pts who are admitted and expire in hospice?
> Thanks,
> Kerry
>
> Kerry Seekircher, RN, BS, CCDS, CDIP
>
>
>
>
> Note:
> This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.
>
> Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.
>
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
> If you would like to be removed from CDI Talk, please send a blank email to
> leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
> ---
> Copyright 2013
> HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: dsmith12h@aol.com
> If you would like to be removed from CDI Talk, please send a blank email to
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> Copyright 2013
> HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Subject: RE: Rhabdomyolysis
From:
Date: Thu, 18 Feb 2016 21:51:05 +0000
X-Message-Number: 12
This article is from 2015
For patients with AKI due to rhabdomyolysis, coders should sequence AKI as the principal diagnosis, according to Coding Clinic, Third Quarter 2002, p. 28
http://blr.hcpro.com/content.cfm?content_id=319012
V
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 1:36 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
Looking at the coding clinic for rhabodmyolysis it appears there was 2003/4th quarter update, is that just an update to the code? Making the coding clinic you provided below still active?
Thank you again, apologize for the multiple questions.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:27 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
I found a couple of references and this is what all seem to say:
The third quarter of 2002 Coding Clinic clarifies the proper code assignment of acute renal failure due to rhabdo. This advice supersedes the Coding Clinic advice found in the 2nd Quarter 2001 in which the guidance was to assign the rhabdo, ICD-9 code 728.89 as principal diagnosis with acute renal failure, ICD-9 584.9, as secondary diagnosis. Instead, the acute renal failure is to be assigned as principal diagnosis with rhabdo as secondary, provided the documentation and circumstances of admission support the same. Keep in mind that acute renal failure is an "unspecified code." If the physician documented a more specific diagnosis such as acute tubular necrosis, a specified acute renal failure, this diagnosis would be sequenced as principal diagnosis.
http://health-information.advanceweb.com/Article/Coding-QA-Aug-30-2005.aspx
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, February 18, 2016 1:10 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: angie.guiler@bergerhealth.com
If you would like to be removed from CDI Talk, please send a blank email to
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
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Copyright 2013
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----------------------------------------------------------------------
Subject: RE: Rhabdomyolysis
From: Angie Guiler
Date: Thu, 18 Feb 2016 21:52:31 +0000
X-Message-Number: 13
Perfect. Thank you:)
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:51 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
This article is from 2015
For patients with AKI due to rhabdomyolysis, coders should sequence AKI as the principal diagnosis, according to Coding Clinic, Third Quarter 2002, p. 28
http://blr.hcpro.com/content.cfm?content_id=319012
V
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 1:36 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
Looking at the coding clinic for rhabodmyolysis it appears there was 2003/4th quarter update, is that just an update to the code? Making the coding clinic you provided below still active?
Thank you again, apologize for the multiple questions.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:27 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
I found a couple of references and this is what all seem to say:
The third quarter of 2002 Coding Clinic clarifies the proper code assignment of acute renal failure due to rhabdo. This advice supersedes the Coding Clinic advice found in the 2nd Quarter 2001 in which the guidance was to assign the rhabdo, ICD-9 code 728.89 as principal diagnosis with acute renal failure, ICD-9 584.9, as secondary diagnosis. Instead, the acute renal failure is to be assigned as principal diagnosis with rhabdo as secondary, provided the documentation and circumstances of admission support the same. Keep in mind that acute renal failure is an "unspecified code." If the physician documented a more specific diagnosis such as acute tubular necrosis, a specified acute renal failure, this diagnosis would be sequenced as principal diagnosis.
http://health-information.advanceweb.com/Article/Coding-QA-Aug-30-2005.aspx
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, February 18, 2016 1:10 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
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Copyright 2013
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----------------------------------------------------------------------
Subject: RE: PCS is KILLING me!!
From: "Lueck, Cheree RN"
Date: Thu, 18 Feb 2016 15:00:16 -0700
X-Message-Number: 14
Katy,
The ex fix device is not coded separately, as it is included in the closed reduction. You account for it in the device character. The report stated "the external fixator was tightened down...", so I'm not sure a query is required for the device, as it seems fairly clear what device was used to keep the fracture reduced.
Also, the fracture is open, but they do not state that they made a separate or deepened the incision to reduce the fracture. They clearly have stated that they performed a closed reduction (external approach) of the fracture & then irrigated the wound or "open part" and eventually go on to close and dress this wound.
The body part seems fairly clear as well in the axial images as to where the pins of the exfix are placed. I would code this out the same way that you did if I were looking at this. I personally, would not send a query out on this case, as it seems very clear what they did.
I'm curious as to what "coding language" they would like the surgeon to use. (externally reposition? , exfix device?, L ankle joint???)
Those are my thoughts.
Cheree
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 2:22 PM
To: Lueck, Cheree RN
Subject: [cdi_talk] PCS is KILLING me!!
Whew!
Trauma undergoes an closed reduction and external fixation procedure. Coding told me they did not have enough information to code the procedure. They want queries for the approach, device specificity, location...
This is what I see:
[cid:image002.png@01D16A5A.F4B923F0]
Then from post-op xray....
[cid:image004.png@01D16A5A.F4B923F0]
I go here:
[cid:image005.png@01D16A5A.F4B923F0]
Without a query.
But do we need to code the placement of the fixation decide separately? And if so, do you think the approach is clear or are queries needed?
We are getting quite a few requests for queries on PCS stuff that is actually in there its just not in 'coding language'. I am trying to be diligent about making sure queries are needed. But it is time consuming and PCS is definitely NOT my forte ;-)
Thanks!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
---
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The Denver Health email system has made the following annotations
---------------------------------------------------------------------CONFIDENTIALITY NOTICE - This e-mail transmission, and any documents, files or previous e-mail messages attached to it may contain information that is confidential or legally privileged. If you are not the intended recipient, or a person responsible for delivering it to the intended recipient, you are hereby notified that you must not read this transmission and that any disclosure, copying, printing, distribution or use of any of the information contained in or attached to this transmission is STRICTLY PROHIBITED. If you have received this transmission in error, please immediately notify the sender by telephone or return e-mail and delete the original transmission and its attachments without reading or saving in any manner. Thank you.
----------------------------------------------------------------------
Subject: RE: mortality reviews
From: "Evans, Paul"
Date: Thu, 18 Feb 2016 14:00:34 -0800
X-Message-Number: 15
Kerry
What I have been able to discern, in some quality models, if a patient qualifies for Inpatient Hospice Services, an order is written for same, and the service is reported as Hospice, these patients are not included in the Mortality Outcomes data and are not tabulated as an expired outcome for acute inpatient admission. Your site is required to have a license for a hospice designation.
Paul
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation
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@01D16A54.BC524380]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 1:38 PM
To: Evans, Paul
Subject: Re: [cdi_talk] mortality reviews
Mortality reviews were just added to our workflow and if they were admitted as an acute inpatient we are asked to review them.
Debbie Smith, RN, CCDS, CCS
UT Southwestern Medical Center at Dallas-
William P Clements and Zale Lipshy University Hospitals
6201 Harry Hines Blvd.
Dallas, TX 75390
214-645-5217
Deborahw.smith@utsouthwestern.edu
Sent from my iPad
On Feb 18, 2016, at 3:03 PM, CDI Talk wrote:
Hi Kerry,
If they were admitted as an acute inpatient then yes we would review the case. Admin has flip flopped a couple of times and has now removed out-patient from our population.
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, February 18, 2016 12:58 PM
To: Vanessa Falkoff
Subject: [cdi_talk] mortality reviews
For those of you conducting mortality reviews, do you also review pts who are admitted and expire in hospice?
Thanks,
Kerry
Kerry Seekircher, RN, BS, CCDS, CDIP
________________________________
Note:
This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.
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----------------------------------------------------------------------
Subject: Query Question
From: "Hudson, Cynthia"
Date: Thu, 18 Feb 2016 22:10:49 +0000
X-Message-Number: 16
We are being asked to audit queries for compliance. I am being told that there is a difference in auditing queries for compliance from a Children's hospital versus Adult facility. I thought that the basic query guidelines pertained to everyone with clinical indicators present in order to query.
Am I wrong in my thinking? Also, does anyone know what the productivity standards for auditing charts are for children as compared to adults?
Thanks,
Syndi
Syndi Hudson, RN, CCDS,CCM
CHRISTUS Santa Rosa New Braunfels
CDI Specialist
cynthia.hudson@christushealth.org
830-643-6116 (Office)
830-643-5139 (Fax)
[CCDS_pin_1inch]
"We are His hands". Isaiah 64:8
CONFIDENTIALITY NOTICE: Confidential information, such as identifiable patient health information or business information, is subject to protection under state and federal law. If you are not the intended recipient of this message, you may not disclose, print, copy or disseminate this information. If you have received this in error, please reply and notify the sender (only) and delete the message. Unauthorized interception of this e-mail is a violation of federal criminal law.
----------------------------------------------------------------------
Subject: RE: cdi_talk digest: February 17, 2016
From: rmhosler
Date: Thu, 18 Feb 2016 18:49:16 -0500
X-Message-Number: 17
What about cardiorenal syndrome?
Sent from my Verizon Wireless 4G LTE smartphone
-------- Original message --------
From: CDI Talk digest
Date: 2/18/2016 12:00 AM (GMT-05:00)
To: cdi_talk digest recipients
Subject: cdi_talk digest: February 17, 2016
CDI_TALK Digest for Wednesday, February 17, 2016.
1. RE: Pdx selection: sepsis
2. Outpatient CDI?
3. RE: Outpatient CDI?
4. RE: Outpatient CDI?
5. RE: Outpatient CDI?
6. RE: Outpatient CDI?
7. RE: Outpatient CDI?
8. RE: Outpatient CDI?
9. RE: Outpatient CDI?
10. RE: Outpatient CDI?
11. RE: Outpatient CDI?
12. Re: Outpatient CDI?
13. Re: Outpatient CDI?
----------------------------------------------------------------------
Subject: RE: Pdx selection: sepsis
From: Mary Snook
Date: Wed, 17 Feb 2016 07:56:08 -0500
X-Message-Number: 1
I would code the Sepsis as primary.�� That is what brought the patient in to the hospital.
Mary L. Snook RN-BC
Clinical Documentation Improvement Specialist
Fairfield Medical Center
740-689-4443
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, February 16, 2016 10:53 AM
To: Mary Snook
Subject: RE:[cdi_talk] Pdx selection: sepsis
Hi Katy,
I would still stick with the sepsis as the acute issue that caused this admit.
Have a great week!
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: Monday, February 15, 2016 1:02 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Pdx selection: sepsis
I have a patient with underlying CHF with end-stage cardiomyopathy,�� ESRD, diabetes, liver disease, malnutrition with numerous stage 3/4 decubes, with hx of numerous hospitalizations and surgeries that came in with shock. This was immediately thought to be cardiogenic but possibly some component of septic shock as well. No source was identified until 5 days in when we had a positive c-diff culture. The entire time he was on antibiotics however ultimately treatment was deemed medical future because of his multiple organ failures and underlying chronic illnesses (not assoc with sepsis).
I had sepsis sequenced as primary per guidelines until I got to the DCS. It states:
�������� Antibiotics were given for possible infection and several cultures were positive, however, Mr. Benally's primary clinical issue was his end stage cardiomyopathy plus end stage renal and hepatic disease.�� After antibiotic therapy, on 1/30/2016, after multiple family conferences, pressor and inotrope support were removed as he had failed to wean and there were no interventions that were reasonably to be offered for end stage multi system organ failure.
Would you stick with sepsis as pdx or does this change the Pdx selection in your opinion?
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
���������������������������� ---
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CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
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--
Fairfield Medical Center
People you know. Care you trust.
"Confidentiality Notice: This email message, including any attachments is
for the sole use of the intended recipient(s) and may contain confidential
and privileged information. Any unauthorized review; use; disclosure or
distribution is prohibited. If you are not the intended recipient, please
contact the sender by reply e-mail and destroy all copies of the original
message."
----------------------------------------------------------------------
Subject: Outpatient CDI?
From: "Katherine Rushlau"
Date: Wed, 17 Feb 2016 10:10:24 -0500
X-Message-Number: 2
Hi CDI Talkers!
ACDIS is considering publishing a book on outpatient CDI and I need your feedback! Do you think the book is a good idea/why, and, if so, what are some topics etc. you'd like to see in an outpatient book?
Please feel free to comment here or contact me directly! I appreciate the help!
Katherine Rushlau | Editor
Association of Clinical Documentation Improvement Specialists
75 Sylvan Street, Suite A-101 |�� Danvers, MA 01923
(p) 978-223-1721 ext. 3270 | (f) 781-639-7857
krushlau@hcpro.com
----------------------------------------------------------------------
Subject: RE: Outpatient CDI?
From: "Bourque, Suzonne"
Date: Wed, 17 Feb 2016 15:56:07 +0000
X-Message-Number: 3
I think it's a good idea as our facility is possibly looking at expanding CDI into the OP arena.�� It would be good to have a resource to help us expand to OP, what metrics to capture, what to watch for, education tips, etc.
Suzonne Bourque, RHIA, CCS, CCDS
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Wednesday, February 17, 2016 9:10 AM
To: Bourque, Suzonne
Subject: [cdi_talk] Outpatient CDI?
Hi CDI Talkers!
ACDIS is considering publishing a book on outpatient CDI and I need your feedback! Do you think the book is a good idea/why, and, if so, what are some topics etc. you'd like to see in an outpatient book?
Please feel free to comment here or contact me directly! I appreciate the help!
Katherine Rushlau | Editor
Association of Clinical Documentation Improvement Specialists
75 Sylvan Street, Suite A-101 |�� Danvers, MA 01923
(p) 978-223-1721 ext. 3270 | (f) 781-639-7857
krushlau@hcpro.com
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----------------------------------------------------------------------
Subject: RE: Outpatient CDI?
From: "Debby Dallen, BSN, RN , CCDS"
Date: Wed, 17 Feb 2016 11:11:41 -0500
X-Message-Number: 4
I am not involved in outpatient CDI but my facility has hired staff for Ambulatory CDI. I think it would be wonderful to have a resource those involved in CDI in the Outpatient area.
I will be meeting with the new CDI educator for this unit and provide her with as much information as possible but I am sure there are some differences between inpatient and outpatient.��
Our goal is to ensure we are as consistent as possible when we educate our physicians.
Excellent idea!!
Deborah A Dallen, BSN, RN, CCDS
Supervisor
Clinical Documentation Improvement
Einstein Medical Center
Health Information Management
Phila PA 19141
215-456-8902
dallend@einstein.edu
>>> CDI Talk 2/17/2016 10:56 AM >>>
I think it's a good idea as our facility is possibly looking at expanding CDI into the OP arena.�� It would be good to have a resource to help us expand to OP, what metrics to capture, what to watch for, education tips, etc.
Suzonne Bourque, RHIA, CCS, CCDS
-----Original Messa
Comments
Paul Evans
Sent from iPad2
On Feb 19, 2016, at 4:49 PM, CDI Talk wrote:
Could you go for atn since needed dialysis, ?
Sent from my Verizon Wireless 4G LTE smartphone
-------- Original message --------
From: CDI Talk digest
Date: 2/19/2016 12:00 AM (GMT-05:00)
To: cdi_talk digest recipients
Subject: cdi_talk digest: February 18, 2016
CDI_TALK Digest for Thursday, February 18, 2016.
1. Rhabdomyolysis
2. mortality reviews
3. RE: mortality reviews
4. RE: Rhabdomyolysis
5. RE: mortality reviews
6. RE: Rhabdomyolysis
7. Re: mortality reviews
8. PCS is KILLING me!!
9. RE: Rhabdomyolysis
10. RE: Rhabdomyolysis
11. Re: mortality reviews
12. RE: Rhabdomyolysis
13. RE: Rhabdomyolysis
14. RE: PCS is KILLING me!!
15. RE: mortality reviews
16. Query Question
17. RE: cdi_talk digest: February 17, 2016
18. RE: PCS is KILLING me!!
19. re: Query Question
20. RE: cdi_talk digest: February 17, 2016
21. RE: mortality reviews
----------------------------------------------------------------------
Subject: Rhabdomyolysis
From: Angie Guiler
Date: Thu, 18 Feb 2016 20:55:11 +0000
X-Message-Number: 1
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
----------------------------------------------------------------------
Subject: mortality reviews
From: "Seekircher, Kerry"
Date: Thu, 18 Feb 2016 15:57:51 -0500
X-Message-Number: 2
For those of you conducting mortality reviews, do you also review pts who are admitted and expire in hospice?
Thanks,
Kerry
Kerry Seekircher, RN, BS, CCDS, CDIP
________________________________
Note:
This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.
Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.
----------------------------------------------------------------------
Subject: RE: mortality reviews
From:
Date: Thu, 18 Feb 2016 20:58:47 +0000
X-Message-Number: 3
We do not include Hospice at our institution!
Juli
Juli Bovard RN CCDS
Certified Clinical Documentation Specialist
Clinical Effectiveness/Clinical Quality
Rapid City Regional Hospital
755-8426 (work)
786-2677 (cell)
"No Limit to Better......"
[CCDS_pin_1inch]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 1:58 PM
To: Bovard, Juli
Subject: [cdi_talk] mortality reviews
For those of you conducting mortality reviews, do you also review pts who are admitted and expire in hospice?
Thanks,
Kerry
Kerry Seekircher, RN, BS, CCDS, CDIP
________________________________
Note:
This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.
Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.
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Regional Health is an integrated health care system with the purpose of helping patients and communities live well.
Note: The information contained in this message, including any attachments, may be privileged, confidential, or protected from disclosure under state or federal laws . If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly prohibited. If you have received this communication in error, please notify the Sender immediately by a "reply to sender only" message and destroy all electronic or paper copies of the communication, including any attachments.
----------------------------------------------------------------------
Subject: RE: Rhabdomyolysis
From:
Date: Thu, 18 Feb 2016 21:00:18 +0000
X-Message-Number: 4
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Subject: RE: mortality reviews
From:
Date: Thu, 18 Feb 2016 21:03:11 +0000
X-Message-Number: 5
Hi Kerry,
If they were admitted as an acute inpatient then yes we would review the case. Admin has flip flopped a couple of times and has now removed out-patient from our population.
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, February 18, 2016 12:58 PM
To: Vanessa Falkoff
Subject: [cdi_talk] mortality reviews
For those of you conducting mortality reviews, do you also review pts who are admitted and expire in hospice?
Thanks,
Kerry
Kerry Seekircher, RN, BS, CCDS, CDIP
________________________________
Note:
This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.
Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.
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CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
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If you would like to be removed from CDI Talk, please send a blank email to
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Subject: RE: Rhabdomyolysis
From: Angie Guiler
Date: Thu, 18 Feb 2016 21:09:53 +0000
X-Message-Number: 6
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: angie.guiler@bergerhealth.com
If you would like to be removed from CDI Talk, please send a blank email to
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----------------------------------------------------------------------
Subject: Re: mortality reviews
From: Steven Robinson
Date: Thu, 18 Feb 2016 16:19:13 -0500
X-Message-Number: 7
No, we exclude from the population of reviews.
On Thu, Feb 18, 2016 at 3:58 PM, CDI Talk wrote:
> We do not include Hospice at our institution!
>
>
>
> Juli
>
> *Juli Bovard RN CCDS*
>
> *Certified Clinical Documentation Specialist*
>
> *Clinical Effectiveness/Clinical Quality*
>
> *Rapid City Regional Hospital*
>
> *755-8426 (work)*
>
> *786-2677 (cell)*
>
> *"No Limit to Better......"*
>
> *[image: CCDS_pin_1inch]*
>
>
>
>
>
>
>
> *From:* CDI Talk [mailto:cdi_talk@hcprotalk.com]
> *Sent:* Thursday, February 18, 2016 1:58 PM
> *To:* Bovard, Juli
> *Subject:* [cdi_talk] mortality reviews
>
>
>
> For those of you conducting mortality reviews, do you also review pts who
> are admitted and expire in hospice?
>
> Thanks,
>
> Kerry
>
>
>
> *Kerry Seekircher, RN, BS, CCDS, CDIP*
>
>
>
>
>
>
>
>
> ------------------------------
>
> Note:
> This message is for the named person's use only. It may contain
> confidential, proprietary or legally privileged information. No
> confidentiality or privilege is waived or lost by any mistransmission. If
> you receive this message in error, please immediately delete it and all
> copies of it from your system, destroy any hard copies of it and notify the
> sender. You must not, directly or indirectly, use, disclose, distribute,
> print, or copy any part of this message if you are not the intended
> recipient. This organization and any of its subsidiaries each reserve the
> right to monitor all e-mail communications through its networks.
>
> Any views expressed in this message are those of the individual sender,
> except where the message states otherwise and the sender is authorized to
> state them to be the views of any such entity.
>
>
>
> ---
>
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
>
>
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>
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>
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>
> Copyright 2013
>
> HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
>
> ------------------------------
> Regional Health is an integrated health care system with the purpose of
> helping patients and communities live well.
>
> Note: The information contained in this message, including any
> attachments, may be privileged, confidential, or protected from disclosure
> under state or federal laws . If the reader of this message is not the
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>
>
--
Steve Robinson
slrobinson329@gmail.com
404-694-0778
----------------------------------------------------------------------
Subject: PCS is KILLING me!!
From: Kathryn Good
Date: Thu, 18 Feb 2016 21:22:05 +0000
X-Message-Number: 8
Whew!
Trauma undergoes an closed reduction and external fixation procedure. Coding told me they did not have enough information to code the procedure. They want queries for the approach, device specificity, location...
This is what I see:
[cid:image002.png@01D16A57.0ACAD8E0]
Then from post-op xray....
[cid:image004.png@01D16A4F.33DAC130]
I go here:
[cid:image003.png@01D16A4F.33DAC130]
Without a query.
But do we need to code the placement of the fixation decide separately? And if so, do you think the approach is clear or are queries needed?
We are getting quite a few requests for queries on PCS stuff that is actually in there its just not in 'coding language'. I am trying to be diligent about making sure queries are needed. But it is time consuming and PCS is definitely NOT my forte ;-)
Thanks!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
----------------------------------------------------------------------
Subject: RE: Rhabdomyolysis
From:
Date: Thu, 18 Feb 2016 21:26:52 +0000
X-Message-Number: 9
I found a couple of references and this is what all seem to say:
The third quarter of 2002 Coding Clinic clarifies the proper code assignment of acute renal failure due to rhabdo. This advice supersedes the Coding Clinic advice found in the 2nd Quarter 2001 in which the guidance was to assign the rhabdo, ICD-9 code 728.89 as principal diagnosis with acute renal failure, ICD-9 584.9, as secondary diagnosis. Instead, the acute renal failure is to be assigned as principal diagnosis with rhabdo as secondary, provided the documentation and circumstances of admission support the same. Keep in mind that acute renal failure is an "unspecified code." If the physician documented a more specific diagnosis such as acute tubular necrosis, a specified acute renal failure, this diagnosis would be sequenced as principal diagnosis.
http://health-information.advanceweb.com/Article/Coding-QA-Aug-30-2005.aspx
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, February 18, 2016 1:10 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
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---
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CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
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----------------------------------------------------------------------
Subject: RE: Rhabdomyolysis
From: Angie Guiler
Date: Thu, 18 Feb 2016 21:36:12 +0000
X-Message-Number: 10
Looking at the coding clinic for rhabodmyolysis it appears there was 2003/4th quarter update, is that just an update to the code? Making the coding clinic you provided below still active?
Thank you again, apologize for the multiple questions.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:27 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
I found a couple of references and this is what all seem to say:
The third quarter of 2002 Coding Clinic clarifies the proper code assignment of acute renal failure due to rhabdo. This advice supersedes the Coding Clinic advice found in the 2nd Quarter 2001 in which the guidance was to assign the rhabdo, ICD-9 code 728.89 as principal diagnosis with acute renal failure, ICD-9 584.9, as secondary diagnosis. Instead, the acute renal failure is to be assigned as principal diagnosis with rhabdo as secondary, provided the documentation and circumstances of admission support the same. Keep in mind that acute renal failure is an "unspecified code." If the physician documented a more specific diagnosis such as acute tubular necrosis, a specified acute renal failure, this diagnosis would be sequenced as principal diagnosis.
http://health-information.advanceweb.com/Article/Coding-QA-Aug-30-2005.aspx
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, February 18, 2016 1:10 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
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HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
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If you would like to be removed from CDI Talk, please send a blank email to
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---
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---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: angie.guiler@bergerhealth.com
If you would like to be removed from CDI Talk, please send a blank email to
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HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Subject: Re: mortality reviews
From: Debbie Smith
Date: Thu, 18 Feb 2016 15:37:38 -0600
X-Message-Number: 11
Mortality reviews were just added to our workflow and if they were admitted as an acute inpatient we are asked to review them.
Debbie Smith, RN, CCDS, CCS
UT Southwestern Medical Center at Dallas-
William P Clements and Zale Lipshy University Hospitals
6201 Harry Hines Blvd.
Dallas, TX 75390
214-645-5217
Deborahw.smith@utsouthwestern.edu
Sent from my iPad
> On Feb 18, 2016, at 3:03 PM, CDI Talk wrote:
>
> Hi Kerry,
>
> If they were admitted as an acute inpatient then yes we would review the case. Admin has flip flopped a couple of times and has now removed out-patient from our population.
>
> 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, February 18, 2016 12:58 PM
> To: Vanessa Falkoff
> Subject: [cdi_talk] mortality reviews
>
> For those of you conducting mortality reviews, do you also review pts who are admitted and expire in hospice?
> Thanks,
> Kerry
>
> Kerry Seekircher, RN, BS, CCDS, CDIP
>
>
>
>
> Note:
> This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.
>
> Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.
>
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
> If you would like to be removed from CDI Talk, please send a blank email to
> leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
> ---
> Copyright 2013
> HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: dsmith12h@aol.com
> If you would like to be removed from CDI Talk, please send a blank email to
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> ---
> Copyright 2013
> HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Subject: RE: Rhabdomyolysis
From:
Date: Thu, 18 Feb 2016 21:51:05 +0000
X-Message-Number: 12
This article is from 2015
For patients with AKI due to rhabdomyolysis, coders should sequence AKI as the principal diagnosis, according to Coding Clinic, Third Quarter 2002, p. 28
http://blr.hcpro.com/content.cfm?content_id=319012
V
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 1:36 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
Looking at the coding clinic for rhabodmyolysis it appears there was 2003/4th quarter update, is that just an update to the code? Making the coding clinic you provided below still active?
Thank you again, apologize for the multiple questions.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:27 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
I found a couple of references and this is what all seem to say:
The third quarter of 2002 Coding Clinic clarifies the proper code assignment of acute renal failure due to rhabdo. This advice supersedes the Coding Clinic advice found in the 2nd Quarter 2001 in which the guidance was to assign the rhabdo, ICD-9 code 728.89 as principal diagnosis with acute renal failure, ICD-9 584.9, as secondary diagnosis. Instead, the acute renal failure is to be assigned as principal diagnosis with rhabdo as secondary, provided the documentation and circumstances of admission support the same. Keep in mind that acute renal failure is an "unspecified code." If the physician documented a more specific diagnosis such as acute tubular necrosis, a specified acute renal failure, this diagnosis would be sequenced as principal diagnosis.
http://health-information.advanceweb.com/Article/Coding-QA-Aug-30-2005.aspx
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, February 18, 2016 1:10 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: angie.guiler@bergerhealth.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-20325672.4ff02ea37fab4b038fabf4550c231787@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: angie.guiler@bergerhealth.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-20325672.4ff02ea37fab4b038fabf4550c231787@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Subject: RE: Rhabdomyolysis
From: Angie Guiler
Date: Thu, 18 Feb 2016 21:52:31 +0000
X-Message-Number: 13
Perfect. Thank you:)
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:51 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
This article is from 2015
For patients with AKI due to rhabdomyolysis, coders should sequence AKI as the principal diagnosis, according to Coding Clinic, Third Quarter 2002, p. 28
http://blr.hcpro.com/content.cfm?content_id=319012
V
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 1:36 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
Looking at the coding clinic for rhabodmyolysis it appears there was 2003/4th quarter update, is that just an update to the code? Making the coding clinic you provided below still active?
Thank you again, apologize for the multiple questions.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:27 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
I found a couple of references and this is what all seem to say:
The third quarter of 2002 Coding Clinic clarifies the proper code assignment of acute renal failure due to rhabdo. This advice supersedes the Coding Clinic advice found in the 2nd Quarter 2001 in which the guidance was to assign the rhabdo, ICD-9 code 728.89 as principal diagnosis with acute renal failure, ICD-9 584.9, as secondary diagnosis. Instead, the acute renal failure is to be assigned as principal diagnosis with rhabdo as secondary, provided the documentation and circumstances of admission support the same. Keep in mind that acute renal failure is an "unspecified code." If the physician documented a more specific diagnosis such as acute tubular necrosis, a specified acute renal failure, this diagnosis would be sequenced as principal diagnosis.
http://health-information.advanceweb.com/Article/Coding-QA-Aug-30-2005.aspx
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, February 18, 2016 1:10 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
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----------------------------------------------------------------------
Subject: RE: PCS is KILLING me!!
From: "Lueck, Cheree RN"
Date: Thu, 18 Feb 2016 15:00:16 -0700
X-Message-Number: 14
Katy,
The ex fix device is not coded separately, as it is included in the closed reduction. You account for it in the device character. The report stated "the external fixator was tightened down...", so I'm not sure a query is required for the device, as it seems fairly clear what device was used to keep the fracture reduced.
Also, the fracture is open, but they do not state that they made a separate or deepened the incision to reduce the fracture. They clearly have stated that they performed a closed reduction (external approach) of the fracture & then irrigated the wound or "open part" and eventually go on to close and dress this wound.
The body part seems fairly clear as well in the axial images as to where the pins of the exfix are placed. I would code this out the same way that you did if I were looking at this. I personally, would not send a query out on this case, as it seems very clear what they did.
I'm curious as to what "coding language" they would like the surgeon to use. (externally reposition? , exfix device?, L ankle joint???)
Those are my thoughts.
Cheree
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 2:22 PM
To: Lueck, Cheree RN
Subject: [cdi_talk] PCS is KILLING me!!
Whew!
Trauma undergoes an closed reduction and external fixation procedure. Coding told me they did not have enough information to code the procedure. They want queries for the approach, device specificity, location...
This is what I see:
[cid:image002.png@01D16A5A.F4B923F0]
Then from post-op xray....
[cid:image004.png@01D16A5A.F4B923F0]
I go here:
[cid:image005.png@01D16A5A.F4B923F0]
Without a query.
But do we need to code the placement of the fixation decide separately? And if so, do you think the approach is clear or are queries needed?
We are getting quite a few requests for queries on PCS stuff that is actually in there its just not in 'coding language'. I am trying to be diligent about making sure queries are needed. But it is time consuming and PCS is definitely NOT my forte ;-)
Thanks!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
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The Denver Health email system has made the following annotations
---------------------------------------------------------------------CONFIDENTIALITY NOTICE - This e-mail transmission, and any documents, files or previous e-mail messages attached to it may contain information that is confidential or legally privileged. If you are not the intended recipient, or a person responsible for delivering it to the intended recipient, you are hereby notified that you must not read this transmission and that any disclosure, copying, printing, distribution or use of any of the information contained in or attached to this transmission is STRICTLY PROHIBITED. If you have received this transmission in error, please immediately notify the sender by telephone or return e-mail and delete the original transmission and its attachments without reading or saving in any manner. Thank you.
----------------------------------------------------------------------
Subject: RE: mortality reviews
From: "Evans, Paul"
Date: Thu, 18 Feb 2016 14:00:34 -0800
X-Message-Number: 15
Kerry
What I have been able to discern, in some quality models, if a patient qualifies for Inpatient Hospice Services, an order is written for same, and the service is reported as Hospice, these patients are not included in the Mortality Outcomes data and are not tabulated as an expired outcome for acute inpatient admission. Your site is required to have a license for a hospice designation.
Paul
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation
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@01D16A54.BC524380]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 1:38 PM
To: Evans, Paul
Subject: Re: [cdi_talk] mortality reviews
Mortality reviews were just added to our workflow and if they were admitted as an acute inpatient we are asked to review them.
Debbie Smith, RN, CCDS, CCS
UT Southwestern Medical Center at Dallas-
William P Clements and Zale Lipshy University Hospitals
6201 Harry Hines Blvd.
Dallas, TX 75390
214-645-5217
Deborahw.smith@utsouthwestern.edu
Sent from my iPad
On Feb 18, 2016, at 3:03 PM, CDI Talk wrote:
Hi Kerry,
If they were admitted as an acute inpatient then yes we would review the case. Admin has flip flopped a couple of times and has now removed out-patient from our population.
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, February 18, 2016 12:58 PM
To: Vanessa Falkoff
Subject: [cdi_talk] mortality reviews
For those of you conducting mortality reviews, do you also review pts who are admitted and expire in hospice?
Thanks,
Kerry
Kerry Seekircher, RN, BS, CCDS, CDIP
________________________________
Note:
This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.
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----------------------------------------------------------------------
Subject: Query Question
From: "Hudson, Cynthia"
Date: Thu, 18 Feb 2016 22:10:49 +0000
X-Message-Number: 16
We are being asked to audit queries for compliance. I am being told that there is a difference in auditing queries for compliance from a Children's hospital versus Adult facility. I thought that the basic query guidelines pertained to everyone with clinical indicators present in order to query.
Am I wrong in my thinking? Also, does anyone know what the productivity standards for auditing charts are for children as compared to adults?
Thanks,
Syndi
Syndi Hudson, RN, CCDS,CCM
CHRISTUS Santa Rosa New Braunfels
CDI Specialist
cynthia.hudson@christushealth.org
830-643-6116 (Office)
830-643-5139 (Fax)
[CCDS_pin_1inch]
"We are His hands". Isaiah 64:8
CONFIDENTIALITY NOTICE: Confidential information, such as identifiable patient health information or business information, is subject to protection under state and federal law. If you are not the intended recipient of this message, you may not disclose, print, copy or disseminate this information. If you have received this in error, please reply and notify the sender (only) and delete the message. Unauthorized interception of this e-mail is a violation of federal criminal law.
----------------------------------------------------------------------
Subject: RE: cdi_talk digest: February 17, 2016
From: rmhosler
Date: Thu, 18 Feb 2016 18:49:16 -0500
X-Message-Number: 17
What about cardiorenal syndrome?
Sent from my Verizon Wireless 4G LTE smartphone
-------- Original message --------
From: CDI Talk digest
Date: 2/18/2016 12:00 AM (GMT-05:00)
To: cdi_talk digest recipients
Subject: cdi_talk digest: February 17, 2016
CDI_TALK Digest for Wednesday, February 17, 2016.
1. RE: Pdx selection: sepsis
2. Outpatient CDI?
3. RE: Outpatient CDI?
4. RE: Outpatient CDI?
5. RE: Outpatient CDI?
6. RE: Outpatient CDI?
7. RE: Outpatient CDI?
8. RE: Outpatient CDI?
9. RE: Outpatient CDI?
10. RE: Outpatient CDI?
11. RE: Outpatient CDI?
12. Re: Outpatient CDI?
13. Re: Outpatient CDI?
----------------------------------------------------------------------
Subject: RE: Pdx selection: sepsis
From: Mary Snook
Date: Wed, 17 Feb 2016 07:56:08 -0500
X-Message-Number: 1
I would code the Sepsis as primary.�� That is what brought the patient in to the hospital.
Mary L. Snook RN-BC
Clinical Documentation Improvement Specialist
Fairfield Medical Center
740-689-4443
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, February 16, 2016 10:53 AM
To: Mary Snook
Subject: RE:[cdi_talk] Pdx selection: sepsis
Hi Katy,
I would still stick with the sepsis as the acute issue that caused this admit.
Have a great week!
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: Monday, February 15, 2016 1:02 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Pdx selection: sepsis
I have a patient with underlying CHF with end-stage cardiomyopathy,�� ESRD, diabetes, liver disease, malnutrition with numerous stage 3/4 decubes, with hx of numerous hospitalizations and surgeries that came in with shock. This was immediately thought to be cardiogenic but possibly some component of septic shock as well. No source was identified until 5 days in when we had a positive c-diff culture. The entire time he was on antibiotics however ultimately treatment was deemed medical future because of his multiple organ failures and underlying chronic illnesses (not assoc with sepsis).
I had sepsis sequenced as primary per guidelines until I got to the DCS. It states:
�������� Antibiotics were given for possible infection and several cultures were positive, however, Mr. Benally's primary clinical issue was his end stage cardiomyopathy plus end stage renal and hepatic disease.�� After antibiotic therapy, on 1/30/2016, after multiple family conferences, pressor and inotrope support were removed as he had failed to wean and there were no interventions that were reasonably to be offered for end stage multi system organ failure.
Would you stick with sepsis as pdx or does this change the Pdx selection in your opinion?
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
���������������������������� ---
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Fairfield Medical Center
People you know. Care you trust.
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message."
----------------------------------------------------------------------
Subject: Outpatient CDI?
From: "Katherine Rushlau"
Date: Wed, 17 Feb 2016 10:10:24 -0500
X-Message-Number: 2
Hi CDI Talkers!
ACDIS is considering publishing a book on outpatient CDI and I need your feedback! Do you think the book is a good idea/why, and, if so, what are some topics etc. you'd like to see in an outpatient book?
Please feel free to comment here or contact me directly! I appreciate the help!
Katherine Rushlau | Editor
Association of Clinical Documentation Improvement Specialists
75 Sylvan Street, Suite A-101 |�� Danvers, MA 01923
(p) 978-223-1721 ext. 3270 | (f) 781-639-7857
krushlau@hcpro.com
----------------------------------------------------------------------
Subject: RE: Outpatient CDI?
From: "Bourque, Suzonne"
Date: Wed, 17 Feb 2016 15:56:07 +0000
X-Message-Number: 3
I think it's a good idea as our facility is possibly looking at expanding CDI into the OP arena.�� It would be good to have a resource to help us expand to OP, what metrics to capture, what to watch for, education tips, etc.
Suzonne Bourque, RHIA, CCS, CCDS
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Wednesday, February 17, 2016 9:10 AM
To: Bourque, Suzonne
Subject: [cdi_talk] Outpatient CDI?
Hi CDI Talkers!
ACDIS is considering publishing a book on outpatient CDI and I need your feedback! Do you think the book is a good idea/why, and, if so, what are some topics etc. you'd like to see in an outpatient book?
Please feel free to comment here or contact me directly! I appreciate the help!
Katherine Rushlau | Editor
Association of Clinical Documentation Improvement Specialists
75 Sylvan Street, Suite A-101 |�� Danvers, MA 01923
(p) 978-223-1721 ext. 3270 | (f) 781-639-7857
krushlau@hcpro.com
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CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation
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@01D16D4E.C6F5CFD0]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Saturday, February 20, 2016 7:51 AM
To: Evans, Paul
Subject: Re: [cdi_talk] cdi_talk digest: February 18, 2016
Absolutely right, Paul. This article tells everyone a lot about the disease, its cause in face of rhabdo, the stages of AKI that might ensue and how to treat each stage (check Figure 2, it's great!). Just because RRT (renal replacement therapy or, in this case, intermittent hemodialysis) is used is NOT sufficient evidence to push for ATN as RRT is a mechsnism to remove the rhabo molecules faster. ATN does occur occasionally and it will likely take weeks of dialysis for the patient to recover from rhabdo induced ATN.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056317/
Robert S. Gold, M.D.
CEO
DCBA, Inc.
4611 Brierwood Place
Atlanta, Georgia 30360
(770) 216-9691 - office
(404) 580-0204 Cell
-----Original Message-----
From: CDI Talk
To: DCBAInc
Sent: Fri, Feb 19, 2016 9:06 pm
Subject: Re: [cdi_talk] cdi_talk digest: February 18, 2016
ARF stated in scenario must be PDX over Ckd
Paul Evans
Sent from iPad2
On Feb 19, 2016, at 4:49 PM, CDI Talk wrote:
Could you go for atn since needed dialysis, ?
Sent from my Verizon Wireless 4G LTE smartphone
-------- Original message --------
From: CDI Talk digest
Date: 2/19/2016 12:00 AM (GMT-05:00)
To: cdi_talk digest recipients
Subject: cdi_talk digest: February 18, 2016
CDI_TALK Digest for Thursday, February 18, 2016.
1. Rhabdomyolysis
2. mortality reviews
3. RE: mortality reviews
4. RE: Rhabdomyolysis
5. RE: mortality reviews
6. RE: Rhabdomyolysis
7. Re: mortality reviews
8. PCS is KILLING me!!
9. RE: Rhabdomyolysis
10. RE: Rhabdomyolysis
11. Re: mortality reviews
12. RE: Rhabdomyolysis
13. RE: Rhabdomyolysis
14. RE: PCS is KILLING me!!
15. RE: mortality reviews
16. Query Question
17. RE: cdi_talk digest: February 17, 2016
18. RE: PCS is KILLING me!!
19. re: Query Question
20. RE: cdi_talk digest: February 17, 2016
21. RE: mortality reviews
----------------------------------------------------------------------
Subject: Rhabdomyolysis
From: Angie Guiler
Date: Thu, 18 Feb 2016 20:55:11 +0000
X-Message-Number: 1
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
----------------------------------------------------------------------
Subject: mortality reviews
From: "Seekircher, Kerry"
Date: Thu, 18 Feb 2016 15:57:51 -0500
X-Message-Number: 2
For those of you conducting mortality reviews, do you also review pts who are admitted and expire in hospice?
Thanks,
Kerry
Kerry Seekircher, RN, BS, CCDS, CDIP
________________________________
Note:
This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.
Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.
----------------------------------------------------------------------
Subject: RE: mortality reviews
From:
Date: Thu, 18 Feb 2016 20:58:47 +0000
X-Message-Number: 3
We do not include Hospice at our institution!
Juli
Juli Bovard RN CCDS
Certified Clinical Documentation Specialist
Clinical Effectiveness/Clinical Quality
Rapid City Regional Hospital
755-8426 (work)
786-2677 (cell)
"No Limit to Better......"
[CCDS_pin_1inch]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 1:58 PM
To: Bovard, Juli
Subject: [cdi_talk] mortality reviews
For those of you conducting mortality reviews, do you also review pts who are admitted and expire in hospice?
Thanks,
Kerry
Kerry Seekircher, RN, BS, CCDS, CDIP
________________________________
Note:
This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.
Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.
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Regional Health is an integrated health care system with the purpose of helping patients and communities live well.
Note: The information contained in this message, including any attachments, may be privileged, confidential, or protected from disclosure under state or federal laws . If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly prohibited. If you have received this communication in error, please notify the Sender immediately by a "reply to sender only" message and destroy all electronic or paper copies of the communication, including any attachments.
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Subject: RE: Rhabdomyolysis
From:
Date: Thu, 18 Feb 2016 21:00:18 +0000
X-Message-Number: 4
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Subject: RE: mortality reviews
From:
Date: Thu, 18 Feb 2016 21:03:11 +0000
X-Message-Number: 5
Hi Kerry,
If they were admitted as an acute inpatient then yes we would review the case. Admin has flip flopped a couple of times and has now removed out-patient from our population.
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, February 18, 2016 12:58 PM
To: Vanessa Falkoff
Subject: [cdi_talk] mortality reviews
For those of you conducting mortality reviews, do you also review pts who are admitted and expire in hospice?
Thanks,
Kerry
Kerry Seekircher, RN, BS, CCDS, CDIP
________________________________
Note:
This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.
Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Subject: RE: Rhabdomyolysis
From: Angie Guiler
Date: Thu, 18 Feb 2016 21:09:53 +0000
X-Message-Number: 6
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
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You are receiving this message as a member of CDI Talk as: angie.guiler@bergerhealth.com
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Subject: Re: mortality reviews
From: Steven Robinson
Date: Thu, 18 Feb 2016 16:19:13 -0500
X-Message-Number: 7
No, we exclude from the population of reviews.
On Thu, Feb 18, 2016 at 3:58 PM, CDI Talk wrote:
> We do not include Hospice at our institution!
>
>
>
> Juli
>
> *Juli Bovard RN CCDS*
>
> *Certified Clinical Documentation Specialist*
>
> *Clinical Effectiveness/Clinical Quality*
>
> *Rapid City Regional Hospital*
>
> *755-8426 (work)*
>
> *786-2677 (cell)*
>
> *"No Limit to Better......"*
>
> *[image: CCDS_pin_1inch]*
>
>
>
>
>
>
>
> *From:* CDI Talk [mailto:cdi_talk@hcprotalk.com]
> *Sent:* Thursday, February 18, 2016 1:58 PM
> *To:* Bovard, Juli
> *Subject:* [cdi_talk] mortality reviews
>
>
>
> For those of you conducting mortality reviews, do you also review pts who
> are admitted and expire in hospice?
>
> Thanks,
>
> Kerry
>
>
>
> *Kerry Seekircher, RN, BS, CCDS, CDIP*
>
>
>
>
>
>
>
>
> ------------------------------
>
> Note:
> This message is for the named person's use only. It may contain
> confidential, proprietary or legally privileged information. No
> confidentiality or privilege is waived or lost by any mistransmission. If
> you receive this message in error, please immediately delete it and all
> copies of it from your system, destroy any hard copies of it and notify the
> sender. You must not, directly or indirectly, use, disclose, distribute,
> print, or copy any part of this message if you are not the intended
> recipient. This organization and any of its subsidiaries each reserve the
> right to monitor all e-mail communications through its networks.
>
> Any views expressed in this message are those of the individual sender,
> except where the message states otherwise and the sender is authorized to
> state them to be the views of any such entity.
>
>
>
> ---
>
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
>
>
> You are receiving this message as a member of CDI Talk as: jbovard@regionalhealth.com
>
> If you would like to be removed from CDI Talk, please send a blank email to
>
> leave-cdi_talk-12940160.55ea2c13b419eb7deb7e5125c36e4234@hcprotalk.com
>
> ---
>
> Copyright 2013
>
> HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
>
> ------------------------------
> Regional Health is an integrated health care system with the purpose of
> helping patients and communities live well.
>
> Note: The information contained in this message, including any
> attachments, may be privileged, confidential, or protected from disclosure
> under state or federal laws . If the reader of this message is not the
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> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
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> Copyright 2013
> HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
>
>
--
Steve Robinson
slrobinson329@gmail.com
404-694-0778
----------------------------------------------------------------------
Subject: PCS is KILLING me!!
From: Kathryn Good
Date: Thu, 18 Feb 2016 21:22:05 +0000
X-Message-Number: 8
Whew!
Trauma undergoes an closed reduction and external fixation procedure. Coding told me they did not have enough information to code the procedure. They want queries for the approach, device specificity, location...
This is what I see:
[cid:image002.png@01D16A57.0ACAD8E0]
Then from post-op xray....
[cid:image004.png@01D16A4F.33DAC130]
I go here:
[cid:image003.png@01D16A4F.33DAC130]
Without a query.
But do we need to code the placement of the fixation decide separately? And if so, do you think the approach is clear or are queries needed?
We are getting quite a few requests for queries on PCS stuff that is actually in there its just not in 'coding language'. I am trying to be diligent about making sure queries are needed. But it is time consuming and PCS is definitely NOT my forte ;-)
Thanks!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
----------------------------------------------------------------------
Subject: RE: Rhabdomyolysis
From:
Date: Thu, 18 Feb 2016 21:26:52 +0000
X-Message-Number: 9
I found a couple of references and this is what all seem to say:
The third quarter of 2002 Coding Clinic clarifies the proper code assignment of acute renal failure due to rhabdo. This advice supersedes the Coding Clinic advice found in the 2nd Quarter 2001 in which the guidance was to assign the rhabdo, ICD-9 code 728.89 as principal diagnosis with acute renal failure, ICD-9 584.9, as secondary diagnosis. Instead, the acute renal failure is to be assigned as principal diagnosis with rhabdo as secondary, provided the documentation and circumstances of admission support the same. Keep in mind that acute renal failure is an "unspecified code." If the physician documented a more specific diagnosis such as acute tubular necrosis, a specified acute renal failure, this diagnosis would be sequenced as principal diagnosis.
http://health-information.advanceweb.com/Article/Coding-QA-Aug-30-2005.aspx
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, February 18, 2016 1:10 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: angie.guiler@bergerhealth.com
If you would like to be removed from CDI Talk, please send a blank email to
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
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---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Subject: RE: Rhabdomyolysis
From: Angie Guiler
Date: Thu, 18 Feb 2016 21:36:12 +0000
X-Message-Number: 10
Looking at the coding clinic for rhabodmyolysis it appears there was 2003/4th quarter update, is that just an update to the code? Making the coding clinic you provided below still active?
Thank you again, apologize for the multiple questions.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:27 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
I found a couple of references and this is what all seem to say:
The third quarter of 2002 Coding Clinic clarifies the proper code assignment of acute renal failure due to rhabdo. This advice supersedes the Coding Clinic advice found in the 2nd Quarter 2001 in which the guidance was to assign the rhabdo, ICD-9 code 728.89 as principal diagnosis with acute renal failure, ICD-9 584.9, as secondary diagnosis. Instead, the acute renal failure is to be assigned as principal diagnosis with rhabdo as secondary, provided the documentation and circumstances of admission support the same. Keep in mind that acute renal failure is an "unspecified code." If the physician documented a more specific diagnosis such as acute tubular necrosis, a specified acute renal failure, this diagnosis would be sequenced as principal diagnosis.
http://health-information.advanceweb.com/Article/Coding-QA-Aug-30-2005.aspx
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, February 18, 2016 1:10 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
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---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: angie.guiler@bergerhealth.com
If you would like to be removed from CDI Talk, please send a blank email to
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Subject: Re: mortality reviews
From: Debbie Smith
Date: Thu, 18 Feb 2016 15:37:38 -0600
X-Message-Number: 11
Mortality reviews were just added to our workflow and if they were admitted as an acute inpatient we are asked to review them.
Debbie Smith, RN, CCDS, CCS
UT Southwestern Medical Center at Dallas-
William P Clements and Zale Lipshy University Hospitals
6201 Harry Hines Blvd.
Dallas, TX 75390
214-645-5217
Deborahw.smith@utsouthwestern.edu
Sent from my iPad
> On Feb 18, 2016, at 3:03 PM, CDI Talk wrote:
>
> Hi Kerry,
>
> If they were admitted as an acute inpatient then yes we would review the case. Admin has flip flopped a couple of times and has now removed out-patient from our population.
>
> 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, February 18, 2016 12:58 PM
> To: Vanessa Falkoff
> Subject: [cdi_talk] mortality reviews
>
> For those of you conducting mortality reviews, do you also review pts who are admitted and expire in hospice?
> Thanks,
> Kerry
>
> Kerry Seekircher, RN, BS, CCDS, CDIP
>
>
>
>
> Note:
> This message is for the named person's use only. It may contain confidential, proprietary or legally privileged information. No confidentiality or privilege is waived or lost by any mistransmission. If you receive this message in error, please immediately delete it and all copies of it from your system, destroy any hard copies of it and notify the sender. You must not, directly or indirectly, use, disclose, distribute, print, or copy any part of this message if you are not the intended recipient. This organization and any of its subsidiaries each reserve the right to monitor all e-mail communications through its networks.
>
> Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.
>
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
> If you would like to be removed from CDI Talk, please send a blank email to
> leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
> ---
> Copyright 2013
> HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: dsmith12h@aol.com
> If you would like to be removed from CDI Talk, please send a blank email to
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> ---
> Copyright 2013
> HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
----------------------------------------------------------------------
Subject: RE: Rhabdomyolysis
From:
Date: Thu, 18 Feb 2016 21:51:05 +0000
X-Message-Number: 12
This article is from 2015
For patients with AKI due to rhabdomyolysis, coders should sequence AKI as the principal diagnosis, according to Coding Clinic, Third Quarter 2002, p. 28
http://blr.hcpro.com/content.cfm?content_id=319012
V
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 1:36 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
Looking at the coding clinic for rhabodmyolysis it appears there was 2003/4th quarter update, is that just an update to the code? Making the coding clinic you provided below still active?
Thank you again, apologize for the multiple questions.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:27 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
I found a couple of references and this is what all seem to say:
The third quarter of 2002 Coding Clinic clarifies the proper code assignment of acute renal failure due to rhabdo. This advice supersedes the Coding Clinic advice found in the 2nd Quarter 2001 in which the guidance was to assign the rhabdo, ICD-9 code 728.89 as principal diagnosis with acute renal failure, ICD-9 584.9, as secondary diagnosis. Instead, the acute renal failure is to be assigned as principal diagnosis with rhabdo as secondary, provided the documentation and circumstances of admission support the same. Keep in mind that acute renal failure is an "unspecified code." If the physician documented a more specific diagnosis such as acute tubular necrosis, a specified acute renal failure, this diagnosis would be sequenced as principal diagnosis.
http://health-information.advanceweb.com/Article/Coding-QA-Aug-30-2005.aspx
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, February 18, 2016 1:10 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
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Subject: RE: Rhabdomyolysis
From: Angie Guiler
Date: Thu, 18 Feb 2016 21:52:31 +0000
X-Message-Number: 13
Perfect. Thank you:)
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:51 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
This article is from 2015
For patients with AKI due to rhabdomyolysis, coders should sequence AKI as the principal diagnosis, according to Coding Clinic, Third Quarter 2002, p. 28
http://blr.hcpro.com/content.cfm?content_id=319012
V
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 1:36 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
Looking at the coding clinic for rhabodmyolysis it appears there was 2003/4th quarter update, is that just an update to the code? Making the coding clinic you provided below still active?
Thank you again, apologize for the multiple questions.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:27 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
I found a couple of references and this is what all seem to say:
The third quarter of 2002 Coding Clinic clarifies the proper code assignment of acute renal failure due to rhabdo. This advice supersedes the Coding Clinic advice found in the 2nd Quarter 2001 in which the guidance was to assign the rhabdo, ICD-9 code 728.89 as principal diagnosis with acute renal failure, ICD-9 584.9, as secondary diagnosis. Instead, the acute renal failure is to be assigned as principal diagnosis with rhabdo as secondary, provided the documentation and circumstances of admission support the same. Keep in mind that acute renal failure is an "unspecified code." If the physician documented a more specific diagnosis such as acute tubular necrosis, a specified acute renal failure, this diagnosis would be sequenced as principal diagnosis.
http://health-information.advanceweb.com/Article/Coding-QA-Aug-30-2005.aspx
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, February 18, 2016 1:10 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
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----------------------------------------------------------------------
Subject: RE: PCS is KILLING me!!
From: "Lueck, Cheree RN"
Date: Thu, 18 Feb 2016 15:00:16 -0700
X-Message-Number: 14
Katy,
The ex fix device is not coded separately, as it is included in the closed reduction. You account for it in the device character. The report stated "the external fixator was tightened down...", so I'm not sure a query is required for the device, as it seems fairly clear what device was used to keep the fracture reduced.
Also, the fracture is open, but they do not state that they made a separate or deepened the incision to reduce the fracture. They clearly have stated that they performed a closed reduction (external approach) of the fracture & then irrigated the wound or "open part" and eventually go on to close and dress this wound.
The body part seems fairly clear as well in the axial images as to where the pins of the exfix are placed. I would code this out the same way that you did if I were looking at this. I personally, would not send a query out on this case, as it seems very clear what they did.
I'm curious as to what "coding language" they would like the surgeon to use. (externally reposition? , exfix device?, L ankle joint???)
Those are my thoughts.
Cheree
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 2:22 PM
To: Lueck, Cheree RN
Subject: [cdi_talk] PCS is KILLING me!!
Whew!
Trauma undergoes an closed reduction and external fixation procedure. Coding told me they did not have enough information to code the procedure. They want queries for the approach, device specificity, location...
This is what I see:
[cid:image002.png@01D16A5A.F4B923F0]
Then from post-op xray....
[cid:image004.png@01D16A5A.F4B923F0]
I go here:
[cid:image005.png@01D16A5A.F4B923F0]
Without a query.
But do we need to code the placement of the fixation decide separately? And if so, do you think the approach is clear or are queries needed?
We are getting quite a few requests for queries on PCS stuff that is actually in there its just not in 'coding language'. I am trying to be diligent about making sure queries are needed. But it is time consuming and PCS is definitely NOT my forte ;-)
Thanks!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
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The Denver Health email system has made the following annotations
---------------------------------------------------------------------CONFIDENTIALITY NOTICE - This e-mail transmission, and any documents, files or previous e-mail messages attached to it may contain information that is confidential or legally privileged. If you are not the intended recipient, or a person responsible for delivering it to the intended recipient, you are hereby notified that you must not read this transmission and that any disclosure, copying, printing, distribution or use of any of the information contained in or attached to this transmission is STRICTLY PROHIBITED. If you have received this transmission in error, please immediately notify the sender by telephone or return e-mail and delete the original transmission and its attachments without reading or saving in any manner. Thank you.
----------------------------------------------------------------------
Subject: RE: mortality reviews
From: "Evans, Paul"
Date: Thu, 18 Feb 2016 14:00:34 -0800
X-Message-Number: 15
Kerry
What I have been able to discern, in some quality models, if a patient qualifies for Inpatient Hospice Services, an order is written for same, and the service is reported as Hospice, these patients are not included in the Mortality Outcomes data and are not tabulated as an expired outcome for acute inpatient admission. Your site is required to have a license for a hospice designation.
Paul
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation
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@01D16A54.BC524380]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 1:38 PM
To: Evans, Paul
Subject: Re: [cdi_talk] mortality reviews
Mortality reviews were just added to our workflow and if they were admitted as an acute inpatient we are asked to review them.
Debbie Smith, RN, CCDS, CCS
UT Southwestern Medical Center at Dallas-
William P Clements and Zale Lipshy University Hospitals
6201 Harry Hines Blvd.
Dallas, TX 75390
214-645-5217
Deborahw.smith@utsouthwestern.edu
Sent from my iPad
On Feb 18, 2016, at 3:03 PM, CDI Talk wrote:
Hi Kerry,
If they were admitted as an acute inpatient then yes we would review the case. Admin has flip flopped a couple of times and has now removed out-patient from our population.
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, February 18, 2016 12:58 PM
To: Vanessa Falkoff
Subject: [cdi_talk] mortality reviews
For those of you conducting mortality reviews, do you also review pts who are admitted and expire in hospice?
Thanks,
Kerry
Kerry Seekircher, RN, BS, CCDS, CDIP
________________________________
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----------------------------------------------------------------------
Subject: Query Question
From: "Hudson, Cynthia"
Date: Thu, 18 Feb 2016 22:10:49 +0000
X-Message-Number: 16
We are being asked to audit queries for compliance. I am being told that there is a difference in auditing queries for compliance from a Children's hospital versus Adult facility. I thought that the basic query guidelines pertained to everyone with clinical indicators present in order to query.
Am I wrong in my thinking? Also, does anyone know what the productivity standards for auditing charts are for children as compared to adults?
Thanks,
Syndi
Syndi Hudson, RN, CCDS,CCM
CHRISTUS Santa Rosa New Braunfels
CDI Specialist
cynthia.hudson@christushealth.org
830-643-6116 (Office)
830-643-5139 (Fax)
[CCDS_pin_1inch]
"We are His hands". Isaiah 64:8
CONFIDENTIALITY NOTICE: Confidential information, such as identifiable patient health information or business information, is subject to protection under state and federal law. If you are not the intended recipient of this message, you may not disclose, print, copy or disseminate this information. If you have received this in error, please reply and notify the sender (only) and delete the message. Unauthorized interception of this e-mail is a violation of federal criminal law.
----------------------------------------------------------------------
Subject: RE: cdi_talk digest: February 17, 2016
From: rmhosler
Date: Thu, 18 Feb 2016 18:49:16 -0500
X-Message-Number: 17
What about cardiorenal syndrome?
Sent from my Verizon Wireless 4G LTE smartphone
-------- Original message --------
From: CDI Talk digest
Date: 2/18/2016 12:00 AM (GMT-05:00)
To: cdi_talk digest recipients
Subject: cdi_talk digest: February 17, 2016
CDI_TALK Digest for Wednesday, February 17, 2016.
1. RE: Pdx selection: sepsis
2. Outpatient CDI?
3. RE: Outpatient CDI?
4. RE: Outpatient CDI?
5. RE: Outpatient CDI?
6. RE: Outpatient CDI?
7. RE: Outpatient CDI?
8. RE: Outpatient CDI?
9. RE: Outpatient CDI?
10. RE: Outpatient CDI?
11. RE: Outpatient CDI?
12. Re: Outpatient CDI?
13. Re: Outpatient CDI?
----------------------------------------------------------------------
Subject: RE: Pdx selection: sepsis
From: Mary Snook
Date: Wed, 17 Feb 2016 07:56:08 -0500
X-Message-Number: 1
I would code the Sepsis as primary.�� That is what brought the patient in to the hospital.
Mary L. Snook RN-BC
Clinical Documentation Improvement Specialist
Fairfield Medical Center
740-689-4443
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, February 16, 2016 10:53 AM
To: Mary Snook
Subject: RE:[cdi_talk] Pdx selection: sepsis
Hi Katy,
I would still stick with the sepsis as the acute issue that caused this admit.
Have a great week!
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: Monday, February 15, 2016 1:02 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Pdx selection: sepsis
I have a patient with underlying CHF with end-stage cardiomyopathy,�� ESRD, diabetes, liver disease, malnutrition with numerous stage 3/4 decubes, with hx of numerous hospitalizations and surgeries that came in with shock. This was immediately thought to be cardiogenic but possibly some component of septic shock as well. No source was identified until 5 days in when we had a positive c-diff culture. The entire time he was on antibiotics however ultimately treatment was deemed medical future because of his multiple organ failures and underlying chronic illnesses (not assoc with sepsis).
I had sepsis sequenced as primary per guidelines until I got to the DCS. It states:
�������� Antibiotics were given for possible infection and several cultures were positive, however, Mr. Benally's primary clinical issue was his end stage cardiomyopathy plus end stage renal and hepatic disease.�� After antibiotic therapy, on 1/30/2016, after multiple family conferences, pressor and inotrope support were removed as he had failed to wean and there were no interventions that were reasonably to be offered for end stage multi system organ failure.
Would you stick with sepsis as pdx or does this change the Pdx selection in your opinion?
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
���������������������������� ---
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Fairfield Medical Center
People you know. Care you trust.
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----------------------------------------------------------------------
Subject: Outpatient CDI?
From: "Katherine Rushlau"
Date: Wed, 17 Feb 2016 10:10:24 -0500
X-Message-Number: 2
Hi CDI Talkers!
ACDIS is considering publishing a book on outpatient CDI and I need your feedback! Do you think the book is a good idea/why, and, if so, what are some topics etc. you'd like to see in an outpatient book?
Please feel free to comment here or contact me directly! I appreciate the help!
Katherine Rushlau | Editor
Association of Clinical Documentation Improvement Specialists
75 Sylvan Street, Suite A-101 |�� Danvers, MA 01923
(p) 978-223-1721 ext. 3270 | (f) 781-639-7857
krushlau@hcpro.com
----------------------------------------------------------------------
Subject: RE: Outpatient CDI?
From: "Bourque, Suzonne"
Date: Wed, 17 Feb 2016 15:56:07 +0000
X-Message-Number: 3
I think it's a good idea as our facility is possibly looking at expanding CDI into the OP arena.�� It would be good to have a resource to help us expand to OP, what metrics to capture, what to watch for, education tips, etc.
Suzonne Bourqu
Have a wonderful week!
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, February 22, 2016 11:55 AM
To: Angie Guiler
Subject: RE: [cdi_talk] cdi_talk digest: February 18, 2016
Thanks for sharing this excellent reference, Dr. Gold.
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation
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: Saturday, February 20, 2016 7:51 AM
To: Evans, Paul
Subject: Re: [cdi_talk] cdi_talk digest: February 18, 2016
Absolutely right, Paul. This article tells everyone a lot about the disease, its cause in face of rhabdo, the stages of AKI that might ensue and how to treat each stage (check Figure 2, it's great!). Just because RRT (renal replacement therapy or, in this case, intermittent hemodialysis) is used is NOT sufficient evidence to push for ATN as RRT is a mechsnism to remove the rhabo molecules faster. ATN does occur occasionally and it will likely take weeks of dialysis for the patient to recover from rhabdo induced ATN.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056317/
Robert S. Gold, M.D.
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