Arterial lines

tiffany.andras · February 2016

Does anyone out there place codes for the use of an arterial line when it placed and used for continuous monitoring. And if so what is the procedure codes you are using. We are having a discussion about this with our coders. Looking for opinions/help?

Thanks

Tiffany Andras LPN CCS CCDS

Clinical Documentation Improvement
Thibodaux Regional Medical Center
602 North Acadia Road
Thibodaux, La. 70301
985-493-4593

lsipos@monument.health · February 2016

Andrea

Everyone seems to be having this discussion! ACDIS has a survey going on right now and this is one of the questions on the survery-related to whether you have identified this issue and are coding it. Our coders have not (in the past) coded Art lines and now with the code changing some DRG's to a surgical DRG we broached the subject again with them.. . I was told our coders have decided against coding this..... so I am very interested to see what others are doing...

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]

cmclose@saintfrancis.com · February 2016

Our coders have been capturing the art-line insertion which I disagree with; I think the monitoring code should be captured, not the insertion. This is a new topic of debate that the coding dept is supposed to be discussing and creating a policy on.

Claudine Hutchinson RN (CDI)

gwojo · February 2016

The monitoring should be coded. You code the purpose of insertion. Instructions on how to code are in the PCS book.

afeighner · February 2016

We had an incident where the insertion did not go well and the patient was left with a hematoma that extended the hospital stay and the coders were wondering because of the complication did the insertion have to be captured on this instance.

Amber L. Feighner RN MSN CCDS
Clinical Documentation Improvement Analyst
Blanchard Valley Health System
1900 South Main Street
Findlay, Ohio 45840
P: 419-425-5787
F: 419-423-5100

[http://thecore.bvhealthsystem.org/upload/images/logos/BVHS.logo.Werheresignature350.jpg]

gwojo · February 2016

in that instance, I would code the insertion.

m.leblanc · February 2016

Thanks Dr. Gold for your great thought provoking comments. As a Licensed Healthcare professional, I am more likely to take the words " everyone's concern about inserting a device into an artery becoming an operating room procedure" and say it becomes an ethical issue for me around continuing to capture the code. It feels wrong to capture a Procedure DRG knowing that it is not an operating room procedure. I have to remind myself that ICD-10-CM is the system utilized by all countries around the globe to capture statistics and not necessarily reimbursement. Thus it feels to me like we will find areas like this that do not make sense in the mapping and should choose to do the right thing by choosing to not capture and notify the appropriate entities (CMS, Coding Clinic, etc.).

I look forward to others replies around your comments.

Mark

tiffany.andras · February 2016

Thanks everyone!! Dr. G your knowledge and willingness to teach others is so appreciated.

Tiffany

evanspx@sutterhealth.org · February 2016

This is quite the conundrum, unlike any issue I have encountered in terms of potential impact and scope.

My personal opinion for A-lines is that we need to look at the intent and definition offered in the Guidelines...Insertion with intent of Monitoring. I can only say this is concerning and confusing.

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With an A-line, the line is INSERTED with the intent of Monitoring. Therefore, at this time, I see no other choice but to use:

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I can’t find a reference in Coding Clinic for insertion of A-line.

A similar logic for insertion of lines is as below, indicating we are not to code the monitoring, but the root operation of ‘insertion’.

[cid:image003.png@01D16E1C.92E42560]

There is some precedence for coding A-lines to “Insertion’ with the related issue below cited in Coding Clinic, which pertains to Placement of a Venous Catheter…the instructions are to code to the Root Operation Insertion for this particular procedure.

[cid:image004.png@01D16E1D.EEBEE590]

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

evanspx@sutterhealth.org · February 2016

I'd only state that if a site IS using the intended PCS code for any procedure, it is not improper to use that code - nor is it unethical or not compliant. It is not surprising that certain issues are apparently being identified as we move to a very new and more complex coding system. I am not a lawyer, but I can't imagine anyone would be held accountable for properly using the existing set of codes, flawed as they appear to be...

I do believe CMS and others may ask for adjustments if/when technical issues are solved, but I personally do not believe one can or should be 'culpable' if/when we code this as per the existing codes, and actually, per HIPAA, one has a duty to use PCS 'properly'.

I certainly agree that this code, and several others, that did not impact DRG assignment in the past, now are impacting the DRG. No one can imagine this was the 'intent' when these codes were derived.

However, to argue another side of the coin, codes are also used to report the time and effort of the staff performing the procedures...simply not coding such procedures as line insertion, Paracentesis, and others, means a sites database used to track such procedures will not be accurate.

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

afeighner · February 2016

I agree with you Paul. In order to capture the "resource intensity" that is included in the management of an arterial line it would not be shown any other way if not captured in that code. This is something that I think would be important to code especially on the lengthy stays in order to support level and intensity of care in a critical care unit. Maybe I am looking at this from too clinical a viewpoint?.

Amber L. Feighner RN MSN CCDS
Clinical Documentation Improvement Analyst
Blanchard Valley Health System
1900 South Main Street
Findlay, Ohio 45840
P: 419-425-5787
F: 419-423-5100

dbeiseldenton · February 2016

Read Coding Clinic, 3Q, 2015, page 35 that provides an answer related to Insertion of Swan Ganz arterial cath. This should help!

evanspx@sutterhealth.org · February 2016

Here is the referenced issue of Coding Clinic – again, not an ‘exact’ match for insertion of arterial line used for monitoring, but provides some insight into the rationale.

Please see the ACDIS Website as there is a poll about the issue of PCS coding and DRG impact..the more that participate, the better

[cid:image001.png@01D16E40.FC1E9500]

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

m.leblanc · February 2016

I captured the Swan Ganz as directed and it did not drive to a surgical DRG.

Thoughts?

Mark

evanspx@sutterhealth.org · February 2016

I’d say that is what we would desire and expect. Using I-9, insertion of Swan Ganz did not drive to a surgical DRG.

(The Coding Clinic was cited in reference to root procedure determination ‘Measure’ versus “Insertion”).

PE

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

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katysuegood@gmail.com · February 2016

So Paul…..
What are your thoughts on the coding of a-lines with this CC in mind. At this point would you suggest coding the monitoring only? This is an ongoing discussion between CDI and coding at my facility…..

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, February 23, 2016 2:58 PM
To: Kathryn Good
Subject: RE: re:[cdi_talk] Arterial lines

I’d say that is what we would desire and expect. Using I-9, insertion of Swan Ganz did not drive to a surgical DRG.

(The Coding Clinic was cited in reference to root procedure determination ‘Measure’ versus “Insertion”).

PE

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

evanspx@sutterhealth.org · February 2016

Hi, Katy

Can you see my earlier and lengthy response?

Brian is planning to contact various partners in order to seek clarity on this particular issue, as well as several other questions pertaining to PCS coding.

Meanwhile, Katy, feel free to give me a call.

I believe to report as ‘monitoring’ is a ‘coding error’, but it may be an ‘error’ that should be pursued, given the financial implications: I understand why many would not code the A-Line Insertion. I honestly believe this is an oversight either w/ PCS coding promulgation and/or Grouper Logic.

However, there are disadvantages to not coding procedures that should be reported per the UHDDS Guidelines.

Thanks, PE

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

katysuegood@gmail.com · February 2016

Ahhh… I missed it! Just read your earlier response and was nodding my head while reading it ;-).

This is what we had previously determined. We have been continuing to code the monitoring and insertion codes with the thought that though CMS may eventually take back some dollars (we have seen a 400% increase in coding of the unrelated procedure DRG’s-not entirely due to A-lines…. ), the coding is correct and defensible. Based on this coding clinic then would you code both the monitoring and insertion code since continuous monitoring is performed with the A-line? Looks to me like the insertion code is definite but now I am not sure about the monitoring code?

Thanks so much!

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

evanspx@sutterhealth.org · February 2016

I believe the coding is correct as per our current instructions we are compelled to use – this places the coding staff in an unenviable position. However, it is ‘defensible’.

I would not code monitoring with the insertion…I can provide rationale as to why, if you’d like, but not today as I have been quite active today w/ all of this ☺ - need to review some cases.

The insertion, not the monitoring, is driving the case to Surgical DRG.

One fast note RE: Monitoring – I’d not code BOTH as per logic stated below in Coding Clinic ….see reference to ‘previously placed” and ‘may’ choose to code monitoring.

PE

[cid:image003.png@01D16E4B.D2855110]

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

katysuegood@gmail.com · February 2016

I agree with you. It seems like ‘insertion of a monitoring’ device captures the a-line effectively. Now if we got a transfer with an A-line or something like that, I can see using the monitoring code since we are not coding an insertion but we want to capture the resources.

Thanks so much Paul!

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

Arterial lines

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