Depression coding

cari.merlina@uchealth.orgcari.merlina@uchealth.org
in CDI Expansion
Friends,
I'm being asked by my hospitalist why it is so important to CMS to specifiy the type of depression (why does it add money to reimbursemet?). I try to avoid the conversations surrounding finances, but not sure how to intelligently answer this question. Thanks for advice!

CM

Comments

  • cari.merlina@uchealth.orgcari.merlina@uchealth.org
    edited May 2016
    Thanks Dr. G!

    Best Regards,

    Cari Merlina RN, BSN
    Clinical Documentation Improvement Specialist
    Revenue Cycle
    Yampa Valley Medical Center
    1024 Central Park Dr
    Steamboat Springs, CO 80487
    p.970.871.2425
    f.970.875.2796
    Cari.merlina@yvmc.org
    [yvmc]







  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Dr. Gold, et al



    Point of clarification? When you refer to the coding software, I assume you must mean how we use the decision points in our automated groupers? In some cases, I actually find DIFFERENCES in the logic and decision trees in the SOFTWARE versus the paper copies of I-10 and PCS. (There are some logic errors in some of the groupers). Just wanted to mention this as a hint to the audience..sometimes, it can be faster to code using the books. By the way, the logic in any grouper must match the Books versions in order to render the proper code. (Book trumps software all day).

    I believe this is one reason why some folks will code ‘extirpation’ of mucus via a bronchoscopy – the software takes one down this path. I personally don’t think a bronchoscopy with removal of some mucus is ‘extirpation’. Just one example.

    Such issues, compounded by apparent problems with the grouper this year, are apparently contributing to DRGS that some consider problematic.

    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


  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Dr. Gold

    Spot on…what I find concerning is that for some of the PCS procedures, as you stated, none of the offered choices reflect the accurate work performed. I agree that ‘word needs to get out’ to the proper 3rd parties.

    Thank you,

    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


  • cynthia.hudson@christushealth.orgcynthia.hudson@christushealth.org
    edited May 2016
    This is important for the patient. We do not want a patient being classified as having a Major Depressive Disorder when they have situational depression, etc. that is mild. It really has nothing to do with finances but more about getting the right diagnosis for the patient. Clinical documentation is about integrity of the medical record and accurate representation of diagnoses of the patient.

    I hope this helps.

    Syndi Hudson, RN, CCM, CCDS
    Director of Case Management
    CHRISTUS Santa Rosa Medical Center
    210-705-6147 (Office)
    210-705-6009 (Fax)
    cynthia.hudson@christushealth.org
    “We are His hands”. Isaiah 64:8


     


  • cari.merlina@uchealth.orgcari.merlina@uchealth.org
    edited May 2016
    Agreed. It's just that the hospitalists are frustrated that they must clarify the depression diagnosis when they admit they aren't psychiatrists. It therefore gets left as unspecified often.

    Best Regards,

    Cari Merlina RN, BSN
    Clinical Documentation Improvement Specialist
    Revenue Cycle
    Yampa Valley Medical Center
    1024 Central Park Dr
    Steamboat Springs, CO 80487
    p.970.871.2425
    f.970.875.2796
    Cari.merlina@yvmc.org








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