MCC's

Unknown
edited May 2016 in CDI Talk Archive
A few months ago, some CDI Talk contributors looked at overall "top ten" CC's and MCC's - do you have a few favorites you tend to use for surgical DRG's?

Thanks, I look forward to your ideas.


Linnea Thennes, RN, BS, CCDS
Clinical Documentation Specialist
Clinical Resource Management
Northwest Community Hospital
847.618-3089
lthennes@nch.org

Comments

  • wfreemanwfreeman
    I like to capture post-op respiratory insufficiency/failure 518.5(codes the same) on patients that are not able to wean and extubate. Our coding department said that they should do a post discharge query if the patient had been intubated more than 12 hours after the surgery. As a previous CVICU/CV Recovery nurse, I would like to ask if someone is not extubated after 6 hours, but our CDI team has determined that we will wait for 12 hours.
  • dogdog
    I had a physician whom I felt was overdiagnosing 518.5, so I did some research and found that the general standard is 48 hours postop before diagnosing postop respiratory insufficiency/VDRF.

    I've told our docs that if the patient doesn't wean overnight as per expectations for that procedure, they can probably safely document VDRF on POD 2 if the patient isn't actively weaning.

    Probably my biggest MCCs are acute renal failure, dissection of an artery during surgery, postoperative encephalopathy, and sepsis.
  • dogdog
    reposting, sorry for double post:

    I had a physician whom I felt was overdiagnosing 518.5, so I did some research and found that the general standard is 48 hours postop before diagnosing postop respiratory insufficiency/VDRF.

    I've told our docs that if the patient doesn't wean overnight as per expectations for that procedure, they can probably safely document VDRF on POD 2 if the patient isn't actively weaning.

    Probably my biggest MCCs are acute renal failure, dissection of an artery during surgery, postoperative encephalopathy, and sepsis.

    Renee

    Linda Renee Brown, RN, CCRN, CCDS
    Clinical Documentation Specialist
    Arizona Heart Hospital
  • Unknown
    edited May 2016
    Thank you for the detail Renee.
  • sbeattysbeatty
    edited May 2016
    As a former CCRN myself, I would say what is the evidence-based standard
    and can you defend the diagnosis at 6 hours? If the standard for
    post-extubation is 6 hours, then there is an increase in resources in
    hours 6-12 to be reflected-vent time, ICU time, RT and RN management
    which impacts staffing ratios, etc. If you can defend it from the
    literature, I say query. However, it may increase your denial ratio so
    you need to check with your coders/HI department because there's a cost
    involved in appealing such as copying and sending records, recoupment
    time and effort by staff. Is it worth it? What is the cost/benefit
    ratio? We have to make decisions as a team which mountain to die on, so
    to speak. They may know something you don't about this issue from the
    post-discharge arena.

    Is there anything else I can do for you?
    Clinical Quality Management would like your feedback on our ability to
    meet your needs. Please complete a satisfaction survey for our
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    Sandy Beatty, RN, BSN, C-CDI
    Clinical Documentation Specialist
    Columbus Regional Hospital
    Columbus, IN
    (812) 376-5652
    sbeatty@crh.org

    "Obstacles are those frightful things you see when you take your eyes
    off the goal." Hannah More
  • sbeattysbeatty
    edited May 2016
    Do you have a citation for your researched standard? If so, I'd like to
    have it for appeal purposes. I don't do the appeals. We have Revenue
    Integrity Specialists, 2 FTEs (RN) who deal with RAC and other denials,
    but it would sure be helpful to CDS' on the front end. What does the
    group think about sharing research sources for issues we investigate on
    the list? I did a lot of work in finding diagnosis-specific criteria to
    guide/protect our query activity and incorporated that research into
    query forms. I've shared those on the website so others wouldn't need to
    reinvent the wheel. Brian, what is your opinion about the best way to do
    this, should others agree?


    Is there anything else I can do for you?

    Clinical Quality Management would like your feedback on our ability to
    meet your needs. Please complete a satisfaction survey for our
    department.



    Sandy Beatty, RN, BSN, C-CDI
    Clinical Documentation Specialist
    Columbus Regional Hospital
    Columbus, IN
    (812) 376-5652
    sbeatty@crh.org


    "Obstacles are those frightful things you see when you take your eyes
    off the goal." Hannah More
  • cstukenbergcstukenberg
    edited May 2016
    I would like to see us build a database that supports our queries. This would help "back" why we query what we do. I have been telling our organization for a while now we need to have this and have been starting a small file on my own.
    Colleen Stukenberg MSN, RN, CMSRN, CCDS
    815-599-6820
    Please consider the environment before printing this email.
  • fishdl@shands.ufl.edufishdl@shands.ufl.edu
    edited May 2016
    We've also been dealing with the postop respiratory failure PSI issue with some physicians documenting "respiratory failure" right out of the OR because they are still on the vent - so coders assign 518.5 or 518.81. According to Coding Clinic, "Do not assign a code for mechanical ventilation used during surgery unless it is followed by an extended period (several days) of ventilation after surgery." Based on the Coding Clinic, I would query before assigning a code for respiratory failure unless the patient has been on the vent for greater than 48 hours,if the patient was extubated and had to be re-intubated, or if the physician provides documented evidence that he/she feels the patient's respiratory status is more compromised than would be expected.

    Donna Fisher, CCS, CCDS
    Shands at the University of Florida
  • dsmith12h@aol.comdsmith12h@aol.com
    edited May 2016
    I like this idea as well. I have collected data and have a file also but it is not feasible time-wise to get the information completed and compiled in an organized manner. I had hoped to accomplish this as a department goal but again, time has not been on my side with this. I find it very labor intensive. So, yes, I like the idea of a database.

    Debbie Smith, RN CDIS-Cm
  • dogdog
    Sandy, I located and printed several physician research articles from a variety of locations that support the 48 hour standard. I had to show them to my doc before he would believe me. When I have time, I will pull those out and share them with the group.

    Renee

    Linda Renee Brown, RN, CCRN, CCDS
    Clinical Documentation Specialist
    Arizona Heart Hospital
  • sbeattysbeatty
    edited May 2016
    Thanks so much.

    Is there anything else I can do for you?
    Clinical Quality Management would like your feedback on our ability to
    meet your needs. Please complete a satisfaction survey for our
    department.

    Sandy Beatty, RN, BSN, C-CDI
    Clinical Documentation Specialist
    Columbus Regional Hospital
    Columbus, IN
    (812) 376-5652
    sbeatty@crh.org

    "Obstacles are those frightful things you see when you take your eyes
    off the goal." Hannah More
  • dogdog
    Here are a few cites:

    "Postoperative respiratory failure was defined as mechanical ventilation for longer than 48 hours or unplanned reintubation."
    --Multivariable predictors of postoperative respiratory failure after general and vascular surgery, RG Johnson, et.al, J Am Coll Surgeons June 2007

    "Respiratory failure was defined as greater than 48 hours of ventilator assistance or postoperative reintubation."
    --Postoperative mortality and pulmonary complication rankings: how well do they correlate at the hospital level, AM Arozullah, et.al, Medical Care, Vol 41, No 8

    "...postoperative respiratory failure, usually defined as a requirement for mechanical ventilatory support for more than two days or a failed attempt at extubation."
    --Preoperative Maneuvers to Avert Postoperative Respiratory Failure in Elderly Patients, D Gore, Gerontology, May 2008

    Renee

    Linda Renee Brown, RN, CCRN, CCDS
    Clinical Documentation Specialist
    Arizona Heart Hospital
  • sbeattysbeatty
    edited May 2016
    Perfect-thanks so much!

    Is there anything else I can do for you?
    Clinical Quality Management would like your feedback on our ability to
    meet your needs. Please complete a satisfaction survey for our
    department.

    Sandy Beatty, RN, BSN, C-CDI
    Clinical Documentation Specialist
    Columbus Regional Hospital
    Columbus, IN
    (812) 376-5652
    sbeatty@crh.org

    "Obstacles are those frightful things you see when you take your eyes
    off the goal." Hannah More
  • don.cdi.rn@gmail.comdon.cdi.rn@gmail.com
    edited May 2016
    The annual final rule contains a table (7 I believe) that shows the number of each DRG. One could use that to calculate the percentage of DRGs with MCC and slice / dice anyway you would like.

    I haven't done that for previous years, but I refer you to this blog post:
    http://blogs.hcpro.com/acdis/2012/11/tip-use-ipps-data-for-your-cdi-program-benchmarking/

    Don
  • judithbatesjudithbates
    edited May 2016
    Thanks Don,
    I will be reading and rereding that blog in preparation for a impending meeting...I'm not a slice and dice person but just reading it through without absorbing the statistics, I think I can show some differences to be considered...
    JUDI
  • dallend@einstein.edudallend@einstein.edu
    edited May 2016
    Hi Judi,
    Have you ever done an audit of your charts that have been coded without MCC's to determine if query opportunities have been missed?
    Charts that are coded without a cc/mcc are reviewed on a monthly basis to determine if a query opportunity was missed or the diagnosis was documented but not coded.
    I have found it very helpful to have that information available when meeting with upper management.

    Just a thought,
    Deb

    Deborah A Dallen,RN, CCDS
    Albert Einstein Medical Center
    Phila PA 19141
    Clinical Documentation Coordinator
    Health Information Management
    215-456-8902
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