Hypos/Hypers

cheryl.rymercheryl.rymer
edited May 2016 in CDI Talk Archive
Throughout my education to CDI, several places I have seen said physicians should write hypo/hyper NA,K,etc... as oppose to up and down arrows. This has really caused some issues with my physicians and they would like to know where this rule came from. Can anyone help?

Cheryl Rymer,RN
Clinical Documentation Inprovement Specialist
Athens Regional Medical Center
1114 West Madison Avenue
Athens, TN 37303
Email: cheryl.rymer@lpnt.net
Phone: (423)744-3360
Fax: (423)744-3483

Comments

  • robert.hodges2robert.hodges2
    edited May 2016
    I don't know the history or detail, but I was always told you can't code
    an arrow.

    Robert

    Robert S. Hodges, BSN, MSN, RN, CCDS
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
    Mail Code 136
    1500 Weiss Street
    Saginaw MI 48602
    P: 989-497-2500 x13101
    F: 989-321-4912
    E: Robert.Hodges2@va.gov


    "We are dealing with Veterans, not procedures; With their problems, not
    ours." --General Omar Bradley
  • kari.eskenskari.eskens
    edited May 2016
    See rational below from Coding Clinic.

    Kari L. Eskens, RHIA
    BryanLGH Medical Center
    Coding & Clinical Documentation Manager
  • ddouthitddouthit
    Cheryl,

    Please see Coding Clinic 1st Q 2011 pages 17-18. This addresses the use of arrows and states "it is not appropriate for the coder to report the diagnosis based on up and down arrows."

    Dorie
  • dvitalone1dvitalone1
    I know that this is a JCAHO standard



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  • sharon.colesharon.cole
    edited May 2016
    Ask your physicians if the arrow up Na/K, etc means elevated or improved?? If the arrow up means elevated that could be interpreted as hyperna. If the arrow up means improved, are they expecting the coder to interpret that to mean the patient HAD hypona and it's now resolved??
    See the issue?
    If that doesn't work, explain to them that they went to med school for the express privilege of being the person who diagnoses the patient. It's not a CDIS or Coders job to diagnose - it's the physicians.

    Sharon Cole, RN, CCDS
    Providence Health Center
    Case Management Dept
    254.751.4256
    srcole@phn-waco.org
  • vdavis2vdavis2
    edited May 2016
    Our electronic record solved this problem- it doesn't allow symbols in the text fields. When an MD uses an arrow next to a lab value name that doesn't = a dx! (Increased Na+ is NOT an actual diagnosis...it means the lab value was high...(which could just be the patient's baseline sodium level that just looked elevated due to a minor difference in the accepted range of a lab values.)

    Hypernatremia is a condition with symptoms that requires intervention/monitoring.

    Sharon is right- the MD is an "MD" b/c they are the only ones given the express privilege to diagnose a condition! Anyone can interpret that a lab value that is high or low-that is why the lab notes the high and low range next to each lab result! See my quote below... tell the MD that not documenting the right word can be the difference between being the Med Student and being the MD.... :)

    Good Luck-
    VICKI

    Vicki S. Davis, RN CDS
    Clinical Documentation Improvement Manager
    Health Information Management Department
    Alamance Regional Medical Center
    Office (336) 586-3765
    Ascom Mobile (336) 586-4191
    Fax (336) 538-7428
    vdavis2@armc.com

    "The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens
  • sharon.colesharon.cole
    edited May 2016
    Love that - med student vs MD!!

    Sharon Cole, RN, CCDS
    Providence Health Center
    Case Management Dept
    254.751.4256
    srcole@phn-waco.org
  • sharon.colesharon.cole
    edited May 2016
    Here$B!G(Bs a perfect example:
    Diagnosis of Hypernatremia given on day 1.
    Day 2 prog note says $B!H(BPt slowly improving. NA $B"-!I(B.

    Since each note should stand alone, you would now have conflicting documentation if your facility accepted $B!H(BNA $B"-!I(B as a diagnosis. AND, in this case, the physician means that the sodium is no longer as elevated as it was on admit.


    Sharon Cole, RN, CCDS
    Providence Health Center
    Case Management Dept
    254.751.4256
    srcole@phn-waco.org
  • ddouthitddouthit
    Regardless of policy of individual facility to allow or disallow up and down arrows to be used by physicians...Coders are directed per first quarter 2011 coding clinic to not code from up and down arrows.
  • cheryl.rymercheryl.rymer
    edited May 2016
    Do you by any chance know the # of the standard?
  • leimapaloleimapalo
    Hi,

    So just to check on hypo/hyper: if MD writes hypoNa, hypoK, etc - coders are allowed to assign hyponatremia, hypokalemia, right?

    Thanks,
    Lorelei
  • ssalinasssalinas
    Yes. - I suppose there can be a debate regarding if these are on the approved abbreviation list, etc but I still say yes.

    Sharon
  • sharon.colesharon.cole
    edited May 2016
    My coders have told me that they cannot/will not code hypona, hyperna, hypoK, hyperK, etc. It's frustrating, the docs will sometimes dig in their heels and not clarify. I really can't blame them and with the coders not agreeable to code it, we frequently miss reporting those conditions.

    Sharon Cole, RN, CCDS
    Providence Health Center
    Case Management Dept
    254.751.4256
    srcole@phn-waco.org
  • fentona@bronsonhg.orgfentona@bronsonhg.org
    edited May 2016
    Our codes will code these. Na is an approved abbreviation for sodium, etc..... just like the rest of the lytes have approved abbreviations. How would this be any different then coding SBO, lap chole, ARF, etc?

    Just a thought:)
    Amy
  • ssalinasssalinas
    edited May 2016
    I have been coding for longer than I care to admit and I have never heard of coders refusing to code this type of abbreviation. I have worked as a contract coder at many facilities as well as being employed at different facilities and, as I said, have never heard of this. I sent emails to coders at different facilities after reading the original email regarding this. All have responded that they accept hypo/hyper as appropriate documentation. Have you asked them what they base this decision on?

    I posed the question to 3M Nosology just for the heck of it. Here is their response.

    Is it appropriate to code 2760/2761/2768 if a physician documents hypoNa or HyperNa, hypoK, etc? I have always assumed this is appropriate. What do you think?
    RESOLUTION:
    Sharon,
    Na and K are recognized abbreviations for sodium and potassium, respectively. It would be appropriate to assign codes based on the documentation you have submitted. To ensure consistency in your facility's coding, you may wish to add abbreviations such as hypoK and hyperNa to your hospital's official abbreviation list.

    Jane E. Kopping, RHIA, CCS | Nosology Coding Support
    3M Health Information Systems Div


    Sharon
  • sharon.colesharon.cole
    edited May 2016
    Don't understand it myself. Our coders are very set in their ways:0)

    Sharon Cole, RN, CCDS
    Providence Health Center
    Case Management Dept
    254.751.4256
    srcole@phn-waco.org
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