MOSF

cmclose@saintfrancis.comcmclose@saintfrancis.com
edited May 2016 in CDI Talk Archive
Anyone have a good query for clarifying MOSF (multi organ system
failure)? Looks to me like pt had ATN, DIC, pancreatitis, sepsis after
drug overdose. Only dx documented are: cardiac arrest (pt was PEA when
ambulance arrived) and acute resp failure, prerenal azotemia, acidosis.
Thanks for any advice!

Claudine Hutchinson RN
Clinical Documentation Improvement Specialist
Children's Hospital at Saint Francis
Email: chutchinson@saintfrancis.com
Office: (918) 502-6603
Pager: 98-1001

Comments

  • sharon.colesharon.cole
    edited May 2016
    NO query template, but I would just ask them to docuement all diagnoses that are being monitored/treated as part of this patient's MSOF.

    Sharon Cole, RN, CCDS
    Providence Health Center
    Case Management Dept
    254.751.4256
    srcole@phn-waco.org
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    I don't ave a template either. I would draft something that said something like "the medical record includes documentation of 'MSOF', with ....(symptoms/labs/treatment listed). Please document the specific organ failures monitored/treated during this admission". I may include a list of organ failures with check boxes....

    Katy Good, RN
    Clinical Documentation Program Coordinator
  • kmaritankmaritan
    edited May 2016
    Per my experience and verifying with our coding auditor this morning, there is no specific code for MOD (multiple organ dysfunction) which is the term used in the explanation portion for code 995.92 Severe Sepsis in the ICD-9 book. I also looked in coding clinics and used the encoder practice module to try to find it. The info in the code book is great and has always been very helpful. For your example, with all the obvious organ dysfunctions presented as well as the patient having sepsis, my query would simply have addressed the documented sepsis and all the organ dysfunctions with the question "could the sepsis be further specified as severe sepsis". Another approach that would get you the same code 995.92 would be (again in the query addressing sepsis and all the organ dysfunctions) would be question "could this be sepsis with multiple and/or acute organ dysfunction". Then the coder, in addition to assigning code 995.92, will be coding all the below diagnoses (multiple organ dysfunctions) to support code 995.92. Hope this helps.

    Karen Maritano, RN
    Clinical Documentation Improvement Specialist
    Legacy Health
    Portland, OR
    Office 503-413-7154
    Email kmaritan@lhs.org
  • cmclose@saintfrancis.comcmclose@saintfrancis.com
    edited May 2016
    Unfortunately physicians didn't mention sepsis. Gets tricky sometimes in
    wording queries so there is no leading :)
    Thanks for the advice.
    Claudine Hutchinson RN
    Clinical Documentation Improvement Specialist
    Children's Hospital at Saint Francis
    Email: chutchinson@saintfrancis.com
    Office: (918) 502-6603
    Pager: 98-1001
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    If sepsis IS documented, then perhaps ask the MD to document any
    associated acute organ failure, such as



    Septic Shock

    Acute Renal Failure

    Acute Respiratory Failure

    ARDS

    DIC

    Encephalopathy

    Acute Hepatic Failure


    As always, offer responding MD opportunity to state NO Acute Organ
    Failure is present and/or "cannot be determined" or Other Choice -
    please indicate.









    Paul Evans, RHIA, CCS, CCS-P
    Supervisor, Clinical Documentation Integrity, Quality Department
    California Pacific Medical Center
    2351 Clay #243
    San Francisco, CA 94115
    Cell: 415.637.9002
    Fax: 415.600.1325
    Ofc: 415.600.3739
  • robert.hodges2robert.hodges2
    edited May 2016
    Or even Severe Sepsis (sepsis with damage to another organ system)


    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
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Yes - if the chart links sepsis to other organ failure, then Severe
    Sepsis - 995.92 - is coded as an additional code (Sepsis is principal)
    , with additional codes for each acute organ failure by site.



    Paul Evans, RHIA, CCS, CCS-P
    Supervisor, Clinical Documentation Integrity, Quality Department
    California Pacific Medical Center
    2351 Clay #243
    San Francisco, CA 94115
    Cell: 415.637.9002
    Fax: 415.600.1325
    Ofc: 415.600.3739
  • kmaritankmaritan
    edited May 2016
    My answer was formulated because it appeared in your email that sepsis and all the other diagnoses were documented. Sorry if this was misleading.


    Karen Maritano, RN
    Clinical Documentation Improvement Specialist
    Legacy Health
    Portland, OR
    Office 503-413-7154
    Email kmaritan@lhs.org
  • leah.taylorleah.taylor
    edited May 2016
    This is an excellent suggestion!!!

    Leah Taylor,RN, CCDS
    Iredell Memorial Hospital
    557 Brookdale Drive
    Statesville, NC 28625
    E- leah.taylor@iredellmemorial.org
    p- 704-878-7436
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