jwmorris1

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jwmorris1
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  • Just curious...what's different about NY State regs? Are there additional privacy laws surrounding PHI?
  • Agree with Aimee— No, I would not use the first code you listed. This code is for use for cardiac output assistance with devices such as balloon pumps or Impellar devices and will most likely change your DRG. I would definitely use the manual CPR co…
  • Septic shock is a manifestation code and should not be sequenced as the PDX. From the Official Coding Guidelines Septic shock (a) Septic shock generally refers to circulatory failure associated with severe sepsis, and therefore, it repres…
  • I guess technically it's "other" but just curious if there were indicators for a more specific code? Jeff
  • I am guessing the patient is currently in house? Has the UTI been ruled in or out? Not much you can do for a stage 1 pressure ulcer except turn the patient and keep them clean...not really a good reason for admission to inpatient care. I'd think the…
  • What's the focus of the admission? Jeff
  • I have struggled with this one also...hoping to see what others think of this guideline.
  • Short on time and will try to provide further details later but anything that can potentially raise the CMI can potentially cause a decrease. Other possibilities could be if your hospital goes on diversion and/or cancels surgeries due to flu epide…
    in CMI Comment by jwmorris1 February 26
  • Many ESRD patients I’ve cared for over the years still make urine (especially overnight) but there’s no real filtering of toxins going on regardless of UOP.  I wouldnt Query for AKI on ESRD
  • Doesn't get reported if it doesn't meet the definition is my stance. Guideline 1.A.19 is more for clinical validity where the condition was monitored, evaluated and possibly treated...just doesn't exactly meet evidenced based guidelines. Interested …
  • Agree with Maggie. Does the original poster have any examples of diagnoses that are in question? Jeff
  • I haven’t ever really encountered this issue in my practice but J1181 does not have an instructional note instructing you to code also the type of encephalopathy. That leads me to believe this is an all inclusive code but seems unfair that it’s not …
  • Jillian, I think that’s usually just inherent to those procedures. If it’s what is routinely expected in those patients then it’s not a complication. Would probably be helpful to talk to your CV Surgeons to see what they consider postop shock, do th…
  • Agree with Paul. I think once a patient is deemed to have ESRD there’s really no further insult that can cause an acute decompensation in renal function as the kidneys aren’t functioning at a level that an acute insult could really be measured.  Je…
  • Agree with Jorde, building the relationship and being seen as a resource is half the battle. Both of my teams reside in the basement and go up on floors as needed. Prior to us being 100% electronic we “lived” on the floors doing reviews but had no d…
  • I agree with the advice from Coding Clinic on the sequencing of those conditions but I am still on the fence about the PDX for a patient with stroke due to sickle cell dz. I think it would be good to write them and get some official advice. Also I w…
  • Agree with Paul, the cardiac arrest did not occasion the admit since it did not happen until ours after the admission. I would sequence the most acute/resource intensive dx as the PDX. Jeff
  • First of all, Congrats on expanding your team by such a large number! I know you are very excited! As far as the training I guess it would depend on how long the 2.5 CDI staff have been in their current roles and how fast you plan to add the additio…
  • I would code the stroke as PDX
  • You might could use this coding clinic to help with denial letter Septicemia with negative blood cultures ICD-9-CM Coding Clinic, Second Quarter 2000 Page: 5 Effective with discharges: July 1, 2000 Related Information …
  • I would query if it's being described as 2/3. I agree clinically it may be in between stages but for coding someone needs to definitively stage it....it's either a stage 2 or a stage 3. Is there a certified wound care nurse involved that can provide…
  • You could code the suspected child abuse...that's about as good as it gets plus any associated injuries. I think the shaken infant syndrome code is meant to be confirmed for data collection also. Jeff
  • Look under the resource library, there are two samples
  • Interesting article in today's CDI Strategy email regarding the 1 hour bundle. http://https//acdis.org/articles/news-hospitals-shouldn%E2%80%99t-implement-one-hour-sepsis-bundles-sccm-and-acep-say?utm_source=silverpop&utm_medium=email&ut…
    in Sepsis Comment by jwmorris1 January 24
  • Nothing more than the code book listing specified site NEC as D18.09 I'd send to Coding Clinic
  • Sorry, typed the response wrong :-)
  • Yes, I'd consider it an intra-abdominal structure also. Might be a good question to submit to Coding Clinic via Coding Clinic Advisor. If you do submit, please keep us updated when you receive a response.
  • Just curious, was there any change in the DRG or SOI/ROM by using D18.09 vs. D18.03
  • If there is no Medical diagnosis in the chart and you have the BMI as your clinical indicator (may have more if they require assistance OOB, two person assist, etc...) you’d need to query the provider using a multiple choice format.  The BMI can be…
  • I guess you have to go back to your organization and team and have some discussions—what do your MD’s consider sepsis, are you using SEP2 or SEP3, etc.. how important are blood cultures in the diagnosis of sepsis when negative blood cultures do not …
    in Sepsis Comment by jwmorris1 January 17