Posted: June 17th, 2023
The health information management team at Anywhere University Hospital (AUH)
The health information management team at
Anywhere University Hospital (AUH) contracted with an auditing firm to perform
full assessment coding review. The results from this baseline assessment are
provided in four tables:
Variation Log by Type of Error
Variation Log by Coder
Variation
Log by MS-DRG
MS-DRG
Relationship Assessment
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You are the inpatient coding manager at AUH. Your
director has asked you to develop an ongoing review and monitoring schedule for
the next year based on the results from the outside review.
Include internal and external reviews, coding
in-services, physician workshops, and external seminars/educational sessions
that will be performed and or provided for your staff. The schedule should be
specific (include volumes and/or percentages of charts to be reviewed). Keep in
mind that on average it takes 18 minutes to review one inpatient chart. Budget
provides for $65,000 for external reviews. The average cost for reviewing one
inpatient record by an external review team is $55.00 (fully loaded).
In addition to preparing the schedule, outline how you
will maintain coding quality statistics and report them back to the HIM
Director and Compliance Committee at your facility.
How will you reward your staff members
who show great improvements?
How will you reward and/or recognize
that your staff has made improvements overall?
Your Coding Team consists of:
Coding Manager (you)
1-Data Quality Auditor (1 FTE)
8-Inpatient Coders (8 FTE)
2-RHIA, CCS
3-CCS
3-RHIT
Results of the full assessment coding review for AUH:
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Two audits were
performed:
1. Coding quality review by MS-DRG
2. MS-DRG Relationship Analysis
Variation
Log by Type of Error
%
of errors
Inaccurate
sequencing or specificity principal diagnosis, affect MS-DRG
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17%
Inaccurate
sequencing or specificity principal diagnosis, non affect MS-DRG
16%
Omission CC,
affect MS-DRG
33%
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Omission CC, non
affect MS-DRG
2%
Inaccurate
principal procedure, affect MS-DRG
3%
Omission
procedure, affect MS-DRG
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4%
More specific
coding of diagnosis or procedure, non affect MS-DRG
12%
Inaccurate
coding
5%
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Missed diagnosis
or procedure code
8%
Variation
Log by Coder
Coder
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Error
Rate
Standard
Coder 1
3%
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5%
Coder 2
9%
5%
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Coder 3
8%
5%
Coder 4
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2%
5%
Coder 5
4%
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5%
Coder 6
16%
5%
Coder 7
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12%
5%
Coder 8
3%
5%
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Variation Log by MS-DRG*
MS-DRG
Volume
Error Rate
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470
420
2%
313
233
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14%
392
232
1%
291
232
17%
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247
220
3%
292
216
5%
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871
213
12%
641
209
0%
194
195
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3%
293
193
1%
885
188
3%
312
177
0%
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191
175
7%
287
173
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2%
310
171
15%
689
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157
11%
603
143
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2%
379
137
3%
192
131
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9%
683
116
11%
189
114
1%
069
110
2%
190
92
12%
193
87
10%
690
76
4%
065
76
5%
195
72
2%
066
52
2%
064
41
5%
906
35
2%
*MS-DRG descriptions provided below
Variation Log by MS-DRG* Set
MS-DRG Set
Hospital %
Nation %
064
24.3%
21.4%
065
45.0%
43.8%
066
30.8%
34.8%
190
23.1%
15.2%
191
44.0%
33.5%
192
32.9%
51.3%
193
24.6%
17.5%
194
55.1%
54.2%
195
20.3%
28.3%
291
34.6%
29.2%
292
36.7%
38.8%
293
28.8%
31.9%
689
67.4%
21.7%
690
32.6%
78.3%
*MS-DRG
descriptions provided below
MS-DRG
MS-DRG Title (FY 2008)
064
Intracranial hemorrhage or
cerebral infarction w MCC
065
Intracranial hemorrhage or
cerebral infarction w CC
066
Intracranial hemorrhage or
cerebral infarction w/o CC/MCC
069
Transient ischemia
189
Pulmonary edema &
respiratory failure
190
Chronic obstructive pulmonary
disease w MCC
191
Chronic obstructive pulmonary
disease w CC
192
Chronic obstructive pulmonary
disease w/o CC/MCC
193
Simple pneumonia &
pleurisy w MCC
194
Simple pneumonia &
pleurisy w CC
195
Simple pneumonia &
pleurisy w/o CC/MCC
247
Perc cardiovasc proc w
drug-eluting stent w/o MCC
287
Circulatory disorders except
AMI, w card cath w/o MCC
291
Heart failure & shock w
MCC
292
Heart failure & shock w
CC
293
Heart failure & shock w/o
CC/MCC
310
Cardiac arrhythmia &
conduction disorders w/o CC/MCC
312
Syncope & collapse
313
Chest pain
379
G.I. hemorrhage w/o CC/MCC
392
Esophagitis, gastroent &
misc digest disorders w/o MCC
470
Major joint replacement or
reattachment of lower extremity w/o MCC
603
Cellulitis w/o MCC
641
Nutritional & misc
metabolic disorders w/o MCC
683
Renal failure w CC
689
Kidney & urinary tract
infections w/ MCC
690
Kidney & urinary tract
infections w/o MCC
871
Septicemia w/o MV 96+ hours w
MCC
885
Psychoses
906
Hand procedures for injuries
Submit the following question to think
about as you design this:
Who will be responsible for providing education
regarding coding issues?
Who will be responsible for arranging clinical
education sessions?
Who will audit charts?
Who will answer coding questions for the coders?
Who will monitor coding improvement and provide
progressive discipline when required?
Note: The more administrative
duties given to the data quality auditor, the fewer number of charts he or she
can review on a daily basis.
Please
also include the following:
A schedule that
optimally utilizes the data quality auditorâs position before scheduling
external reviews that have an additional cost. The data quality auditorâs
review schedule should be designed not to delay the completion of accounts
for billing. If the DQA has piles of charts to review, then the bills are
not being released for payment. The workflow must be logical.
There should be at
least one education session per month. The month of September should
include an in-service for ICD-9-CM updates, and December should include an
in-service for CPT/HCPCS updates. Keep in mind that scheduling too many
sessions per month may negatively affect productivity.
Educational topics should be related to clinical areas
where there was significant MS-DRG coding variation [Respiratory, Cardiology
and Vascular Services].
Educational topics should relate to coding areas
identified in the Variation Log by Type of Error including:
Correct coding of
major complications and comorbidities and complications and comorbidities
i.
This is again emphasized in the MS-DRG relationship assessment where
several pairs of with and without MCC/CC MS-DRGs are reported at a higher rate
at the hospital than in the state.
Correct sequencing
of diagnoses
Specificity of codes
i.
A conversation regarding documentation issues may be warranted here.
Be CREATIVE!
Reporting coding quality statistics:
How are you going to
maintain the coding quality statistics? I
Rewards, etc.
1. How are you going to
reward your team, think about what incentives you appreciate at your current
position or a previous position.
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