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The AAPC Local Chapter Handbook states that requests for CEUs for chapter meetings should be made 30 days in advance. AAPC’s CEU vendor team requires that you submit requests 14 days in advance but encourages you to submit 45 days prior to the event. We have found that queuing all the possible email reminders 1, […]
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We have physicians who may not perform an initial exam, therefore, not meeting 3 out of 3 required elements (HEM) and we don’t bill for the EM. Then the patient returns for follow up to discuss treatment, review tests, start treatment, etc. and if the physician meets the 2 out of 3 requirements, with still NO exam, we were told, we cannot bill the established patient visit until the physicican performs an exam.
I belive this is incorrect, and I’d like some feedback.
Thanks!
Is the anemia due to a malignancy or an adverse effect to treatment of the malignancy? Proper ICD-10-CM coding of anemia requires the coder to know what is causing the condition. Let’s look at types of anemia, and medical coding and sequencing of the disease when it is caused by a malignancy or adverse effect. […]
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The Joint Commission recently released its final sentinel event statistics for 2017. The same medical miscues as last year top the list; however, it seems encouraging that the total number of reported sentinel events declined for a second consecutive year while the proportion of self-reported incidents continued to climb.
Review your policies and procedures for treating suicidal patients in general acute inpatient and emergency care areas following newly finalized recommendations from The Joint Commission.
An epidural was given later that day, and the patient gave birth.
Insurance only allows for one anesthesia event per day. What is the correct way to bill this?
PSI 90’s transformation into the Patient Safety and Adverse Events Composite
by Shannon Newell, RHIA, CCS, AHIMA-approved ICD-10-CM/PCS trainer
The fiscal year (FY) 2017 IPPS proposed rule alerted us to some significant changes to Patient Safety Indicator (PSI) 90, one of which is a new name: the Patient Safety and Adverse Events Composite. A fact sheet released by the measure’s owner, the Agency for Healthcare Research and Quality (AHRQ), provides insights into what may lie ahead if the proposed rule’s content is finalized.
Nothing new here
The underlying objective of this modified claims-based quality measure remains the same. The Patient Safety and Adverse Events Composite provides an overview of hospital-level quality as it relates to a set of potentially preventable hospital-related events associated with harmful outcomes for patients.
The measure will also continue to be included in CMS hospital pay-for-performance programs:
PSIs in the CMS composite will change
CMS has included eight PSIs in the composite used in hospital pay-for-performance programs:
The modified measure will delete PSI 7 from the composite, citing duplication with other similar measures.
Three of the PSIs (8, 12, and 15) will be re-specified, which means that the types of patients included in the PSIs will be revised (see "Revised PSIs" on p. 3).
Composite weights are revised
A new algorithm that considers both the volume of events and their probability of harm will be used. The graph on p. 3 illustrates the proposed impact of each PSI’s performance on the overall composite weight. PSI 15, which at present comprises half of the composite weight, is reduced to 0.82%!
Preparation challenges
Although the HACRP will adopt this modified measure in FY 2018, performance will be based on today’s discharges. Therefore, a review of the revised measure specifications and risk adjustment variables is encouraged. The challenge: The ICD-10-ready specifications for this modified version will not be ready until sometime this summer, and the risk adjustment variables are not anticipated to be ready until next year. AHRQ is evaluating ICD-10 data in its databases to finalize this information.
What to do in the interim?
In the meantime, we recommend the following:
Summary
Strong performance in patient safety events has broad implications. Patient safety events have downstream cost and quality ramifications ranging from the cost to treat the safety event to readmissions and mortality. Data quality is an essential component to appropriate focus and measurement of patient care improvement efforts.
CDI programs that have already established the infrastructure to monitor and effectively impact claims-based quality measures are likely positioned well to navigate these changing waters. Additional information can be located at www.qualityindicators.ahrq.gov/News/PSI90_Factsheet_FAQ.pdf as well as www.qualityindicators.ahrq.gov/Modules/psi_resources.aspx.
Editor’s note: Newell is the director of CDI quality initiatives for Enjoin. Her team provides health systems with physician-led education and infrastructure design to sustainably address documentation and coding challenges essential to optimal performance under value-based payments across the continuum. She has extensive operational and consulting expertise in coding and clinical documentation improvement, performance improvement, case management, and health information management. You can reach Newell at 704-931-8537 or [email protected]. Opinions expressed are that of the author and do not represent HCPro or ACDIS.