Saturday, May 16, 2009
The crossroads between care and documentation
At an afternoon Hospital Medicine session today, Bryce Gartland, MD, of Emory University offered hospitalists practical advice on improving their clinical documentation. He first provided a brief review of the 2008 change from CMS-DRGs to Medicare Severity DRGs (MS-DRGs). Under the new system, diagnoses are now classified as being with or without complications/comorbidities (CCs) or major complications/comorbidities (MCCs). Nonspecific codes can cost a facility money: The reimbursement for heart failure and shock with MCC is $8,218 versus $3,959 for heart failure without CC or MCC.
"Documentation of this has astonishing financial impact for hospitals," Dr. Gartland said. He offered the following tips to optimize documentation:
1. Be specific. "If you're not specific, it usually doesn't correspond with a specific code with an ICD-9."
2. Emphasize acute diseases and chronic diseases with acute exacerbations, those that are end-stage or those with extensive disability. "For those who like acronyms, we've come up with ACE3," he said.
3. Remember that "In coding world, the words 'possible,' 'probable,' 'likely,' and 'suspected' all count."
4. Don't forget the small stuff, such as electrolytes and nutrition status.
Accurate coding is linked to quality, Dr. Gartland said, because failing to accurately document comorbidities or complications makes the risk for death look lower than expected. Accurate and complete documentation, on the other hand, helps align expected and accurate mortality.
"Clinical language does not equal coding language," Dr. Gartland said. "We have to retrain our brains to understand that we actually have to document not only to convey knowledge from one care team member to another but also to make sure that coding understands specifically what we're doing."
Labels: billing and coding, Hospital Medicine 2009
posted by Jennifer Kearney-Strouse at
6:55 PM
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