Question

Resources

This assignment is based on the content of Lesson 4, including the readings provided in that lesson.

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

Your Coding Team consists of:

Coding Manager (you)

Data Quality Auditor (1 FTE)

Inpatient Coders (8 FTE)

2 RHIA, CCS

3 CCS

3 RHIT

Results of the full assessment coding review for AUH:

Two audits were performed:

Coding quality review by MS-DRG

MS-DRG Relationship Analysis

Variation Log by Type of Error	% of errors
Inaccurate sequencing or specificity principal diagnosis, affect MS-DRG	17%
Inaccurate sequencing or specificity principal diagnosis, non affect MS-DRG	16%
Omission CC, affect MS-DRG	33%
Omission CC, non affect MS-DRG	2%
Inaccurate principal procedure, affect MS-DRG	3%
Omission procedure, affect MS-DRG	4%
More specific coding of diagnosis or procedure, non affect MS-DRG	12%
Inaccurate coding	5%
Missed diagnosis or procedure code	8%

Variation Log by Coder
Coder	Error Rate	Standard
Coder 1	3%	5%
Coder 2	9%	5%
Coder 3	8%	5%
Coder 4	2%	5%
Coder 5	4%	5%
Coder 6	16%	5%
Coder 7	12%	5%
Coder 8	3%	5%

Variation Log by MS-DRG*
MS-DRG	Volume	Error Rate
470	420	2%
313	233	14%
392	232	1%
291	232	17%
247	220	3%
292	216	5%
871	213	12%
641	209	0%
194	195	3%
293	193	1%
885	188	3%
312	177	0%
191	175	7%
287	173	2%
310	171	15%
689	157	11%
603	143	2%
379	137	3%
192	131	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%

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%

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* Click here to see the MS-DRG descriptions

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

Questions

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 by 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 $15,000 for external reviews. The average cost for reviewing one inpatient record by an external review team is $55.00 (fully loaded).

Your schedule for the next year can be in the form of the following table. Some example activities are included below.

Date	Activity	Who is involved	Outcome
June 1	Review the data on current variations	All	Identify which areas we need to focus on for the next year
	…
July 1	Schedule a lunch hour educational activity on how to code for MS DRG 689 (Kidney & urinary tract infections w/ MCC)	All coders and coding manager	Coders gain knowledge on correctly coding for MS DRG 689
	…
July 10-17	Audit charts randomly for correctness of coding	Data quality auditor	Check for improvements, if any, in coding accuracy
	…

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Click here for a few hints on preparing the schedule

Preparing the schedule

You need to make a distinction between the duties of the coding manager and the data quality auditor in regard to the schedule. You need to address the following questions:

In your team, 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?

The more administrative duties given to the data quality auditor, the fewer number of charts he or she can review on a daily basis.

You need to develop a schedule that optimally utilizes the data quality auditor’s position before scheduling external reviews that have an additional cost.

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. Thus, first identify the MSDRG codes where there is a significant variation from national percentages.

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.

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 nation.

Correct sequencing of diagnoses.

You can see a more complete example of a schedule by selecting the Homework 5 Schedule Example link

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 and/or recognize that your staff has made improvements overall?

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Click here for a few ideas on rewarding/recognizing your staff

Recognition/Awards/Accolades:

Create a “kudos” section during meetings

Individual and team accolades for achievements mentioned in meeting or status report

Letter acknowledging achievement sent to employee, also send it to upper management and the employee’s file

Establish and announce monthly Employee of the Month or Above and Beyond awards

Give special assignments to employees that have shown additional initiative

Coordinate the team to present results and improvements to upper management

Nominate employee for a more formal award through the organization

Answer 1

Inservice education should be given to the staff in the last day of each and every month by an Registered Health information Administrator

When conduct the meeting if coders having some questions he coding manager is having the ability to answer it

The data quality auditor responsibility is to monitor the coding improvement by daily weekly and monthly basis and if required some improvements try to implement according to a pre-plan.

During the meetings give rewards to the staff who has acheived a non-error work in each and every month

Provide some specific incentives to the staff during a specific day such as a hospital formation day to improve their achievements towards the work