we need to answe all three qs professor is expecting 2 paragraphs for the first q keep in mind i am an international student pls

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Chapter 2: Coding

Class Assignment 1

01/21/2020.

1. The health information management (HIM) 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

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 $15,000 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

8 – Inpatient Coders (including Certified Coding Specialists, Registered Health Information technicians and administrators).

Results of the full assessment coding review for AUH

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

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%

*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 2018)

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

2. Compare the hospital figures to the state average and the peer facilities. Why are an individual hospital’s figures above or below the state average? One potential explanation could be coding or billing errors. Brainstorm other possible explanations for why a facility’s CMI is higher or lower than the state or its peers?

Table 5. Overall CMI—Years 1–3

Facility

Year 1

Year 2

Year 3

Hospital A

1.8694

1.9017

2.1473

Hospital B

1.9662

2.0554

2.0267

Hospital C

1.6440

1.6873

1.7010

Hospital D

1.8454

1.7021

1.6250

State Average

1.4480

1.4778

1.4953

3. What is ICD-10? What is ICD-10-CM? Is this classification system important for the future of healthcare reimbursement? Why or why not?

Begin your research with the National Center for Health Statistics Web site at:
http://www.cdc.gov/nchs/

 
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