Docstoc

Data Quality Task Force

Document Sample
Data Quality Task Force Powered By Docstoc
					Data Quality Task
            Force

              Chart Review
       Postoperative Complications, April 14, 2005
       CIHI AWARENESS
Glad to hear you've been in touch with Helen
and Brenda - I will be bending their ear over
the documentation issue. Does no one dictate
discharge summaries anymore? From my
perspective, the hospitals will need to work to
improve the documentation as it seems that
many have been trying to make it easier for
the physicians.

              Data Quality Task Force Postop Complications
                          Workshop, 2005/04/14
ER SELECTIONS
  Hospital A          Hospital B          Hospital C                     Hospital D      Hospital E
                                      K56.6                      K56.6    Main        K56.6   Main
No Codes Given       No Codes Given   R10.4                      R10.4 (R)            R10.4   R
                                      3.OT.10.VA                 3.OT.10.VA           3.OT.10.VA
                                      1.NF.52.CA-QN              3.GY.10.VA           1.NF.52-CA-QN

   Hospital F         Hospital G          Hospital H                     Hospital I      Hospital J
K56.6   Main         K56.6   Main     K56.6 Main                 K566     Main        K566 (M)
R10.4   R            R10.4   R        R10.4    R                 R104    R code       R104 (R)
3.OT.10.VA - Z /     3OT10VA (LW)     3OT10VA                    1.NF.52.CA.QN        3OT10VA
3.GY.10.VA / / /     3GY10VA          3GY10VA                    3.OT.10.VA           1KX53HAFT
1.ZZ.35.HA-A4        1NF52CA-TL       1NF52CAQN                  3.GY.10.VA
1.ZZ.35.HA-A2                                                    l.KX.53.HA.CH
1.ZZ.35.HA-P2
1.KX.53.HA-FT – PL


   Hospital K

K56.6    (M)


R10.4    (R)


1.NF.52.CA-QN


                                      Data Quality Task Force Postop Complications
                                                  Workshop, 2005/04/14
  ER CONSENSUS
        CODES           DESCRIPTION
K56.6           Main    Other and unspecified intestinal obstruction
R10.4           Rcode   Other and unspecified abdominal pain
3.OT.10.VA              Xray, abdominal cavity without contrast
3.GY.10.VA              Xray, thoracic cavity NEC without contrast

1.NF.52-CA-QN           Drainage, stomach using per orifice approach and mechanical suction pump

1.NF.52.CA-TL           Drainage, stomach using per orifice approach and manual suction (e.g. syringe)
  Other Codes Used
                        Pharmacotherapy, total body (alimentary tract and metabolism agents) using
1.ZZ.35.HA-A4              antiemetic and antinauseant agent (IV)
                        Pharmacotherapy, total body (alimentary tract and metabolism agents) using
1.ZZ.35.HA-A2              drug for treatment of peptic ulcer and flatulence (IV)

1.ZZ.35.HA-P2           Pharmacotherapy, total body (nervous system agents) using analgesic (IV)
                        Implantation of internal device, vein NEC of intravenous catheter using
1.KX.53.HA-FT – PL          percutaneous approach
                        Implantation of internal device, vein NEC of intravenous needle [e.g. with
l.KX.53.HA.CH               anchor, lead or line] using percutaneous approach
                             Data Quality Task Force Postop Complications
                                         Workshop, 2005/04/14
 CIHI Response ER portion
                                 NACRS ABSTRACT
K56.6           Other and unspecified intestinal obstruction                    M



R10.4           Other and unspecified abdominal pain                             R

                Drainage, stomach, using per orifice approach and         Principal
                   mechanical suction pump                                    procedure
1.NF.52.CA-QN



3.OT.10.VA      Xray, abdominal cavity, without contrast
                Xray, lung NEC, without contrast
3.GT.10.VA

                           Data Quality Task Force Postop Complications
                                       Workshop, 2005/04/14
NACRS Questions to CIHI
   Question: Which intervention would be sequenced first in this chart - the
    1.NF.52.CA-QN or the x-rays and why.            If the stomach drainage was
    sequenced first, then the x-rays, which will the grouper select or will it loop
    down to the code that will make the difference.
   Answer: The principal or first listed procedure is the therapeutic insertion of
    the NG tube which provided initial decompression of the obstruction. The
    radiological procedures may or may not be used for CACS grouping but the
    grouper will loop to determine this. Remember to use the correct MIS
    functional centre for "Radiology".
   Question: NG Tube insertion (manual or suction)– when not
    documented, what do we choose?. In a meeting, someone said they were
    told to capture the first listed. Is there a rule for hierarchy?    Is this correct
    and if so, where can I find that documented. This question goes for both
    drainage of small intestine as well as drainage of stomach. Folio in both
    examples shown below in red. When not documented, which one is
    chosen? Why?
   Answer: We recommend that you speak to your emergency room
    physicians to see what happens most often in the ER in terms of types of
    suction being used. We cannot comment on interventions that are not
    documented.

                                Data Quality Task Force Postop Complications
                                            Workshop, 2005/04/14
NACRS Response to IVs
IV insertions are a hot topic indeed!

   If 1KX53^^ is captured as the main intervention the abstract would group to a surgical
   CACS cell Minor Vascular Procedure regardless of the main problem. This is
   concerning since IV insertions are performed quite regularly in an ED setting and
   because we are losing our clinical differentiation. Migraines, cellulitis and pneumonia
   clients would all group to the same CACS cell when 1KX53^^ is coded as the main
   intervention.

   CIHI will be following up with our Case Mix team to discuss. This code may be slated
   for removal from CACS 26 for FY2006 and would solve the problem. In the interim
   CIHI will need to determine how to direct clients. This will likely come in the form of a
   coding standard.

   In the interim I recommend not capturing 1KX53^^ unless the IV access device is
   "set-up" and will maintained over a period of time for continued use (e.g. a cellulitis
   client has an IV access initiated which is maintained for repeated visits for IV
   antibiotic top-ups).

Anne Cote (Brereton)
NACRS Client Support Services Representative

                               Data Quality Task Force Postop Complications
                                           Workshop, 2005/04/14
ER DISCUSSION??




     Data Quality Task Force Postop Complications
                 Workshop, 2005/04/14
Inpatient Diagnosis Selections
         Hospital A      Hospital B                Hospital C                  Hospital D         Hospital E

K56.5     MRDx        K56.5                  K56.5    MRDx               K56.5    MRDx      K56.5    MRDx

K91.3     2           K91.3                  K91.3    2                  K91.3    2         K91.3        2

J95.88    2           J95.88                 J95.88   2                  J95.88   2         J95.88   2

J18.9     3           J98.18                 J18.9    3                  J18.9    3         J18.9    3

                      R33                    R33      2                  R33      2         R33      2

Y83.2     9           Y83.2                  Y83.2    9                  Y83.2    9         Y83.6    9



E86.0     1                                                              E86.0    1         E86.0    1

R00.0     2           R00.0                  R00.0    3                  R00.0    3         R00.0    2

                      Q - C78.0              Z85.4    3                  Z85.4    3         Z85.4    3



                      R73.9                                              I73.9    3

                      F17.1

                                  Data Quality Task Force Postop Complications
                                              Workshop, 2005/04/14
Inpatient Coding Selections
Hospital F          Hospital G               Hospital H                     Hospital I
                                                                                                 Hospital J
K56.5 MRDx          K56.5 MRDx               K56.5 MRDx                     K56.5         MRDx   K56.5    (M)

K91.3    2          K91.3    2               K91.3 -2                       K91.3     2          K91.3    (2)

J95.88 2            J95.88   2               J95.88 -2                      J9818         2      J95.88    (2)

J18.9    3          J18.9    3               J18.9 -3                       J18.1         2      J18.9     (3)



R33      2          R33      2                                              R33       2          R33      (3)



Y83.6    9          Y83.2    9               Y83.2 -9                                            Y83.2    (9)

E86.0    1          E86.0    1               dehydration ?????              E86.0     2

C78.2    3          I47.1    1               I47.1 -3                       R00.0     3

Z85.4    3          Z85.4    3               Z85.4 -3                       Q-C77.1       1

                                             Z72.0 -3                       C80       3          Z85.4    (3)

                                             I73.9 -3                       Z854      3

                                       Hospital K
K56.5        MRDx   R33          3           T81.88      2                  R60.9     3

K91.3        2      Y83.2        (9)         N99.8       3                  I97.8     2

J95.88       2      E86.0        1

J18.9    3          I47.1    1

                                       Data Quality Task Force Postop Complications
                                                   Workshop, 2005/04/14
Diagnosis Consensus
          CODES                                          Description


K56.5    MRDx     Intestinal adhesions [bands] with obstruction

K91.3      2      Postoperative intestinal obstruction

J95.88     2      Other postprocedural respiratory disorders

J18.9     3       Pneumonia, unspecified

R33       2       Retention of urine

Y83.2     9       Surgical operation with anastomosis, bypass or graft

E86.0     1       Dehydration

R00.0     3       Tachycardia, unspecified

Z85.4     3       Personal history of malignant neoplasm of genital organs

I73.9     3       Peripheral vascular disease, unspecified

                     Data Quality Task Force Postop Complications
                                 Workshop, 2005/04/14
Other Codes Used
J181        2   Lobar pneumonia, unspecified
Q - C78.0       Secondary malignant neoplasm of lung
J98.18          Other pulmonary collapse
R73.9           Hyperglycaemia, unspecified                       ?I73.9
                Mental and behavioural disorders due to use of tobacco,
F17.1              harmful use
Z72.0       3   Tobacco use
I47.1       3   Supraventricular tachycardia
C78.2       3   Secondary malignant neoplasm of pleura
Q-C771      1   Secondary malignant neoplasm of intrathoracic lymph nodes
C80         3   Malignant neoplasm without specification of site
T81.88      2   Other complications of procedures, not elsewhere classified
R60.9       3   Oedema, unspecified
I97.8       2   Other postprocedural disorders of circulatory system, NEC
Y83.6       9   Removal of other organ (partial) (total)
                   Data Quality Task Force Postop Complications
                               Workshop, 2005/04/14
CIHI Response to Diagnosis
ICD-10-CA                        CODE DESCRIPTION                           Dx Type

    codes
                                       DAD ABSTRACT
K56.5       Intestinal adhesions [bands] with obstruction                     MRDx


J95.88      Other postprocedural respiratory disorders                       Type 2


J18.1       Lobar pneumonia, unspecified                                     Type 3


I97.8       Other postprocedural disorders of circulatory system, NEC        Type 2



I47.1       Supraventricular tachycardia                                     Type 3


K91.3       Postoperative intestinal obstruction                             Type 2


R33         Retention of urine                                               Type 2


Y83.2       Surgical operation with anastomosis, bypass or graft             Type 9

                                                                             Type 3
I73.9       Peripheral vascular disease, unspecified
                                                                             Type 3
Z85.4       Personal history of malignant neoplasm of genital organs
                                                                             Type 3
Z72.0       Tobacco use

                             Data Quality Task Force Postop Complications
                                         Workshop, 2005/04/14
DIAGNOSIS
   DISCUSSION??


     Data Quality Task Force Postop Complications
                 Workshop, 2005/04/14
INTERVENTION SELECTIONS
      Hospital A           Hospital B              Hospital C                  Hospital D        Hospital E


1.NK.87.RF      loc -Z   1-NK.87.LA              1.NK.87.RF             1.NK.87.RF    LO-Z   1.NK.87.RF (Z)

1.OT.72.LA               LYSIS - no.             1.OT.72.LA             1.OT.72.LA           1.OT.72.LA

1.NK.52.UW               1.NK.52.LA              1.NK.52.UW             1.NK.52.UW           1.NK.52.LA

1.NF.53.CA-TS            1.NF.52.CA                                                          1.NF.52.CA-QN

                                                                                             1.NP.72.LA

                                                                                             10-Sep

3.OT.20.WC               3.OT.20.WC              3.OT.20.WC             3.OT.20.WC LO-Z      3.OT.20-WC

3.GT.20.WC               3.GY.20.WC              3.GT.20.WC             3.GY.20.WC           3.GT.20-WC

                         1.PM.52.CA-TS           3.GT.20.WA             3.GY.20.WA           14-Sep

3.GT.20.WA                                       3.GY.20.WC                                  3.GT.20-WA

                                       Data Quality Task Force Postop Complications
                                                   Workshop, 2005/04/14
Intervention Selections
Hospital F             Hospital G           Hospital H                   Hospital I
                                                                                       Hospital J
1.NK.87.RF – Z -       1NK87RF (Z)          1NK87RF (Z)                  1NK87RF       1NK87RF      Z
1.OT.72.LA -//         1OT72LA              1OT72LA                      1OT72LA       1OT72LA
1.NK.52.LA -//         1NK52LA                                           1NF38JAQN ?   1NK52LA
Sept 10th                                                                              1NF52CAQN
3.OT.20.WC – Z /       3OT20WC              3OT20WC                      3OT20WC       3OT20WC
3.GT.20.WC / / /       3OT20WC              3GT20WC                      3GY20WC       3GY20WC
                       3GT20WC
Sept 14th
3.GT.20.WA / / /       3GT20WA                                           3GT20WA       3GY20WA


                       Hospital K


1.NK.87.,RF      (Z)   1.OT.72.LA           1.NK.52.LA


3.OT.20.WC spt 10      3.GT.20.WC           3.GT.20.WA spt 14
                                     Data Quality Task Force Postop Complications
                                                 Workshop, 2005/04/14
Intervention Consensus
         Codes                                                      Description


1.NK.87.RF   loc -Z            Excision partial, small intestine enteroenterostomy anast. technique
1.OT.72.LA                     Release, abdominal cavity using device NEC open approach


1.NK.52.LA                     Drainage, small intestine aspiration [suction] technique open approach
                               Drainage, small intestine manual [milking] technique [e.g. back to
1.NK.52.UW                         stomach for suction drainage] open approach
                      10-Sep


3.OT.20-WC                     Computerized tomography [CT], abdominal cavity with enhancement
3.GT.20.WC                     Computerized tomography [CT], lung NEC with enhancement
                      14-Sep
3.GT.20-WA                     Computerized tomography [CT], lung NEC without enhancement

                                  Data Quality Task Force Postop Complications
                                              Workshop, 2005/04/14
Other CCI Codes Used
1.NF.52.CA-QN     Drainage, stomach using per orifice and mechanical suction pump

1.NF.52.CA        Drainage, stomach

1.NF.53.CA-TS     Implantation of internal device, stomach of (gastric) tube per orifice

1.PM.52.CA-TS     Drainage, bladder NEC using per orifice and drainage catheter

1.NP.72.LA        Release, small and large intestine using open approach

1-NK.87.LA        Excision partial, small intestine simple excisional technique open

3.GY.20.WC        Computerized tomography [CT], thoracic cavity with enhancement



3.GY.20.WA        Computerized tomography [CT], thoracic cavity without enhancement

1.NF.38.JA-QN ?   Management of external appliance, stomach of suction pump

                     Data Quality Task Force Postop Complications
                                 Workshop, 2005/04/14
CIHI Response to Interventions

                                    CODE DESCRIPTION
   CCI codes
                                    DAD ABSTRACT
1.NK.87.RF     Excision partial, small intestine open approach              Principal
                                                                              procedure
   L=Z            enteroenterostomy anastomosis technique Location Z =
                  Other area of small intestine (e.g. jejunum, ileum, not
                  otherwise specified)




1.OT.72.LA     Release, abdominal cavity, OA, using device NEC

               Computerized tomography [CT], abdominal cavity with
3.OT.20.WC        enhancement
               Computerized tomography [CT], lung NEC with
3.GT.20.WC        enhancement
               Computerized tomography [CT], lung NEC without
3.GT.20.WA        enhancement
                          Data Quality Task Force Postop Complications
                                     Workshop, 2005/04/14
INTERVENTION

    DISCUSSION??

      Data Quality Task Force Postop Complications
                  Workshop, 2005/04/14
Question/Answer to CIHI
Sinus Tachycardia:
  We felt that the tachycardia should be classified as a
  post-procedural condition. While the tachycardia may
  not be specifically treated, in this case it was persistent.
  As the code for the tachycardia is from the circulatory
  chapter, the code for tachycardia is a diagnosis type (3)
  but the code I97.8 is used first as a diagnosis type (2).
  The type of tachycardia was also listed in the progress
  notes, which is what we used to determine the correct
  code. The ECG may be a source of the specific
  condition, but should be used with caution, and further
  clarification obtained from the physician if necessary.


                     Data Quality Task Force Postop Complications
                                 Workshop, 2005/04/14
Question/Answer to CIHI
Dehydration:
 We felt that the dehydration was an inherent
 part of the admitting diagnosis and did not
 code the dehydration. The patient did
 receive IV fluids, however, the use of this as
 justification of significance is a standard for
 the treatment of gastroenteritis.


                Data Quality Task Force Postop Complications
                            Workshop, 2005/04/14
Question/Answer CIHI
Other Post-Procedural Conditions:
 It appears that your understanding of the post-procedural conditions is quite
   good. We would suggest a few modifications to the codes that your group
   selected.
 We agree with the code choice of I47.1 for the tachycardia, but as this
   condition is classified in the circulatory system chapter, we have paired it
   with I97.8.
   Only one external cause is required when all post procedural conditions are
   related to the same intervention. We have coded the urinary retention as
   significant because it was persistent. The Foley catheter was removed on
   day 2 following surgery but then had to be reinserted. The physician has
   clearly documented the retention, so we felt that the persistence of the
   condition helped to justify the qualification as a diagnosis type 2. The
   external cause code was added with the R33. A T-code is not used in this
   case.
 There is no explicit hierarchy for the use of the external cause codes in
   category Y83. We have selected Y83.2 because this intervention resulted
   in an anastomosis which is typically more intense that a simple excision.
 If you require further information regarding the classification of post-
   procedural conditions, you may wish to review query #6763.

                          Data Quality Task Force Postop Complications
                                      Workshop, 2005/04/14
Question/Answer CIHI
Interventions
 We agreed with all your intervention codes and have provided
   our thoughts in response to your questions.
 In this case, suctioning of the ascitic fluid is part of the
   intervention does not require coding as a separate intervention.
 We agree that the lysis of adhesions should be coded in this
   case. Typically, if the lysis of adhesions is described as tedious,
   extensive, time-consuming, or as in this case difficult, it should
   be coded. For further discussion on this topic, you may wish to
   review coding query #11644.
 Decompression of the mid ileum by enterotomy is part of the
   resection and does not require a separate code
 We have also selected the code for CT of the chest based on the
   content of the report.


                       Data Quality Task Force Postop Complications
                                   Workshop, 2005/04/14
Comorbidities
Comorbidities are all conditions that coexist at the time of admission or
develop subsequently and demonstrate at least one of the following:

•significantly affects the treatment received
•requires treatment beyond maintenance of the preexisting condition
•increases the length of stay (LOS) by at least 24 hours.

Consider the following in determining whether a condition qualifies as a
comorbidity.

To support a determination of significance, there must be documented evidence in
the physician’s notes or discharge summary that the condition required at least one
of the following:

•clinical evaluation/consultation, excluding pre-operative anesthetic consults, where a
  new or amended course of treatment is recommended and instituted
•therapeutic treatment/intervention with a code assignment of 50 or greater
  from Section 1 of CCI
•diagnostic intervention, inspection or biopsy with a code assignment from
  Section 2 of CCI
•extended the length of stay (LOS) by at least 24 hours
Reference – Canadian Coding Standards   Data Quality Task Force Postop Complications
                                                    Workshop, 2005/04/14
ICD-10-CA and CCI 2004 – page 9
Diagnosis Type (2).Post-admit Comorbidity

A Diagnosis Type (2) is a condition that arises post-admission,

has been assigned an ICD-10-CA code and satisfies the

requirements for determining comorbidity.




Reference – Canadian Coding Standards ICD-10-CA and CCI 2004 – page 10




                                     Data Quality Task Force Postop Complications
                                                 Workshop, 2005/04/14
?? Questions ??


    Data Quality Task Force Postop Complications
                Workshop, 2005/04/14

				
DOCUMENT INFO