Archive for July, 2011

Start Preparing NOW for ICD-10 Coding

Thursday, July 28th, 2011

In this session, Select Data is including a link to the PowerPoint Presentation presented by teleconference, nationally, on July 27, 2011.


ICD-10 PCS and ICD-10 CM are being actively discussed, especially since CMS stated in their recent online training that the transition from ICD-9 to ICD-10 “Requires changes to almost all clinical and administrative systems and requires changes to business processes.”


As we all are aware, ICD-10 will replace a 30 year old system that has not kept up with modern terminology and clinical practices. ICD- 10 offers detailed information on the patient’s condition through specific diagnoses. It is expected to allow upgrading of current data analysis of both diagnoses and procedures with improved care management for patients/clients as an outcome.

Because of increased specificity, the expectation is that interventions for chronic diseases will occur sooner. ICD-10 will allow tracking of disease severity and progress measurement as well as design educational programs for disease clusters identified. It is also expected to identify disease groupings that “may merit special attention” as well as the designing of new care management programs.

Because there is more specific information tracked sooner, it is expected to provide an opportunity to determine procedural and process cost-efficiencies. More specific information presents an opportunity for coverage and policy revisions. Programs will be expected to make decisions based on more dynamic information.

For an overview of ICD-10 including the differences in number of codes, documentation requirements, differences between ICD-9 and ICD-10, please review the attached Power Point presentation. Contact Select Data Chief Compliance Officer with questions regarding ICD-10.

To download a copy of this PowerPoint presentation click here.


Educational Videos: Face-To-Face Encounter

Monday, July 25th, 2011

Face To Face Encounters CY2011 Clinical Compliance

CMS was mandated by the Affordable Care Act to provide this encounter. You will be able to look on page 296 on the Final Rule to read the depth of it. But, essentially what CMS is stating is that the physician must see the patient within 90 days prior to the admission in a home health agency.  And that means that also, in seeing that patient for that face-to-face encounter, that diagnosis or that reason for seeing that patient must be directly related to the home health referral.  Now, if they don’t see them within 90 days prior to they must see them within 30 days after admission.

As of December 10, 2010 CMS is sending out a notice to the physician regarding this face-to-face encounter information.  So the home health agencies are going to have to do a lot of education with physicians.  It also requires then, that the physician provide this attestation that they have completed this face-to-face encounter, and it has to be attached to/or a part of the POC.

At Select Data we’ve created a documentation of the face-to-face encounter tool click here to download a copy of this form: DocumentationFacetoFaceEncounter.pdf


The face to face encounter must occur within the 90 days prior to the start of care, or within the 30 days after the start of care. While the long standing requirement for physicians to order and certify the need for home health remains unchanged, this new requirement assures that the physician’s order is based on current knowledge of the patient’s condition

Educational Videos: Open Wound As A Primary Diagnosis

Monday, July 25th, 2011

Coding Compliance Open Wounds as a Primary Diagnosis

Open Wound as a Primary Diagnosis

Often we see the term open wound used as a diagnosis, especially as a primary diagnosis.  This is a vague term and should be avoided, because it will need clarification before it can be coded.  Did you know that an open wound can be referred to 10 or more different types of wounds?  And each one of these wounds has a different code or codes.

Some of these different wounds are:

  • Decubitus Ulcer
  • Diabetic Ulcer
  • Venous Stasis Ulcer
  • Normally Healing Surgical Wound
  • Post-Op Wound Infection
  • Dehisced Surgical Wound
  • Traumatic Wound
  • Burn
  • Chronic Skin Ulcer
  • Abscess

Each one of these requires as different code.  This stops the coding process until the nature and the origin and the location of the wound can be identified.  All these variables change the code or codes assigned.

Trauma wounds are caused by an outside trauma to the body and they include:

  • Gun shots
  • Avulsions
  • Lacerations
  • Punctures
  • Not surgical

Surgical wounds are never coded as a traumatic wound.  A superficial traumatic wound is not a full thickness wound and this includes:

  • Skin tears
  • Abrasions
  • Blisters

Skin tear is not coded as a traumatic wound unless it is exceptionally large or the skin flap has been lost.  Remember when you’re tempted to write open wound on that diagnosis line, please stop and consider specifically what kind of wound is this and where is its location, and put that information on the diagnosis line instead.

Adult Learning Principles: Influencing Patient Outcomes through Education

Monday, July 25th, 2011

Understanding the Principles of Adult Learning can assist clinicians to improve patient learning and can result in improved clinical and quality patient outcomes. The brain governs more than memory alone. The brain and mind allow humans to cope with stimuli, creativity, immune responses, language, reasoning, planning, analyzing, and dreaming. It allows the human to feel a myriad of emotions, store experiences, while shaping the capacity to alter behavior and thinking through awareness expansion and critical reflection. The brain is, according to Caine, 2009) biologically designed to learn and learning is a matter of building rich neural networks, but how? Each individual learns a bit differently than their neighbor yet there are 12 strong underlying principles:

  1. All learning is physiological
  2. The brain/mind is social
  3. The search for meaning is innate
  4. The search for meaning occurs through patterning
  5. Emotions are critical to patterning
  6. The brain/mind processes parts and wholes simultaneously
  7. Learning involves both focused attention and peripheral perception
  8. Learning always involves conscious and unconscious processes
  9. There are at least two approaches to memory

10.  Learning is developmental

11.  Complex learning is enhanced by challenge and inhibited by threat associated with helplessness

12.  Each brain is uniquely organized

(Caine, Caine, McClintic, and Klimek, 2009 and Caine and Caine, 1994)

The principles assist us, as clinicians, leaders, managers, to understand that there are several different processes involved. Yet, we all tend to print up some teaching materials and have the nurses leave them with the patient “for reinforcement”. Many people believe, “If I told you, you have had education”.

The best selling education books, Tellin’ ain’t Trainin’ (Stolovitch, 2011) and Sit and Get Won’t Grow Dendrites (Tate, 2004) help us to better understand Brain-Compatible strategies. Some patients may learn well with the written word, while others are spatial and auditory learners.

Future Select Data articles will explore the constructs further but here is one sample activity.

If a patient treatment has changed or is being compared or contrasted, consider using a Venn Diagram. Draw two circles that have an overlapping center like below:

Information that is overlapping in the center is that information that is alike. The information outside that space identifies differences.

A spider chart with the new treatment or new topic in the center of a circle should be drawn. Then draw “spider-like” lines coming out of the circles. These can be goals to be achieved. As the patient articulates each goal they desire to achieve, linking it to the treatment or med in the center of the chart dramatically diagrams the importance of that treatment or medication.

A pie chart can be used to classify the careplan components. Breakdowns can make the plan seem more manageable. Each component or “piece” of the pie can appear to be managed at a setting, much like a tasty lemon pie.

We will look at this topic with more depth in the future. There is a PowerPoint Presentation on the topic of Learning and Brain Compatibility that is based on the Twelve Adult Learning Principles. This presentation was presented at two state association conferences and it could be shared with clinicians.

Having trouble downloading Learning and Brain Compatibility PowerPoint?

right click on the link > Then choose “Save Target As” > “Save”

Educational Videos: CVA Residual Effects

Monday, July 11th, 2011

Coding Compliance CVA Residual Effects

Coding CVA’s, meaning Cerebral Vascular Accident caused by a blood clot or a hemorrhage, or what the patient calls a stroke can be a challenge in home care.  Coding guild lines do not allow the acute code for the specific type of cerebrovascular event to be coded in M1020 or M1022.  These specific does are only allowed to be used in the inpatient settings.

Therefore, what is allowed to be coded in homecare is the Late Effects of Cerebrovascular Disease group of codes.  Late effects mean residual effect on sequelae of the initial acute cerebrovascular event.  These codes are found in the 438.0 to 439.9 category.  In the alphabetical index to Diseases they are found under the word Late Effects: subheading cerebrovascular disease.

In home health, the nurse and therapist are adhering and treating the lingering deficits that the CVA has caused.  Rehabilitation has started in the acute hospital and progressed in the inpatient rehabilitation.  Now, that the patient is home, further therapy helps to regain function in the variable of home setting, as long as the patient remains homebound.  Otherwise, therapy would continue in an outpatient clinic or office.

To code these late effects of cerebrovascular disease, the coder needs to identify what these lingering residual effects are.  It is very important that the clinician completing the OASIS and initial assessment state clearly what these residual effects from the stroke are.  Different late effects have a different code. There are 29 different codes to pick from, so concise information is needed.  Please never document CVA or late effects of CVA without following these words with the specific affects the patient presents.

It is acceptable to list more than 1 deficit, especially if multiple therapies are ordered.  It is also necessary to indicate, if there is hemiplegia or monoplegia, what side of the body is affected. The coding guidelines want to know if the dominant side is affected or the non-dominant side and if it is upper or lower limbs for monoplegia.  Documenting left or right hemiplegia from a CVA does not help the coder if it is not known if the patient is right or left handed.

To recap: never document CVA or late effects of a CVA on the diagnosis list without also coding what the specific residual effects are.  These residual effects will be a focus of care for the clinician and therapist as seen by the orders and goals on the Plan-of-Care.