3M Quality Webinar Series - IPPS 2022 updates and impacts on quality November 2021 - IPPS 2022 updates and impacts ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
3M Quality Webinar Series IPPS 2022 updates and impacts on quality November 2021 Cheryl Manchenton, BSN, RN 3M Quality Webinar Series © 3M 2021. All Rights Reserved
Housekeeping
• Sound check
• Ask questions!
• Archive
• Survey
Disclaimer
The information presented herein contains the views of the presents and does not imply a formal endorsement for consultation engagement on the part of 3M. Participants are
cautioned that information contained in this presentation is not a substitute for informed judgement. The participant and/or participant’s organization are solely responsible for
compliance and reimbursement decisions, including those that may arise in whole or in part from participant’s use of or reliance upon information contained in the presentation. 3M
and the presenters disclaim all responsibility for any use made of such information
3M and its authorized third parties will use your personal information according to 3M’s privacy policy (see Legal link). This meeting may be recorded. If you do not consent to
being recorded, please exit the meeting when the recording begins.
3M Quality Webinar Series © 3M 2021. All Rights Reserved
Meet our speaker
Cheryl Manchenton, BSN, RN,
Senior inpatient consultant
Cheryl has been a nurse for more than 31 years and has
worked in clinical documentation integrity (CDI) for
over 11 years. She is a senior inpatient consultant for
3M Health Information Systems and a frequent
contributor to For the Record magazine as well as a
featured presenter at AHIMA, MHIMA and ACDIS.
3M Quality Webinar Series © 3M 2021. All Rights Reserved 3Learning objectives At the completion of this presentation, the participant will be able to: • Understand FY 2022 ICD-10-CM and ICD-10-PCS coding changes and guideline revisions which impact quality • Understand FY 2022 CMS final rule changes related to quality • Provide updates on FY 2022 impacting quality 3M Quality Webinar Series © 3M 2021. All Rights Reserved 4
FY 2022
ICD-10-CM & ICD-10-PCS and
coding guidelines
updates related to quality
3M Quality Webinar Series
SM
©
©3M
3M2021.
2021.All
AllRights
Rights Reserved
Reserved 5POA exempt changes
Z51.5 is now on the POA exempt list
• Encounter for palliative care has been used by some Quality benchmarking
software as a risk-adjustor only when POA
• Assignment of Z51.5 to POA exempt list may potentially alter risk-adjustment
efforts
3M Quality Webinar Series © 3M 2021. All Rights Reserved 6Acidosis
Revised instructional notes
Code Description
E87.2 Acidosis
Excludes 1: diabetic acidosis – see categories E08-E10, E13 with ketoacidosis
Excludes 1: diabetic acidosis – see categories E08-E10, E11, E13 with ketoacidosis
3M Quality Webinar Series © 3M 2021. All Rights Reserved 7Quality impact
With more excludes 1 edits surfacing for Query/ensure documentation clear on cause
patients with diabetes and acidosis, the of acidosis when unrelated to diabetes
number cases with reported acidosis may • Respiratory
decrease • Lactic acidosis
• Metabolic
• Renal tubular acidosis (rare)
• Acidosis is a common risk-adjuster in quality models • Best practice is not just to get a documented type above but
a clear cause/effect
3M Quality Webinar Series © 3M 2021. All Rights Reserved 8Bronchiectasis
Revised instructional notes
Code Description
J47.0 Bronchiectasis with acute lower respiratory infection
Use additional code to identify the infection
Code also to identify infection, if applicable
3M Quality Webinar Series © 3M 2021. All Rights Reserved 9Quality impact
Previously bronchiectasis was required
to be sequenced as PDx over a LRTI
such as pneumonia
With the change in the tabular notes,
pneumonia may now be sequenced as
Pdx
• This will increase the index admissions used via
the CMS mortality and readmissions cohorts
3M Quality Webinar Series © 3M 2021. All Rights Reserved 10Depression
Revised category title, deleted inclusion terms and created new diagnosis code
Category Description
F32 Major depressive disorder, single episode
Depressive episode
Code Description
F32.9 Major depressive disorder, single episode, unspecified
Depression NOS
Depressive disorder NOS
Major depression NOS
Code Description CC/MCC
F32.A Depression, unspecified No
Depression NOS
Depressive disorder NOS
MDC MS-DRG
19 (Mental) 881 Depressive neuroses
3M Quality Webinar Series © 3M 2021. All Rights Reserved 11Quality impact Clinically correct decrease in reporting of HCCs Prior to writing query for depression specificity such as MDD, ensure appropriate clinical indicators are present such as lifestyle changes, weight loss, frequent medication adjustments etc. Unsure if new code unspecified depression will be included in risk adjustment models in future • Based on 2017-2018 baseline periods at present 3M Quality Webinar Series © 3M 2021. All Rights Reserved 12
Non-ischemic myocardial injury
Created new diagnosis code
Code Description CC/MCC
I5A Non-ischemic myocardial injury (non-traumatic) CC
Acute (non-ischemic) myocardial injury
Chronic (non-ischemic) myocardial injury
Unspecified (non-ischemic) myocardial injury
Code first the underlying cause, if known and applicable, such as:
Acute kidney failure (N17.-)
Acute myocarditis (I40.-)
Cardiomyopathy (I42.-)
Chronic kidney disease (CKD) (N18.-)
Heart failure (I50.-)
Hypertensive urgency (I16.0)
Nonrheumatic aortic valve disorders (I35.-)
Paroxysmal tachycardia (I47.-)
Pulmonary embolism (I26.-)
Pulmonary hypertension (I27.0, I27.2-)
Sepsis (A41.-)
Takotsubo syndrome (I51.81)
Excludes 1: acute myocardial infarction (I21.-)
Injury of heart (S26.-)
Excludes 2: other acute ischemic heart diseases (I24.-)
MDC MS-DRG
05 (Cardio) 314/315/316 Other circulatory system diagnoses with MCC/with CC/without CC or MCC
3M Quality Webinar Series © 3M 2021. All Rights Reserved 13Non-ischemic myocardial injury
The Fourth Global MI Task Force updated the definitions of MI and created a definition for non-
ischemic myocardial injury
MI caused by atherothrombotic coronary artery disease and usually precipitated
Type 1 MI by atherosclerotic plaque disruption (rupture or erosion)
MI caused by a mismatch between oxygen supply and demand by a
Type 2 MI pathophysiological mechanism other than coronary atherothrombosis (type 1 MI)
Non-ischemic
myocardial injury Myocardial injury in the absence of ischemia or trauma
Optimal evaluation and treatment strategies for these etiologically distinct diagnoses have yet to
be defined.
3M Quality Webinar Series © 3M 2021. All Rights Reserved 14Non-ischemic myocardial injury
Myocardial injury
Acute Chronic
Chronic myocardial
Ischemic Non-ischemic
injury
(I5A)
Acute non-ischemic
Acute ischemic myocardial injury
myocardial injury (I5A)
Type 1 myocardial Type 2 myocardial
infarction infarction
(I21.0-I21.4) (I21.A1)
3M Quality Webinar Series © 3M 2021. All Rights Reserved 15Quality impact
Accuracy impact
• Less inappropriate NSTEMIs reported, lower risk adjustment
• Less clinical validation
“Positive” impact
• Decrease in MI (via NSTEMI) as PDx
• Decrease in MIs qualifying for MI readmissions and mortality
cohorts
3M Quality Webinar Series © 3M 2021. All Rights Reserved 16Irritant contact dermatitis
Created new diagnosis codes
Subcategory Description
L24.A Irritant contact dermatitis due to friction or contact with body fluids
Excludes 1: irritant contact dermatitis related to stoma or fistula (L24.B-)
Excludes 2: erythema intertrigo (L30.4)
Code Description CC/MCC
L24.A0 Irritant contact dermatitis due to friction or contact with body fluids, unspecified No
L24.A1 Irritant contact dermatitis due to saliva No
L24.A2 Irritant contact dermatitis due to fecal, urinary or dual incontinence No
Excludes 1: diaper dermatitis (L22)
L24.A9 Irritant contact dermatitis due friction or contact with other specified body fluids No
Irritant contact dermatitis related to endotracheal tube
Wounds fluids, exudate
MDC MS-DRG
09 (Skin/breast) 606/607 Minor skin disorders with MCC/without MCC
3M Quality Webinar Series © 3M 2021. All Rights Reserved 17Irritant contact dermatitis
Created new diagnosis codes
Subcategory Description
L24.B Irritant contact dermatitis related to stoma or fistula
Use additional code to identify any artificial opening status (Z93.1-), if applicable, for contact dermatitis related to stoma secretions
Code Description CC/MCC
L24.B0 Irritant contact dermatitis related to unspecified stoma or fistula No
Irritant contact dermatitis related to fistula NOS
Irritant contact dermatitis related to stoma NOS
L24.B1 Irritant contact dermatitis related to digestive stoma or fistula No
Irritant contact dermatitis related to gastrostomy
Irritant contact dermatitis related to jejunostomy
Irritant contact dermatitis related to saliva or spit fistula
L24.B2 Irritant contact dermatitis related to respiratory stoma or fistula No
Irritant contact dermatitis related to tracheostomy
L24.B3 Irritant contact dermatitis related to fecal or urinary stoma or fistula No
Irritant contact dermatitis related to colostomy
Irritant contact dermatitis related to enterocutaneous fistula
Irritant contact dermatitis related to ileostomy
MDC MS-DRG
09 (Skin/breast) 606/607 Minor skin disorders with MCC/without MCC
3M Quality Webinar Series © 3M 2021. All Rights Reserved 18Quality impact
Availability for unique codes for irritant
contact dermatitis should reduce the volume
of reported pressure ulcers
•Careful review of WC documentation to ensure
appropriate type of skin condition is reported
•Also review for associated evolution to skin ulcer by
depth
Note that codes for device-related pressure
injuries and healed pressure ulcers not yet
created/available
3M Quality Webinar Series © 3M 2021. All Rights Reserved 19Traumatic brain compression and herniation
Created new diagnosis codes
Subcategory Description
S06.A Traumatic brain compression and herniation
Traumatic cerebral compression
Code first the underlying traumatic brain injury, such as:
Diffuse traumatic brain injury (S06.2-)
Focal traumatic brain injury (S06.3-)
Traumatic subdural hemorrhage (S06.5-)
Traumatic subarachnoid hemorrhage (S06.6-)
Code Description
S06.A0- Traumatic brain compression without herniation
Traumatic brain compression NOS
Traumatic cerebral compression NOS
S06.A1- Traumatic brain compression with herniation
Traumatic brain herniation
Traumatic brainstem compression with herniation
Traumatic cerebellar compression with herniation
Traumatic cerebral compression with herniation
7th character Description CC/MCC MDC MS-DRG
A Initial encounter MCC 01 (Neuro) 085/086/087 Traumatic stupor and coma >1 hour
D Subsequent encounter No 23 (Health status) 949/950 Aftercare
S Sequela No 21 (Injury) 913/914 Traumatic injury
3M Quality Webinar Series © 3M 2021. All Rights Reserved 20Traumatic brain injury
Added instructional notes
Subcategory Description
S06.2 Diffuse traumatic brain injury
Use additional code, if applicable, for traumatic brain compression or herniation (S06.A-)
S06.3 Focal traumatic brain injury
Use additional code, if applicable, for traumatic brain compression or herniation (S06.A-)
S06.5 Traumatic subdural hemorrhage
Use additional code, if applicable, for traumatic brain compression or herniation (S06.A-)
S06.6 Traumatic subarachnoid hemorrhage
Use additional code, if applicable, for traumatic brain compression or herniation (S06.A-)
3M Quality Webinar Series © 3M 2021. All Rights Reserved 21Quality impact
Conditions such as
compression and
herniation are not
integral to every
traumatic brain injury
With the
addition of the
new codes, Additionally, not
differentiation every patient with
is possible compression
develops herniation
• Risk-adjustment
• SOI and ROM
3M Quality Webinar Series © 3M 2021. All Rights Reserved 22Social determinants of health
Created new diagnosis codes
Code Description CC/MCC
Z55.5 Less than a high school diploma No
No general equivalence degree (GED)
Z58.6 Inadequate drinking-water supply No
Lack of safe drinking water
Excludes 2: deprivation of water (T73.1)
Z59.00 Homelessness unspecified No
Z59.01 Sheltered homelessness No
Doubled up
Living in a shelter such as: motel, scattered site housing, temporary or transitional living situation
Z59.02 Unsheltered homelessness No
Residing in place not meant for human habitation such as: abandoned buildings, cars, parks, sidewalk
Residing on the street
Z59.41 Food insecurity No
Z59.48 Other specified lack of adequate food No
Inadequate food
Lack of food
MDC MS-DRG
23 (Health status) 951 Other factors influencing health status
3M Quality Webinar Series © 3M 2021. All Rights Reserved 23Social determinants of health
Created new diagnosis codes
Subcategory Description
Z59.81 Housing instability, housed
Foreclosure on home loan
Past due on rent or mortgage
Unwanted multiple moves in the last 12 months
Code Description CC/MCC
Z59.811 Housing instability, housed, with risk of homelessness No
Imminent risk of homelessness
Z59.812 Housing instability, house, homelessness in past 12 months No
Z59.819 Housing instability, housed unspecified No
Z59.89 Other problems related to housing and economic circumstances No
Foreclosure on loan
Isolated dwelling
Problems with creditors
MDC MS-DRG
23 (Health status) 951 Other factors influencing health status
3M Quality Webinar Series © 3M 2021. All Rights Reserved 24Chapter 21: Factors influencing health status and contact with
health services (Z00-Z99)
I.C.21.c.17 Social determinants of health
• Codes describing social determinants of health (SDOH) should be assigned when this information is documented.
• For social determinants of health, such as information found in categories Z55-Z65, Persons with potential health hazards related to
socioeconomic and psychosocial circumstances, code assignment may be based on medical record documentation from clinicians
involved in the care of the patient who are not the patient’s provider since this information represents social information, rather than
medical diagnoses.
• For example, coding professionals may utilize documentation of social information from social workers, community health workers,
case managers, or nurses, if their documentation is included in the official medical record.
• Patient self-reported documentation may be used to assign codes for social determinants of health, as long as the patient self-reported
information is signed-off by and incorporated into the medical record by either a clinician or provider.
• Social determinants of health codes are located primarily in these Z code categories:
Z55 Problems related to education and literacy
Z56 Problems related to employment and unemployment
Z57 Occupational exposure to risk factors
Z58 Problems related to physical environment
Z59 Problems related to housing and economic circumstances
Z60 Problems related to social environment
Z62 Problems related to upbringing
Z63 Other problems related to primary support group, including family circumstances
Z64 Problems related to certain psychosocial circumstances
Z65 Problems related to other psychosocial circumstances
• See Section I.B.14. Documentation by Clinicians Other than the Patient's Provider.
3M Quality Webinar Series © 3M 2021. All Rights Reserved 25Social determinants of health
Education
Inadequate
(less than a Housing Food
Homelessness drinking water
high school instability insecurity
supply
degree)
Although current
Although current
ICD-10-CM
ICD-10-CM
contains a code for
contains general
homelessness, there Health risks and
concepts of literacy
was no distinction There is a vast health costs
and
between sheltered literature associated with food
underachievement Impact of drinking
and unsheltered representing the insecurity are vast.
there was no way to water supply and
homelessness. health risks of Furthermore, as
distinctly represent future neighborhood
COVID discharge economically driven evidenced by the
the known risk and environmental
planning has housing instability research of the
imparted by inability domains.
provided a critical for individuals and USDA, risk increases
to attain a high
use case on why this families. as severity of food
school diploma or
distinction is insecurity increases.
equivalent,
necessary from both
independent of
a treatment plan and
literacy.
risk perspective.
3M Quality Webinar Series © 3M 2021. All Rights Reserved 26Quality Impact
CMS received input on
ways to make reporting of
health disparities based on
With the
social risk factors and race
increase of
and ethnicity more It is logical that
available SDOH Expect to see a
comprehensive and use of SDOH This effort has
codes, broad expansion
actionable by including information will been on-going at
organizations of SDOH codes
additional demographic be incorporated the state level as
can help support over the next
data points (e.g., race, in the future as well
the efforts to several years
ethnicity, well
risk-adjust based
Medicare/Medicaid dual
on SDOH as well
eligible status, disability
status, LGBTQ+, and
socioeconomic status).
3M Quality Webinar Series © 3M 2021. All Rights Reserved 27Chapter 12: Diseases of the skin and subcutaneous tissue (L00-L99) I.C.12.a.2 Unstageable pressure ulcers • Assignment of the code for unstageable pressure ulcer (L89.--0) should be based on the clinical documentation. These codes are used for pressure ulcers whose stage cannot be clinically determined (e.g., the ulcer is covered by eschar or has been treated with a skin or muscle graft). This code should not be confused with the codes for unspecified stage (L89.--9). When there is no documentation regarding the stage of the pressure ulcer, assign the appropriate code for unspecified stage (L89.-- 9). • If during an encounter, the stage of an unstageable pressure ulcer is revealed after debridement, assign only the code for the stage revealed following debridement. 3M Quality Webinar Series © 3M 2021. All Rights Reserved 28
Quality impact Not only was this added to the guidelines, Coding Clinic also published a question regarding evolving DTI Proper assignment of POA status of stage 3 and 4 ulcers as well as movement from the DTI or unstageable code to the stage 3 or 4 ulcer will reduce the number of HACs and PSI 3 cases 3M Quality Webinar Series © 3M 2021. All Rights Reserved 29
Chapter 18: Symptoms, signs, and abnormal clinical and laboratory
findings, not elsewhere classified (R00-R99)
I.C.18.e. Coma scale
• Code R40.20, Unspecified coma, may be assigned in conjunction with codes for any medical condition.
• Do not report codes for unspecified coma, individual or total Glasgow coma scale scores for a patient with a medically induced coma or
a sedated patient.
1) Coma Scale
• The coma scale codes (R40.2- R40.21- to R40.24-) can be used in conjunction with traumatic brain injury codes. These codes are
primarily for use by trauma registries, but they may be used in any setting where this information is collected. The coma scale codes
should be sequenced after the diagnosis code(s).
• These codes, one from each subcategory, are needed to complete the scale. The 7th character indicates when the scale was
recorded. The 7th character should match for all three codes.
• At a minimum, report the initial score documented on presentation at your facility. This may be a score from the emergency
medicine technician (EMT) or in the emergency department. If desired, a facility may choose to capture multiple coma scale scores.
• Assign code R40.24-, Glasgow coma scale, total score, when only the total score is documented in the medical record and not the
individual score(s).
• If multiple coma scores are captured within the first 24 hours after hospital admission, assign only the code for the score at the time
of admission. ICD-10-CM does not classify coma scores that are reported after admission but less than 24 hours later.
3M Quality Webinar Series © 3M 2021. All Rights Reserved 30Quality impact
Due to the oversight in the code
range in the official coding
guidelines, facilities were under-
reporting the incidence of coma in
the population
With the change in the guidelines
and excludes 1 notes, coma can be
reported for non-traumatic cases
• Coma is a major risk-adjustor in all models
3M Quality Webinar Series © 3M 2021. All Rights Reserved 31Short-term external heart assist device
Reassigned the MS-DRG assignment for the following procedure codes
ICD-10-PCS Description
02HA0RJ Insertion of short-term external heart assist system into heart, intraoperative, open approach
02HA3RJ Insertion of short-term external heart assist system into heart, intraoperative, percutaneous approach
02HA4RJ Insertion of short-term external heart assist system into heart, intraoperative, percutaneous endoscopic approach
Current MS-DRGs FY22 MS-DRGs
215 Other heart assist system implant 216/217/218 Cardiac valve and other major cardiothoracic
procedures with cardiac catheterization with MCC/with CC/without
CC or MCC
219/220/221 Cardiac valve and other major cardiothoracic
procedures without cardiac catheterization with MCC/with
CC/without CC or MCC
Reason
• Cases reporting an intraoperative insertion of a short-term external heart assist device are generally less resource intensive and are
clinically distinct from other types of heart assist devices in MS-DRG 215
• The MS-DRG reassignments would be more clinically homogeneous, coherent and better reflect hospital resource use
3M Quality Webinar Series © 3M 2021. All Rights Reserved 32Quality impact
An Impella is frequently inserted as a last-ditch effort for patients with circulatory collapse with the
hope of the heart recovering or to transition to a long-term VAD for consideration of transplant
Frequent principal diagnoses include MI and acute heart failure
Common secondary diagnosis would include cardiogenic shock
With an expiration, cardiogenic shock will result in assignment of PSI 4 if the patient expires as the
Impella procedure will result in assignment of the patient to MS-DRGs 001/002 (Pre-MDC)
With this change, the patient will remain in MDC 5 and be excluded
•NOTE: AHRQ is on version 38.1 so these cases will still flag PSI 4 until the next AHRQ update (typically summer) which is
always retroactive to Oct 1 of the previous year. This means, in one more year, the Impella will not result in a PSI 4 due to the
DRG assignment
3M Quality Webinar Series © 3M 2021. All Rights Reserved 33Q&A
3M Quality Webinar Series
SM
©
©3M
3M2021.
2021.All
AllRights
Rights Reserved
Reserved 343M Education boot camps
3M experts offer a variety of education boot camps to keep you informed and meet the growing need for more specialized trainings in the clinical documentation integrity
(CDI) space. Our educators include clinicians, documentation specialists, and coding experts with decades of industry and education experience, they will deliver the
insights you need to make an impact on your CDI programs.
Virtual advanced CDI training Virtual advanced quality training
The Advanced CDI training week offers comprehensive Discover how CDI, coding and quality efforts can impact
CDI education addressing fundamental CDI skills and the the quality of care across various value-based purchasing
clinical and coding concepts behind key major diagnostic initiatives.
categories (MDCs).
The quality training is a great follow up to the Advanced
This training week is a crucial starting point for any CDI training* and is great for seasoned professionals and
inpatient CDI or coding professional before moving to multidisciplinary CDI teams looking to take their programs
other more advanced topics. to the next level.
Upcoming Advanced CDI Upcoming Advanced quality
training week: training weeks:
• January 24-28, 2022 • TBD Ask your 3M
representative for details
*Dates are subject to change
*Dates are subject to change
*Do not recommend taking the courses back-to-back. We recommend at least two years of experience in a
Learn more at: go.3m.com/cdibootcamps CDI/Coding role, attendance in the Advanced CDI training week or involvement in the Advanced CDI
implementation.
3M Quality Webinar Series © 3M 2021. All Rights Reserved 35If you would like more information about topics in this webinar, please select your top interest. ❑ 3M™ Advanced CDI Services ❑ 3M™ Quality Services ❑ 3M™ Performance Advisory Services ❑ 3M Compliance, Audit and Revenue Services 3M Quality Webinar Series © 3M 2021. All Rights Reserved 36
Handouts, Recording and Certificates A PDF handout that contains all of the presentation slides is available for you to download, and that’s located in the ‘Handouts’ section of your web meeting controls. Look out for an email within the next week that includes a link to the webinar recording and slides. We will provide a certificate of attendance to webinar attendees, and that will be emailed to you later today upon the completion of this webinar. 3M Quality Webinar Series © 3M 2021. All Rights Reserved 37
Thank you! 3M Quality Webinar Series © 3M 2021. All Rights Reserved
You can also read
