Pneumonia continues to remain as one of the most queried diagnoses. There is no other diagnosis that exemplifies how much physician-speak is different than coding-speak. Clinical documentation staff frequently face resistance from physicians on the specificity of queries. Whereas etiology and causative organism queries are often rendered unnecessary and annoying, still physicians continue to document healthcare associated pneumonia (HCAP) as their way of highlighting the specificity. Respiratory failure and sepsis associated with pneumonia diagnosis often go unrecognized, thus negatively affecting accuracy, relative weight, severity of illness (SOI)/risk of mortality (ROM) and overall revenue.
On the other hand, bronchitis documented alongside pneumonia can lead to denials on clinical validity grounds. Infection control related resource use also can lead to resource overuse due to in accurate documentation. And there is the opportunity to involve pulmonary consultants to help improve compliance with clinical documentation accuracy.
The fact that pneumonia, as a primary diagnosis, can fall into simple and complex pneumonia, which carry significant differences in overall impact, is still not well understood by medical staff. This exclusive ICD10monitor webcast will highlight strategies to improve physician proactiveness in documenting elements that differentiate simple pneumonia from complex pneumonia. When pneumonia is a secondary diagnosis it can potentially be an MCC and nuances of documenting pneumonia in ventilated patients must be relayed to medical staff. Use of evidence based diagnostic criteria like CURB 65 and PSI- PORT by emergency room providers is very important to determine appropriate level of care and proactively prevent commercial denials. This is especially true when pneumonia is the solitary MCC on a case. The medical staff needs to know, from coding perspective, the importance of chest x-ray findings in establishing diagnosis of pneumonia. Pneumonia could be an evolving process during the hospital stay and a documentation of suspected or probable pneumonia should evolve seamlessly, parallel to the clinical picture.
CDI staff should have current clinical practice guidelines and evidence available as they query the physicians. Physician advisors should keep pulmonary and infectious disease physicians updated on current coding guidelines and use them as a resource during peer to peer discussion process.
Why This is Relevant:
Physicians continue to document health care–associated pneumonia (HCAP), and or nosocomial pneumonia, believing that such documentation carries higher impact on relative weight, while at the same time they keep disagreeing to the queries that are looking for causative organism.
No other diagnosis carries this level of non-alignment between medical staff and CDI/coding staff.
The impact of simple versus complex pneumonia is not well recognized by medical staff.
This exclusive ICD10monitor webcast will discuss optimum strategies to align the physician thought process to foster proactive accurate documentation culture, when it comes to pneumonia.
Take this quick quiz and see if you and your team, like so many others, struggle with documenting and coding pneumonia:
- Which of the following is an ICD 10 code that is coded as complex pneumonia?
- Pneumonia generally MCC when coded as secondary diagnosis (T/F)
- Which of the following is true about ventilator associated pneumonia (VAP?)
- You don't have to be on a ventilator to be diagnosed with VAP
- VAP is CC
- VAP is hospital acquired condition and is reported
- B and C
- All of the above
- Which of the following can lead to denial of pneumonia diagnosis based on validity?
- O2 saturation of 88% upon arrival that resolved in ED after nebs and antibiotics
- Absence of infiltrate on chest x-ray
- BUN/Cr of 10 and 0.8
- A and C
- All of the above
From this exclusive ICD10monitor webcast on the coding and documentation of pneumonia, you will…
- Learn how to identify current subtle differences in the clinical thought process and the ICD-10 coding guidelines
- Recognize the importance of differentiating simple from complex pneumonia
- Learn the common reasons for payer denials of pneumonia diagnosis
- Know how to identify the importance of documenting concurrent diagnoses of sepsis, respiratory failure and bronchitis
- Learn recommend strategies and interventions to foster a proactive physician documentation culture as it pertains to pneumonia