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CMW Tip of the Week: HIM can help you de-code data

Case Management Weekly, October 29, 2008

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This week’s tip comes from Harriet Kinney, RHIT, CHC, organizational integrity manager for Trinity Health in Novi, MI.
 
Case managers should team up with their health information management (HIM) department when looking at data. There’s usually somebody in HIM, such as the HIM director or a sharp analyst, who can help talk case managers through what they’re looking for. This can be especially useful when it comes to getting data for all pneumonia cases, for example.
 
The way a nurse may think of a pneumonia case is not necessarily how the bill went out the door, because of the DRG. A nurse case manager may think, “Well, Mr. Smith had pneumonia” but actually pneumonia was one of the many secondary conditions that were being treated. After careful study it is revealed that pneumonia was not the reason Mr. Smith was admitted to the hospital. He was admitted because he had a myocardial infarction (MI). The bill goes out saying his principal diagnosis was an MI, and the pneumonia code is listed somewhere down in secondary diagnoses.

Therefore, speaking with somebody in HIM will help case managers understand how claims go out or how the data from coding goes out.

Have a tip or tool you’d like to share? Or maybe a question for our experts? E-mail it to editor Julie McGinley at jmcginley@hcpro.com.Your thoughts could be featured in the next issue of Case Management Weekly!

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