Health Information Management

The complicated process of reporting complications

HIM-HIPAA Insider, December 28, 2010

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By James S. Kennedy, MD, CCS

As the Patient Protection and Affordable Care Act implementation progresses, the quality and outcomes of care face increasing public scrutiny. Policymakers will determine our complication rates and publicize them on the Internet, influencing public perception of our competencies and quality. Don’t believe me? Read in the Atlanta Journal-Constitution about some Georgia hospitals’ “high” pneumonia, heart failure, and myocardial infarction mortality (http://tinyurl.com/GA-mortality). See your own cost efficiency and quality profile on United Healthcare’s website (www.uhc.com) under the “Find a Physician” tab. Where is information to make these determinations obtained? It’s from ICD-9-CM codes assigned by our hospitals based upon documentation. Consequently, we have a vested interest in ensuring that complication codes are submitted accurately.
 
As we all know, certain conditions routinely occur in the postoperative period. AHA Coding Clinic for ICD-9-CM, third quarter 2009, p. 5, instructs coders to not represent these conditions as complications unless they are more than a routinely expected condition or occurrence, have a cause-and-effect relationship between the care provided and the condition, and are documented as a complication. If uncertain, coders must query the surgeon for clarification. Unless the answer is documented in the medical record, coders may be forced to code conditions as complications. This doesn’t reflect well on the surgeon or hospital. 
                                                 
Note: To read more, visit the HCPro website. Subscribers to Medical Records Briefing have access to this article in the December issue of their newsletters.
 



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