Health Information Management

Tip: Monitor diagnoses targeted for readmission reduction

CDI Strategies, November 10, 2011

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Coders and CDI specialists need to understand the implications coding and sequencing may have on readmissions data and cohort selection, says James S. Kennedy, MD, CCS, managing director at FTI Consulting in Atlanta and a member of the ACDIS advisory board.

Kennedy’s admonition comes as CMS moves to reduce excessive readmissions for acute myocardial infarction, heart failure, and/or pneumonia, conditions related to the Hospital Readmissions Reduction Program required by the Affordable Care Act and outlined in the fiscal year 2012 Inpatient Prospective Payment System Final Rule.
"Recognizing that this data will start being collected on October 1, 2011, the sooner the coding [and CDI] department[s] work with the quality department on this issue, the better," Kennedy says.
For example, if coders report documented septicemia or acute respiratory failure as the principal diagnosis when a patient is admitted for pneumonia-and a readmission occurs within 30 days, CMS will not count the second admission as a readmission, says Kennedy. Similarly, certain heart failure patients won't be included depending on how conditions are sequenced. For example, a patient admitted with heart failure also has symptoms and an acute troponin rise indicative of acute myocardial infarction or clinical circumstances supporting acute respiratory failure at the time of admission. If acute myocardial infarction or acute respiratory failure is sequenced as principal and the patient is readmitted within 30 days, CMS won't consider the second admission to be a heart failure readmission.
Visit the QualityNet website at for more information.
Editor’s Note: For more advice, access the article in its entirety in the November issue of Briefings on Coding Compliance Strategies.

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