Coding Queue

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Coding Queue

• Leslie Racine, CPC
• Program Analyst
• Billings Area IHS

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Coding Queue

• Captures all visits created (paper or EHR or
  other RPMS applications) - in a queue for further
  analysis of reporting and coding elements
• There is an option to include or exclude specific
  Service Categories (CASP)
• Contract Health Service (CHS) are excluded
• A visit will not pass to Billing until it is
  marked as Reviewed/Completed
• Incomplete/Orphan Ancillary visits do not show up
  on this list. These visits will show up in the
  LIR and PPPV reports and will need to be
  completed and flagged as Reviewed/Complete
  through the normal data entry process. The
  ancillary visits still show up.
• All visits export whether they are in the queue
  or not
• The visits export to NDW with at least one
  dependent entry
• All visits must be audited whether they have
  third party eligibility or not. The more
  complete and accurate for reporting and coding
  the better cost accounting reports and
  reimbursement rates.

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Start up of the Coding Queue

• Make sure your site is caught up with their
  coding and data entry (4 days or less)
• Select a date at the beginning of a month or
  fiscal year
• Coordinate a conference call to discuss
  preparation, answer questions, and document
  instructions
• All RPMS Applications should be set to pass data
  to PCC (excluding CHS)
• Inform and coordinate with the Site Manager, CAC
  and HIM Supervisor (all three have keys to turn
  the queue on)
• PCC Supervisor/Manager menu is UPMC (Update PCC
  Master Control File)
• The Coding Queue should be managed by HIM
  auditors, data entry and coders

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Coding Queue Menu Structure

• PCC Patient Care Component
• MGR PCC Manager Menu
• PCC Patient Care Data Entry Menu
• ENT Enter/Modify/Append PCC Data
• EHRC EHR/PCC Coding Audit Menu
• OR at the Primary Menu - EHRD

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Menus EHRD coding audit for Visits in a date
range

• Name of Site PCC/EHR
  CODING AUDIT
• This list can be used to audit visits that are
  created by EHR users.
• The visits displayed in the list are those with
  an INCOMPLETE or blank
• chart audit status. This list can be sorted by
  date, primary provider
• clinic code, hospital location (scheduling
  clinic), and facility.
• Once the visit has been reviewed, the review
  status can be set as reviewed/
• complete or incomplete. All visits set as
  reviewed/complete will be passed
• to the IHS/RPMS billing package.
• Contract Health visits are excluded. Visits that
  do not have a primary
• provider are also excluded.
• Visits with the following service categories are
  INCLUDED in the list
• - A Ambulatory S Day Surgery
  O Observation
• - T Telecommunications C Chart Review R
  Nursing Home
• - I In Hospital

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EHRD - continued

• PLEASE NOTE A visit will NOT pass to Billing
  until it is marked
• as reviewed/completed.
• PLEASE ALSO NOTE Incomplete/orphan ancillary
  visits do not show up
• on this list. These visits will show up on the
  LIR and PPPV reports
• and will need to be completed and flagged as
  complete through the normal
• data entry process.
• You should limit your date range to no more than
  7 days. Viewing more
• than 7 days worth of visits may take a while to
  process.
• Enter Beginning Visit Date

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EHRD - continued

• Enter Beginning Visit Date 1001 (OCT 01, 2008)
• Enter Ending Visit Date 1031 (OCT 31, 2008)
• You have selected a 30 date range. Depending on
  the number of visits per
• day at your facility it may take a while to
  gather up and process that many
• visits.
• Do you wish to continue with this date range? Y//
  ES
• Please enter which FACILITY visits will be
  included in the list.
• Select one of the following
• A ALL Locations/Facilities
• S Selected set or Taxonomy of
  Locations
• O ONE Location/Facility

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EHRD - continued

• Enter a code indicating what LOCATIONS/FACILITIES
  are of interest A// LL Locations/Facilities
• Select one of the following
• A ALL Clinics
• S Selected set or Taxonomy of
  Clinics
• O ONE Clinic
• Enter a code indicating what CLINICS (IHS clinic
  code) are of interest A// LL Clinics
• Select one of the following
• A ALL Hospital Locations
• S Selected set of Hospital
  Locations
• O ONE Hospital Location
• Enter a code indicating what HOSPITAL LOCATIONS
  are of interest A// LL Hospital Locations

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EHRD - continued

• Select one of the following
• A ALL Providers
• S Selected set or Taxonomy of
  Providers
• O ONE Provider
• Enter a code indicating which providers are of
  interest A// LL Providers
• A chart deficiency reason may have been
  previously entered for a visit.
• If you wish to display only visits whose LAST
  chart deficiency reason matches
• one or more that you select, please enter them.
• Select one of the following
• D Do NOT screen on Chart
  Deficiency Reason
• S Screen on Chart Deficiency
  Reason
• Select visits based on chart deficiency reason
  D// o NOT screen on Chart Deficiency Reason

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EHRD Continued

• Select one of the following
• I Include ALL Patients
• E Exclude DEMO Patients
• O Include ONLY DEMO Patients
• Demo Patient Inclusion/Exclusion E// xclude DEMO
  Patients NEW FEATURE
• I will display visits that meet the following
  criteria
• VISIT DATES Oct 01, 2008 to Oct 31, 2008
• SERVICE CATEGORY A, O, S, C, T
• VISIT TYPE NOT Contract
• Visits with at least one POV and Primary
  Provider.
• LOCATION OF ENCOUNTER All
• CLINICS All
• HOSPITAL LOCATIONS All
• PRIMARY PROVIDER ON VISIT All

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EHRD - continued

• Please note On the list of visits that will be
  displayed there is a column labeled 'INS', in
  this column M stands for Medicare, C stands for
  Medicaid and P stands for Private Insurance.
  This does not mean the visit is billable, it just
  is an indication of whether or not the patient
  has a policy on file that is currently active.
• Select one of the following
• N Patient Name
• H HRN
• D Date of Visit
• T Terminal Digit of HRN
• S Service Category
• L Location of Encounter
• C Clinic
• O Hospital Location
• P Primary Provider
• A Chart Audit Status
• R Chart Deficiency Reason (Last
  one entered)
• I Has Medicare/Medicaid or PI
• How would you like the list of visits sorted H//

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EHRD - continued

• Visit Dates Oct 01, 2008 to Oct 31, 2008
• an asterisk beside the visit number indicates
  the visit has an error
• VISIT DATE PATIENT NAME HRN
  FAC HOSP LOC CL INS PRIM PROV STATU
• 1) 10/30/08_at_1042 DEMO,PAT 1 1
  DR A Ambulatory 84 M DR A
  .9999
• 2) 10/16/08_at_1759 DEMO, PAT 2 12
  EMERGENC A 30 M/C DR. B
• 3) 10/17/08_at_1039 DEMO, PAT 3 123
  URGENT C A 80 M DR. C
• 4) 10/19/08_at_1748 DEMO, PAT 4 1234
  EMERGENC A 30 M DR. D
• 5) 10/08/08_at_1300 DEMO,PAT 5 12345
  PT A 49 M PT NO Diagnosis
• Q - Quit/?? for more actions/ next/-
  previous gtgtgt
• N Note Display C Chart Audit
  History E E Move V File 2 Dates
• M Modify Visit H Health Summary
  T Change Date/Time
• A Append to Visit O One Patient's
  Visits Z Add a Visit
• G Visit Merge X Visit Delete
• S Status Update B B Merge 2 Diff
  Dates

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EHRD - continued

• The following actions are also available
• Next Screen lt Shift View to Left
  PS Print Screen
• - Previous Screen FS First Screen
  PL Print List
• UP Up a Line LS Last Screen
  SL Search List
• DN Down a Line GO Go to Page
  ADPL Auto Display(On/Off)
• Shift View to Right RD Re Display Screen Q
  Quit
• Note I use this option to run a total of visits
  with insurance and a total of all visits each
  Monday as a PCC status report. Each service
  unit has their own folder for the weekly PCC
  reports. The report also includes benchmarks and
  progress reports weekly

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EHRD browser options

• Display a visit will display a visit as you
  see it in PCC data entry display.
• Note Display will display notes here or in EHR
  and they are the same.
• Modify a visit, append to a visit, visit merge,
  health summary, visit delete, merge 2 different
  dates, move V file, move V file 2 dates, change
  date/time, add visit, - are all menus or
  mnemonics in PCC data entry. This list and
  options are not as complete as the PCC data entry
  and supervisor options.
• You can also resort the list, do a chart
  audit history for 1 visit at a time or Status
  Update. Status Update is where you flag a visit
  Reviewed/Complete or Incomplete.
  Reviewed/Complete will allow the visit to pass
  to TPB for claims processing. The visits that
  are flagged as Reviewed/Complete will no longer
  be in the queue.
• The visits that display with an have errors.
  Keep in mind this list does not display all PCC
  errors. You must go to the VRR for a complete
  list and monitor daily.

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PEHR - coding audit for one patient

• The messages are the same as the EHRD but only
  asks for one patient at a time.
• Select PATIENT NAME
• Select one of the following
• D Date of Visit
• S Service Category
• L Location of Encounter
• C Clinic
• O Hospital Location
• P Primary Provider
• A Chart Audit Status
• R Chart Deficiency Reason (Last
  one entered)
• How would you like the list of visits sorted D//
• The display will be the same as the EHRD except
  for one patient and all the patients visits for
  the date rage specified.

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ACDR - add new chart deficiency reason

• Select OUTPATIENT CHART DEFICIENCY REASONS ?
• Answer with OUTPATIENT CHART DEFICIENCY REASONS
• Do you want the entire 44-Entry OUTPATIENT CHART
  DEFICIENCY REASONS List? y
• (Yes)
• Choose from
• ABNORMAL LABORATORY
• BLOOD TRANSFUSION
• CAUSE OF INJURY
• CHIEF COMPLAINT
• CONSENT FORM
• CONSULTATION REPORT
• CPT CODES
• DATE OF VISIT
• DICT OP REPORT
• DOCUMENTATION FOR PROCEDURES
• EM CODE BY PROVIDER
• I would suggest you define how the reasons will
  be used. Only create a new reason that is not on
  the list and be sure to define it. Make sure all
  involved with the queue are aware of the list and
  definitions.

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TUR count unreviewed visits by Date/Service
Category

• This report will produce a count of all visits
  with a chart audit
• status of incomplete or blank. The visits can be
  selected and sorted
• by date, primary provider, chart audit status.
• Contract Health visits are excluded.
• Visits with the following service categories are
  INCLUDED in the list
• - A Ambulatory
• - S Day Surgery
• - O Observation
• - R Nursing Home
• Enter Beginning Visit Date enter date
• Enter Ending Visit Date enter date
• You can sort by one or all or a template by
  location, clinic, hospital location, provider,
  and chart deficiency reason.
• PCC Data Entry Module

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TUR - continued

• 
  
• COUNT OF VISITS WITH CHART AUDIT
  STATUS OF INCOMPLETE/BLANK
• 
  
• VISIT Date Range OCT 01, 2008
  through OCT 31, 2008
• VISIT DATE SERV CAT UNREVIEWED
  VISITS W/NO PROV
• 
  (ANCILLARY)
• --------------------------------------------------
  --------------------------------------------
• Oct 07, 2008 AMBULATORY 3
• Oct 08, 2008 AMBULATORY 1
• Oct 14, 2008 AMBULATORY 1
• Oct 23, 2008 AMBULATORY 1
• Oct 29, 2008 AMBULATORY 1
  1
• Oct 30, 2008 AMBULATORY 1
  1
• Totals
  8 2

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ACRX autocomplete pharmacy education only visits

• This option is used to automatically
  COMPLETE/REVIEW all"
• visits in a date range that meet the following
  criteria
• - POV is V65.49 or V65.19
• - there is no Medication dispensed
• - Clinic is 39 - Pharmacy
• - there is no other Purpose of
  visit/diagnosis
• A list of visits will be provided.
• Enter beginning Visit Date
• Note The visits have to be pharmacy clinic with
  NO V Medication and must have one POV of V65.49
  or V65.19. Service category is Ambulatory and
  the visit type is what is set in your PCC data
  entry parameters for visit creation. 

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CASP update EHR coding audit site parameters

• Select PCC DATA ENTRY SITE PARAMETERS SITE NAME
  CROW HO// BILLINGS
• CROW 01 MT 100
• Service Category exclusions If you would like
  to exclude
• visits with a particular service category from
  the list of
• visits displayed in the coding queue you must
  enter those
• service categories to the list below. For
  example, if you
• do not wish to have I - In Hospital visits in the
  list then
• you should add 'I' to the list.
• Please note If you leave the list blank (empty)
  then all
• direct (non-CHS) visits will display in the
  coding queue.
• Event visits never display in the coding queue.
• Your site is currently set up to exclude visits
  with the
• following service categories from the coding
  queue
• N - NOT FOUND
• H HOSPITALIZATION
• I - IN HOSPITAL

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CASP - continued

• Select one of the following
• A Add another service category
  to the list
• R Remove a service category
  from the list
• Q Quit - list looks good
• Do you wish to Q// Add another service category
  to the list
• A AMBULATORY
• H HOSPITALIZATION
• I IN HOSPITAL
• C CHART REVIEW
• T TELECOMMUNICATIONS
• D DAY SURGERY
• O OBSERVATION
• R NURSING HOME
• N NOT FOUND

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CASP - continued

• You have the option of seeing all visits in the
  coding queue
• regardless of how they were created. You can see
  all visits or
• limit the list of visits in the coding queue to
  only those
• on which a provider has been entered. If you
  choose to only
• see visits on which a provider was entered then
  you will not
• see visits that were created by an ancillary
  package. Most,
• if not all visits created by EHR users will have
  provider.
• Include all visits in the coding queue list?
  YES, INCLUDE VISITS WITH NO PROVIDER//
• Default Response for 'Is Coding Complete?' in
  Data Entry NO//
• Require Chart Deficiency Reason on Visits marked
  as Incomplete?

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INCV list visits marked as incomplete

• You can run for a specific date range, by
  location, clinic, hospital location, provider,
  and chart deficiency reason.
• The list is by patient name and other data
  elements requested, displays who marked the visit
  as incomplete, what the deficiency is and whether
  there is a V file attached (V Med).

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LIR list unreviewed/incomplete visits

• This report will list all visits with a chart
  audit status of incomplete
• or blank. The visits can be selected and sorted
  by date, primary provider,
• chart audit status. This list can be sorted by
  date, primary provider
• clinic code, hospital location (scheduling
  clinic), or facility.
• Contract Health visits are excluded.
• Visits with the following service categories are
  INCLUDED in the list
• - A Ambulatory
• - S Day Surgery
• - O Observation
• - R Nursing Home
• Enter Beginning Visit Date
• This list is by patient name and other data
  elements. The list also shows what V files are
  part of each visit V Provider, V Medication, V
  Measurement, etc.

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TRV tally of Reviewed/Complete visits by
Operator

• This report will produce a tally of visits
  REVIEWED/COMPLETED
• by the user who reviewed/completed the visit.
  PLEASE NOTE this
• report will only look all visits that have been
  reviewed and
• marked as either REVIEWED/COMPLETE or INCOMPLETE.
  If a visit has
• never been reviewed it is not counted in this
  report. You must
• enter the REVIEW date range. This is the date
  range for which visits
• were reviewed.
• PLEASE NOTE
• Any visit reviewed through the normal data
  entry process
• (not through the coding queue) will only be
  counted if it
• was reviewed AFTER Feb 09, 2007. The review
  dates for data
• entry options were not logged prior this
  date.
• Enter Beginning REVIEW Date
• You can subtotal by Review Date.

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TRV - continued

• REVIEW Date Range Oct 01, 2008 through Dec 31,
  2008
• Operator of
  visits of visits marked
• reviewed
  as complete
• --------------------------------------------------
  ------------------------------
• RACINE,LESLIE 240
  234
• Oct 27, 2008 234
  232
• Oct 29, 2008 1
  1
• Nov 06, 2008 5
  1

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UPMC update PCC master control file

• Each location/division must be turned on for
  auditing.
• Location/Division Crow Hospital, Lodge Grass,
  Pryor
• ----------------------------------------------
  -------------------------
• Default Type of Visit IHS
• Default Health Summary Type ADULT REGULAR
• Type of PCC Link (old mode) DATE ONLY
  REQUIRED
• Beginning FISCAL YEAR Month
• Pass PAP Smears from V LAB to WH?
• EHR Chart Audit Start Date FEB 11,2006
• Default Directory for DM Audit EPI output file
• FACILITY PRINT NAME for Patient Handout CROW
  HOSPITAL
• Prompt to Print Patient Health Handout at
  Check-In?
• Update Package PCC Linkages? Y

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Other Reports to monitor

• PCC Supervisor Other Reports
• CTA Chart Review and Telephone Calls
  w/ancillary data
• VRTS Visits with a Returned to Stock
  Medication
• ICD uncoded diagnoses or .9999 visits
• INP link in-hospital visits to hospitalizations
• Process Accept Commands there are still
  ICD-to-Age edits, ICD-to-Sex edits to review and
  correct.
• DDPR - delete duplicate primary providers from
  visits
• Review your Mneumonics and disallow those you
  will not use.
• Remember to monitor before each NDW export.
• The NDW export can be set to automatically run
  via taskman.
• Monitor the NDW-DQM reports each month.

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Validations Billings Area

• We run the validations to check for consistency
  use, by definition, active codes, etc.
• You can run the reports mostly from PCC
  Management Reports, Quality Assurance, VGen
  search by clinic, visit type, service category,
  location, diagnosis, etc.
• I create taxonomies of standard code set clinics
  or service categories that are reportable and non
  reportable, inactive code usage for location,
  clinic, etc.
• You can run VGEN reports to make sure codes are
  assigned per Coding Guidelines, Primary Provider
  to Clinic usage, etc.
• I have 7 different reports for PCC/Coding, 10
  different for ancillary programs (Lab, X-ray,
  Pharmacy). I will developing more for Providers.

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Exports and Reports

• I post schedules for exporting and reports from
  NDW 1A, Direct Inpatient Tabulation, Dental,
  CHS, Patient Registration (user population) etc.
• I have created folders for each site to retrieve
  their NDW-DQM reports for review and correction.
  Included are instructions to locate the IEN and
  each person designated to review the DQM reports
  have a menu their local RPMS systems to enter the
  IEN by Patient or Visit.
• All weekly, monthly, quarterly, semi-annual and
  annual reports are posted to the home page.