CODING QUALITY TASK FORCE

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CODING QUALITY TASK FORCE

• OHIMA Spring Conference
• May 6th
• Deb Tetreault

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OUR HISTORY

• Originated from an OHIMA Meeting in London
• Gail Crook and Charmaine Shaw shared their coding
  quality concerns
• A committee of 8 was formed
• Brainstorming began on how to reach our coding
  community

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WHO HAVE WE REACHED
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Workshops

• We have meet three times to date
• These have been in the London area
• Kickoff Conference to introduce the CQTF and our
  intent
• Managers and coders
• 105 attended
• First Workshop Diabetic Coding
• 15 Hospitals 50 attended
• Second Workshop Postoperative Complications
• 17 Hospitals 85 attended

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CQTF ORGANIZATIONAL COMMITTEE

• Deb Tetreault, chair Data Quality/Education for
  Salumatics
• Sandra Norton, Health Records Manager from
  Leamington District Memorial Hospital
• Nancy Seers, Coder and previous reabstractor from
  St. Thomas Elgin General Hospital
• Diane Greer, Coder and previous reabstractor
  from Bluewater Health in Sarnia
• Lynne Hopper, Clinical Information Analyst,
  Supervisor Health Records Departments from
  Listowel and Wingham Hospitals Alliance
• Darlene Cambridge, Data Analyst from St.
  Josephs Health Centre, London
• Alison Temple, Data Analyst from Tillsonburg
  General Hospital
• Angela Empey, Data Analyst from Woodstock General
  Hospital

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We have developed

• TERMS OR REFERENCE
• PRIVACY DOCUMENT AND PRIVACY OFFICER
• RELATIONSHIP WITH CIHI
• PRE-WORKSHOP PROTOCOL
• WORKSHOP FORMAT
• POST WORKSHOP FOLLOW UP

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CODING QUALITY TASK FORCETERMS OF REFERENCE

• PURPOSE
• Provide a forum to Health Record Professionals in
  which coding quality and consistency can be
  enhanced
• GOALS
• 1) Provide coders with the tools required for
  coding
• 2) Develop a network for coding professionals
• 3) Work with CIHI and submit recommendations as
  necessary
• 4) Promote coder awareness of their importance
• 5) To maintain the privacy of the patient,
  facility and their staff
• OBJECTIVES
• 1) Promote CIHI's Web Board (e.g. using the
  coding query data base, create queries and to
  retrieve bulletins)
• 2) Refresh coders on the Folio product
• 3) Provide chart review exercises
• 4) Provide a consented network contact list
  (email, fax, phone)
• 5) Develop a network through workshops
• 6) Inform coders how the coded information is
  used
• MEMBERSHIP

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Statement of Privacy for CQTFin development

• Sandra Norton is our Privacy Officer. She is
  working with Gail Puder, Information Officer with
  IPC.
• A Statement of Privacy is being developed along
  with appropriate policies and procedures based on
  the PHIPA Legislation.
• All participating institutions will be required
  to review and acknowledge their acceptance of
  said policies, etc.
• CQTF Committee goes over and above the
  requirement as we have 8 set of eyes that look
  over the chart for anonymization.
• Because of the anonymization, we are not required
  to obtain the patients consent.
• CQTF will contact the patient to ensure they are
  aware that their health information is being
  utilized for educational purposes.

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Pre WORKSHOP

• Committee selects a chart and codes it
• Send the chart to the hospitals
• Send the chart to the physician with questions
• Send the chart to CIHI with questions
• The hospitals code the chart (both IP and ER)
  within their facility and decide on one set of
  codes
• Send those codes back to committee
• CIHI sends their codes to the chart along with
  answers to the questions back to committee

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Workshop Format

• Review codes per hospitals (anonymous)
  consistencies/inconsistencies
• Review the Consensus between the hospitals
• Review CIHI Coding Selections
• Review CIHI Answers to questions
• Discussion
• Create post Workshop questions and/or
  recommendations for CIHI/MoHLTC

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Review Hospital Codes
Hospital A Hospital B Hospital C Hospital D Hospital E
K56.5 MRDx K56.5 K56.5 MRDx K56.5 MRDx K56.5 MRDx
K91.3 2 K91.3 K91.3 2 K91.3 2 K91.3 2
J95.88 2 J95.88 J95.88 2 J95.88 2 J95.88 2
J18.9 3 J98.18 J18.9 3 J18.9 3 J18.9 3
  R33 R33 2 R33 2 R33 2
Y83.2 9 Y83.2 Y83.2 9 Y83.2 9 Y83.6 9
E86.0 1   E86.0 1 E86.0 1
R00.0 2 R00.0 R00.0 3 R00.0 3 R00.0 2
  Q - C78.0 Z85.4 3 Z85.4 3 Z85.4 3
  R73.9 I73.9 3  
  F17.1      
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Diagnosis Consensus
CODES Description
K56.5 MRDx Intestinal adhesions bands with obstruction
K91.3 2 Postoperative intestinal obstruction
J95.88 2 Other postprocedural respiratory disorders
J18.9 3 Pneumonia, unspecified
R33 2 Retention of urine
Y83.2 9 Surgical operation with anastomosis, bypass or graft
E86.0 1 Dehydration
R00.0 3 Tachycardia, unspecified
Z85.4 3 Personal history of malignant neoplasm of genital organs
I73.9 3 Peripheral vascular disease, unspecified
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CIHI RESPONSE and QuestionsTHANK YOU CIHI
ICD-10-CA codes CODE DESCRIPTION Dx Type
DAD ABSTRACT DAD ABSTRACT DAD ABSTRACT
K56.5 Intestinal adhesions bands with obstruction MRDx
J95.88 Other postprocedural respiratory disorders Type 2
J18.1 Lobar pneumonia, unspecified Type 3
I97.8 Other postprocedural disorders of circulatory system, NEC Type 2
I47.1 Supraventricular tachycardia Type 3
K91.3 Postoperative intestinal obstruction Type 2
R33 Retention of urine Type 2
Y83.2 Surgical operation with anastomosis, bypass or graft Type 9
I73.9 Peripheral vascular disease, unspecified Type 3
Z85.4 Personal history of malignant neoplasm of genital organs Type 3
Z72.0 Tobacco use Type 3
1.NK.87.RF L Z Excision partial, small intestine open approach enteroenterostomy anastomosis technique Location Z Other area of small intestine (e.g. jejunum, ileum, not otherwise specified) Principal procedure
3.OT.20.WC Computerized tomography CT, abdominal cavity with enhancement  
3.GT.20.WC Computerized tomography CT, lung NEC with enhancement  
3.GT.20.WA Computerized tomography CT, lung NEC without enhancement  
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Physician Involvement

• Physician shares in chart review
• Answers preWorkshop questions
• Open Discussion
• If possible, show a video of procedure
• If possible, show some surgical instruments and
  explain

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Post Workshop

• Send CIHI Post Workshop Questions
• Send all material to hospitals
• Power Point Presentations
• CIHI Questions and Answers
• Tentative timeframe for next Workshop
• Tentative topic for next Workshop
• Any other material
• Put all material on OHIMA Website
• www.ohima.ca

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What Works

• Workshops are open forum with a relaxed
  atmosphere
• Coders are developing a network
• Standards and CIHI are more in the forefront for
  answers
• We are learning where we differ and developing
  same page results
• Physician Awareness
• CIHI Awareness
• Evaluations show a favorable response

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ISSUES

• There are inconsistencies in coding
• There is lack of confidence in coding
• There is no time for training due to lack of
  staff and/or deadlines
• Some managers are not allowing coders to attend
  Training/Workshops even if they ask to take a
  vacation day
• Coders would like an intense training session
  developed, similar to what the reabstrators
  received

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My little Story

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THE WHOLE ROAST

• Coders need further education
• Coders need a network developed
• Coders need to be kept informed
• Coders feel they are kept in the dark
• Coders need out of the BOX
• Coders need a morale boost
• Coders will produce better

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Contact Information

• Contact anyone on the Committee
• Next Workshop in late October
• Deb Tetreault
• Home Office [phone]
• d.tetreault_at_rogers.com