NEC-NOS

Universal Definition: Acute MI

necnos — Sun, 22 Jun 2008 19:02:03 +0000

Universal Definition of Myocardial
Infarction. Circulation 2007; 116: 2634-2653

This helps to explain why we see more documentation of “demand” MI and why it’s part of the universal definition for acute MI. Troponin leak? Demand ischemia? When does the coder assign an acute MI? Are all coders aware of the universal definition? I’d like to see it addressed in CC before the new CMS fiscal year. That doesn’t leave alot of time.

Here’s a short summary. The expert consensus document is here.

Open Document Formats

necnos — Sat, 24 May 2008 13:04:25 +0000

New York State has issued a report from their study on document formats and electronic records. The report is available for download as a Word document (doc), PDF or open document format (ODF). I opted for the ODF because it’s smaller and I have OpenOffice available (for free) to read it. The major recommendation of the study is a good one.

Recommendation: The State Legislature should not mandate in statute the use of any specific document creation and preservation technologies, as technologies can easily become outdated.

I agree. Many people want to force Word as the only choice in document creation and distribution. I try not to use Word but instead prefer Lyx. Lyx uses the WYSIWYM (What You See Is What You Mean) approach for document creation. In other words, don’t worry about trying to format the page or create paragraph templates because the application will do it for you. LyX uses Latex. LaTeX (pronounced /ˈleɪtɛx/ or /ˈleɪtɛk/) is a document markup language and document preparation system for the TeX typesetting program. Within the typesetting system, its name is styled as . LyX creates beautiful documents that can be saved in many formats including PDF. Get the GUI and try it. I think more options are better.

Gears with Googledocs

necnos — Sun, 11 May 2008 21:24:54 +0000

Just to follow-up from an earlier thought, gears with googledocs is great. Work offline and when you go online, your docs, spreadsheets or presentations are updated automatically. I’m impressed. If you don’t have gmail or googledocs, get an account. You won’t regret it.

HR 4105

necnos — Fri, 18 Apr 2008 22:44:54 +0000

I’m not sure if I agree with AHIMA’s advocacy in favor of HR 4105, to impose a moratorium on the use of recovery audit contractors (RAC) under the Medicare Integrity Program. While I understand there have been issues in the demonstration project, the job of audit recovery is to find payment and collection errors. Many of the inpatient coding problems associated with RAC denials are due to problematic coding advice i.e., “Clarifications” and grouper inconsistencies. Should an excisional debridement qualify as an “operating room” procedure? I would probably move it to a “non-OR” status in this day and age. I would think that the government would want to have a RAC look closely at a new (actually not so new) MS-DRG severity system to help find those payment errors. There is a clear winner when you compare the RAC results with previous QIO (or PRO or PSRO) efforts.

Here’s the content of the bill.

If you get a chance when on the THOMAS Library of Congress site, select the GPO’s PDF display (of the bill). Click on “Continue to the GPO” site. Save the file, “getdoc.cgi” to your desktop. This is the actual bill as it appears in print. Change the file name to have a PDF extension (e.g., hr4105.pdf). Now open the PDF file and view a beautiful Congressional document. Here’s a Wikipedia article on the Common Gateway Interface.

TACT

necnos — Sun, 13 Apr 2008 14:48:06 +0000

The Trial to Assess Chelation Therapy (TACT) is recruiting volunteers at 163 locations across the country.

EDTA chelation therapy involves repeated administrations of a synthetic amino acid to reduce atherosclerotic plaque and other mineral deposits throughout the cardiovascular system.

Participants will be randomly assigned to receive 40 infusions of either the standard chelation solution or placebo. The primary endpoint of this trial will be a composite of all cause mortality, myocardial infarction, stroke, hospitalization for angina and hospitalization for congestive heart failure.

The results of TACT will provide either a significant positive result or an informative null result upon which rational clinical decision-making and health policy can be based.

Chelation therapy with EDTA is also being tried with peripheral vascular and cerebrovascular disease. Click on the STAT podcast (see sidebar) for “Rife With Strife, #2″. TACT is significant because of the implications for changing the landscape of therapy. Reduce or eliminate CABG and PTCAs? CEAs and carotid stents? Fem-pop? I hope this study succeeds. The upside benefits are enormous.

Goodbye JCAHO, Hello NIAHO

necnos — Sun, 13 Apr 2008 14:01:32 +0000

In case you missed the news, there will soon be an alternative in health accreditation.

Det Norske Veritas (DNV) has applied to CMS to become a hospital accreditation service. Unlike the JCAHO, DNV will use ISO 9001 Quality Managment System standards in the accreditation process.

DNV HealthCare Inc. has developed the National Integrated Accreditation for Healthcare Organizations (NIAHO^SM ) program as an alternative to current accreditation paths.

NIAHO^SM is the first Integrated AccreditationSM program for hospitals in the United States. DNV HealthCare Inc. defines Integrated AccreditationSM as a program that utilizes two or more independent sets of standards operating in the same audit process to produce one set of outcomes. NIAHO^SM integrates the internationally recognized ISO 9001 Quality Management System standard with Medicare’s Hospital Conditions of Participation. The result is a fresh, new approach helping hospitals to improve patient care and safety in an economical manner without the aggravation of current accreditation options.

The JCAHO people should be concerned. Competition is long overdue. I can remember the great hospital JCAHO preparation process leading up to the feared survey. Unfortunately, if was never meant to protect the consumer or bring real change to healthcare delivery.

Go DNV.

Gears

necnos — Sun, 13 Apr 2008 12:29:03 +0000

Google Gears is ready to change the way you think. You can now work offline on your favorite documents and “gears” enabled web applications. Then when you go online, gears automatically updates the web application. I tested it out using the web based task app, Remember the Milk. Sure enough I was offline, added a few tasks, then went back online. The task calendar recognized the offline content and updated my agenda. Truly amazing. Check here for the details from the Google development team. Next up, using Gears with GoogleDocs.

UHDDS

necnos — Wed, 26 Mar 2008 19:27:11 +0000

I was trying to find the latest info on the uniform hospital discharge data set (UHDDS) from the National Committee on Vital Health and Statistics (NCVHS). The NCVHS website search was not very helpful, but there is a “Core Health Data Elements Report” from 1996. I remember the 1992 revision and still have the Federal Register documentation (July 1985) for the 1984 Revision of the Uniform Hospital Data Set. I’m curious about how this statement has survived in The Official Guidelines for Coding Reporting.

“C. Two or more diagnoses that equally meet the definition for principal diagnosis
In the unusual instance when two or more diagnoses equally meet the criteria for principal diagnosis as determined by the circumstances of admission, diagnostic workup and/or therapy provided, and the Alphabetic Index, Tabular List, or another coding guidelines does not provide sequencing direction, any one of the diagnoses may be sequenced first.”

Is it really an unusual instance or another case of something that has survived beyond its practical use? Based on the frequency of official “clarifications” it seems like we need to revisit coding guidelines and provide better working definitions for the 21st century. Maybe the committee should plan on having more frequent UHDDS modifications and updates.

Drug-induced liver injury (DILI)

necnos — Wed, 12 Mar 2008 00:46:20 +0000

Apparently drug-induced liver injury (DILI) is difficult to find using administrative data. This study looked at DILI due to amoxicillin/clavulanic acid, phenytoin, valproic acid, and isoniazid. Coders need to be aware of DILI since the study tried three different methods to identify cases and had very few hits. I think that a greater emphasis on E-codes would help to improve identification of this and other drug related diagnoses. “Use of ICD-9-CM codes to identify rare adverse events like DILI remains problematic and highlights the need for prospective surveillance networks.” Here’s the DILIN web site and more info on the studies. Spread the word.

IT and Carr

necnos — Sun, 09 Mar 2008 19:56:23 +0000

(this old post got lost in the import from blogspot)Just finished the follow-up article by Nicholas Carr, The End of Corporate Computing. I like the concept – IT as a utility, just like electricity at the turn of the 20th century. His earlier article, IT Doesn’t Matter sets the stage for what should be a monumental change in the way we compute.

Why do some companies spend millions on Microsoft products, replicated at the PC level? Not a good use of capital. It also hinders the move to an EHR. Carr says that virtualization, grid computing and web services will replace the PC and all that redundancy.

What does this have to do with ICD-9-CM? It might mean that companies wouldn’t have to fret over the MS-DRG grouper transition or worry about distributing copies of an encoder to a user’s PC. Think about the next time you plug your PC into an outlet. It’s only a utility.