e-Newsletter
May 2010

President's Message
Candidates for 2010-2011 GHIMA Board of Directors Election
Annual Meeting Program
Central Office Coordinator Position
V66.7 Coding Roundtable
E-news from AHIMA
AHIMA Recertification Update
CMS Tightens Documentation and Signature Requirements

 
President’s Message

GET READY! GET READY! GET READY!
WE HAVE 75 YEARS TO CELEBRATE!!!

Greetings GHIMA,

The online registration for our Annual Meeting is available. Let’s break the record for attendees at our annual meeting. Don’t forget to include the number of years you have been in the medical records/health information management profession when you register to attend. We really need those old pictures. Do not wait until the last minute to sign up for the annual meeting. The committees are making plans.

Please click here to sign up as a volunteer for the annual meeting. We need your assistance.

I would like to express my gratitude to all members that work so diligently to make GHIMA what it is today. This means YOU! And I salute YOU! We realize time is a concern for everyone and with each of us contributing, the tasks is smaller.

It is election time. Thanks to those members who agreed to be placed on the ballot for leadership positions on the Board of Directors of GHIMA.  As I write this message 208 of you have cast your ballot in GHIMA’s election! Now, for the remainder of the membership, please vote.  Don’t forget to vote in the AHIMA and your Regional elections as well. Please vote and support leadership.

Welcome to Belinda King, BBA, CCS, CCS-P CPC, CPC-H FCS, PCS, CPAR. Brenda has agreed to serve as COP facilitator for the remaining of this term. Thank you Brenda.

There are many demands on us as professionals. We continue to work hard and provide quality service to all of our “customers”. GHIMA’s goal is to encourage and provide resources that help meet the needs of our membership and ultimately our customers. Our Program/Education committee is critical to this process. The workshops and educational sessions are planned to help meet your needs.  Let us know if other topics should be added in the future. The first roll-out for ICD-10 is the sessions planned in this upcoming meeting. We encourage everyone to take advantage of the refresher sessions in preparation for ICD-10 on Wednesday morning, August 4, 2010. See the agenda for the entire meeting on our website.

This month’s newsletter has a wealth of information. Coding Roundtable, AHIMA re-certification, AHIMA’s new website design, CMS more stringent criteria for documentation and signatures, Annual Meeting plans, and the initial call for applicants interested in the COC position. Thanks to all contributors and our editor, Sandra S. Williams, RHIA CPHQ.

As always my door (email) is always open and I am as close as your phone.

It is a privilege to serve as your President,
Sandra B. Williams, RHIT

Candidates for 2010-2011 GHIMA Board of Directors Election

GHIMA’s Nominating Committee is pleased to announce the following slate of candidates for vacant positions on the 2010-2011 GHIMA Board of Directors:

President-Elect:
  • Theresa Hall, RHIT, ACPAR
  • Charlotte McCuen, M.S., RHIA
1st Year Delegate:
  • Ginger Canale, RHIA
  • Michele Hartin, RHIT
Director:
  • Barry S. Herrin, J.D., FACHE
  • Nanette Sayles, Ed.D., RHIA, CHP, CCS
  • Kay Zettler, RHIT
Nominating Committee:
  • Shawana Burch, RHIA
  • Shelley Waid, RHIA
  • LaSha Cofer, RHIA
The polls will open for eligible voters at 8:00 a.m. on Monday, May 10, 2010, and will close promptly at 5:00 p.m., on Monday, May 31, 2010.  Voting is a right of every active GHIMA member, so be sure to vote.

Annual Meeting Program
Program and Education
Ginna Evans, MBA, RHIA

The annual meeting will be held August 4-6, 2010 at the Renaissance Waverly Hotel in Atlanta, Georgia.  The Wednesday morning workshops will provide two offerings.  The first is a refresher course on anatomy and physiology as well as terminology.  If you’ve been reading about the implementation of ICD-10, then you will know one of the many recommended activities is this type of refresher course.  If you are a coder, mark your calendar now and make plans to join us that morning.  The other workshop will be on project management.  The instructor will actually use the topic of ICD-10-CM planning and implementation to teach attendees the basics of project management.  Project management is a tool we can all apply to various tasks whether work related or even at home, so even if ICD-10 planning isn’t your responsibility – you can learn how to apply this process to other jobs/tasks.  Plan to join us for this fun and informative workshop.  Wednesday afternoon will start with the keynote speaker, Doug Keeley.  Doug is the CEO and Chief Storyteller of The Mark of a Leader and a self professed “leadership junkie.”  He believes that great organizations are built on great stories and storytelling – and great stories work on multiple levels: they spark imagination, challenge the mind, touch the heart, and cause the hands to take action.  Several of us got to hear Doug at the AHIMA National Convention in Grapevine, Texas last year and know you will be energized by his two presentations – The Mark of A Leader and Five Level Leadership.

Thursday’s sessions will be built around four different tracks – coding, eHIM, management, and a variety track of topics that don’t fall into the other categories.  Come hear about many topics including RAC’s, Breaches of Unsecured PHI, Meaningful Use, Automated Workflows and How They Benefit an HIM Department, ICD-10 Code Sets, The Joint Commission (TJC), EMR for Long Term Care, and many other educational sessions. 

Friday’s sessions will be more general and one of the features will be Alan Dowling, PhD, the new CEO of AHIMA.  In addition, we will conclude the meeting with our annual Joint Commission update.

The program has been posted so click here for more information and make plans to join us.  This year GHIMA is celebrating 75 years so come out to hear and see many stories and information about the beginnings of GHIMA. 

Central Office Coordinator Position

The Georgia Health Information Management Association (GHIMA) seeks a Central Office Coordinator (COC).  Under the direction of the GHIMA Board of Directors (BoD), and through the President of GHIMA, the COC coordinates delegated professional and support staff functions of the GHIMA in six (6) functional categories: Financial, Program and Educational Support, Information Services, Administrative Support, Publications and Promotional Materials, and Office Operational services.  The selected candidate must cooperate and collaborate with other GHIMA members, as well as comply with all GHIMA Bylaws, Policies and Procedures.

Requirements:

A. Shall be an Active member of GHIMA.
B. Previous GHIMA Board and/or committee experience required.
C. AHIMA credential, i.e., RHIT or RHIA.
D. Prior experience in health information management.
E. Good verbal and written presentation skills.
G. Office skills, including:  accounting, office management, and knowledge of the Microsoft Office suite of software.
H. Attendance at GHIMA and/or AHIMA meetings.
I.  Initiative, resourcefulness, substantive judgment, and ability to coordinate many projects simultaneously.
J.  Home office space required.

Interested candidates may send resumes to: lori.nobles@mckesson.com.  Resumes must be received no later than June 18th, 2010.

V66.7 Coding Roundtable
Tammy Phillips

Question:

An elderly patient with metastatic lung carcinoma is admitted with fever and chills and is diagnosed with pneumonia and urinary tract infection. The principal diagnosis is pneumonia. During the hospitalization, the patient develops severe sepsis and respiratory failure requiring a ventilator. On the day before the patient expires, she is extubated and taken off of Levophed. On the day she expired, the physician documented, "extubated yesterday with goals of comfort/ palliative care." In addition, the physician's plan states, "Continue palliative approach to respiratory failure--increase Morphine to limit work of breathing, stop intensive monitoring, consult palliative care service, continue scopolamine." The patient expired an hour after this note was written. Is it appropriate to assign code V66.7, Encounter for palliative care, as a secondary diagnosis in this situation?

Answer:

Yes, it would be appropriate to assign code V66.7, Encounter for palliative care, as a secondary diagnosis in this case. This code may be reported for any terminally ill patient who receives palliative care, regardless as to when the decision is made. There is no time limit or minimum for the use of this code assignment. As stated in Coding Clinic, First Quarter 1998, pages 11-12, "Code V66.7 can be used for any terminally ill patient receiving palliative care. It is always a secondary code. The terminal condition should be the principal diagnosis. It may be used when a patient is brought in for aggressive treatment for a terminal condition and during the encounter it is determined that further aggressive treatment is no longer appropriate and palliative care is initiated."

Reference:  Coding Clinic, Third Quarter 2008, Page: 13 to 14 Effective with discharges: September 19, 2008
E-news from AHIMA
Submitted by Jennifer McCollum

I.     New Look for www.ahima.org

AHIMA has unveiled a redesigned version of its web site, www.ahima.org. Nearly two years in the making, the redesign will include new and expanded content on HIM topics to provide information AHIMA members need on the job. The site was redesigned to make it easier to find popular features such as AHIMA certification and recertification, online education opportunities, the job bank, and membership renewal. It also will feature a new consolidated events calendar. In addition, www.ahima.org will continue to provide direct links to the Communities of Practice and the AHIMA Body of Knowledge. Changes to the design and navigation of the site were based on online and e-mail surveys of users, Web site usability testing, interviews with users, analysis of competitive Web sites, and site analytics. AHIMA members who have saved or bookmarked favorite pages should be aware that the URLs for all ahima.org pages will change. Please be prepared to update your bookmarks.

Research shows that www.ahima.org is one of the most valued AHIMA member services.

II.    CSA Leadership and Delegate Message to Members

In June delegates will be voting electronically on one or two bylaws amendments. The House Team on House Operations is bringing forward either one or two proposed amendments to the AHIMA Bylaws. The House Team on Best Practices/Standards Team is bringing forth a proposed resolution titled “Leading the Transition to ICD-10,” and the AHIMA Clinical Documentation Improvement e-HIM workgroup is bringing forth ethical standards for CDI professionals.

III.   AHIMA Election

Visit the “AHIMA Election” section of the CoP to review the 2010 candidate photos and brief bios. You will be able to interact with candidates via the Candidate CoP May 24–June 5. The AHIMA election is June 7–25.

AHIMA Recertification Update
Submitted by Nanette B. Sayles, EdD, RHIA, CCS, CHPS, CCS

The transition from ICS-9-CM to ICD-10-CM/PCS making a lot of changes to the way we do business.  We have to update our information systems to accept the new format and rules.  We have to forget all of the codes we have memorized over the years.  We have to update the forms, the chargemaster and much more.  Now the latest change is how those of us with AHIMA certifications retain our credentials.  During the period of January 1, 2011 through December 31, 2013, AHIMA credentialed professionals must earn continuing education hours on ICD-10-CM/PCS in order to retain the credential(s). 

The number of CEU hours required by AHIMA varies by credential:
·    CHPS – 1 CEU
·    CHDA – 6 CEUs
·    RHIT – 6 CEUs
·    RHIA – 6 CEUs
·    CCS-P – 12 CEUs
·    CCS – 18 CEUs
·    CCA – 18 CEUs

It is important to note that if you have multiple certifications, you only have to meet the highest number of CEUs required by your certifications.  I will use myself as an example.  I am a RHIA (6 CEUs), a CHPS (1 CEU), and a CCS (18 CEUs).  I do not have to earn the 25 CEUs required by adding the CEU requirements of all of my credentials together, but I only have to earn 18 CEUs as required by the CCS.  It is also important to note that this change does not increase the number of CE hours required for your normal recertification cycle but rather controls the type of content included.

Stay tuned for more information on educational opportunities.  For additional information, please go to:  http://www.ahima.org/certification/recertification.aspx

CMS Tightens Documentation and Signature Requirements (Impact of More Stringent Review Criteria)
Theresa Hall, RHIT, ACPAR

The Centers for Medicare and Medicaid Services (CMS) recently tightened the signature guidelines for medical review purposes.  These new guidelines implementation date was April 16, 2010, affecting all physicians, non-physician practitioners, and suppliers submitting claims to Medicare Fiscal Intermediaries (FIs), Part A/B Medicare Administrative Contractors (A/B MAC), Carriers, Regional Home Health Intermediaries (RHHIs) and/or Durable Medical Equipment MACs (DME MACs) for services provided to Medicare beneficiaries.

CMS issued CR 6698 to clarify for providers how Medicare claims review contractors review claims and medical documentation submitted by providers.  CR 6698 outlines the new rules for signatures and adds language for E-Prescribing.  Refer to the MedLearn Matter Article MM6698 for complete details.

Historically, The Comprehensive Error Rate Testing (CERT) contractors would review available documentation, including physician orders, supplier documentation, and patient billing history, then apply clinical review judgment as well as consider an unsigned requisition or physicians’ signatures on test results.

Key points of CR 6698 are as follows:

The Comprehensive Error Rate Testing (CERT) contractors will now require:
  • medical records from the treating physician and does not review other available documentation or apply clinical review judgment;
  • evidence of the treatment physician’s intent to order tests, including signed orders and/or progress notes;
  • Disallows entries if a signature is missing or illegible;
CMS has instructed CERT contractors to follow the letter of the law in determining whether a claim has been billed properly and if there is sufficient documentation present to support the need for services.  Thus, each claim must stand alone and be supported by documentation clearly showing the intent of the ordering physician and the reasons for ordering the service(s) for that episode of care, with orders that are complete and signed.

Further details related to signature were published in Transmittal 327 of the Medicare Integrity Manual (100-08), released on March 16, 2010.  The signature guidelines apply to reviews conducted by Medicare Administrative Contractors (MACs), CERT Contractors and Recovery Audit Contractors (RACs).

Providers still accepting rubber stamp signatures should act immediately to enforce these new signature guidelines to avoid loss in revenue.  CMS states that providers should not add late signatures to the medical record (beyond the short delay that occurs during the transcription process), but instead use the signature authentication process.  This process require the author of the order to sign an attest that he/she is the originator of the order, and does not allow for anyone but the ordering/treatment physician to make the attestation.  While there is currently no specified format or language for the attestation, a suggestion is included in the transmittal.  An important note to remember, the signatures must be complete and legible.  If a signature is illegible, there must be a typed or printed name next to the signature.  Initials are no longer acceptable as signature without further documentation (attestation, signature log, typed or printed name next to the initials, etc.)

Providers need to start assessing the impact and conduct their own audits to ensure that complete and accurate orders (supporting documentation for medical necessity) are being obtained to support billing.