>>>>Good afternoon everyone.
You guys ready to move onto something other than GG?
Okay!
So I'm going to be working on Section I with all of you.
My objectives for today are that we're going to illustrate a working knowledge of Section
I, active diagnoses.
Articulate the intent of Section I. Interpret the coding options for each item and apply
coding instructions in order to accurately code practice scenarios.
Section I is similar to the assessment that we currently complete with IRF-PAI Version
1.3.
The items in this section have been consolidated for Version 1.4.
Section I is only assessed at admission because they are used for risk adjustors.
This next slide shows how we're going from Version 1.3 to Version 1.4.
So in Version 1.3 which we currently do right now for peripheral vascular disease and peripheral
arterial disease, they're two separate codes.
Moving forward we'll be coding it under one code, I0900.
Diabetes mellitus, diabetic retinopathy and diabetic nephropathy and diabetic neuropathy
all currently have their own codes.
Moving forward in October they'll have one code, which is I2900 and there's a code for
none of the above, which is code I7900.
It's important to record the presence of active diagnoses.
Because select diagnoses, including peripheral vascular disease and peripheral arterial disease
and diabetes mellitus influence a patient’s risk for developing or worsening pressure
ulcers.
Let's look at some coding instructions.
A diagnosis that is active will have a direct relationship to a patient's current functional,
cognitive, mood, or behavior status.
Medical treatments, nurse monitoring or risk of death at the time of assessment.
We're going to code a disease or a condition that are considered active and are documented
in the medical records at the time of assessment.
This section is a multi-select assessment so you would check all that apply.
There must be specific documentation in the medical records by a physician, a nurse practitioner,
a physician assistant, a clinical specialist, or other -- nurse specialist or other authorized
licensed staff if allowable under state licensure laws.
That the diagnoses or condition is being considered active.
So let's look at some areas of where we find this in the medical record.
Specific documentation areas in the medical record may include, but are not limited to,
progress notes, admission history and physical, your physician assessment, your PAPE, Patient
Assessment of Physician Evaluation, your transfer notes and the hospital discharge summary.
The physician or authorized licensed staff will specifically indicate that a diagnosis
is active.
You want to check that you have an active diagnoses documented by a licensed practitioner.
It's important to note that Section 24 comorbidity conditions on the front page of the IRF-PAI
and Section I, active diagnoses may not always agree, which is okay.
There are different rules to each section.
Let's look at an example.
A physician documents on the post admission physician evaluation, or the PAPE, that the
patient has inadequately controlled diabetes and requires adjustment of the medication
regime.
That is enough documentation and would not require any additional information from the
physician.
There was a documented diagnose and it was confirm that the medication regime would need
to be modified.
Okay, so now we're going to do a practice coding scenario.
You'll pick up your little hand-held devices and we're going to go over this next scenario.
So Mr. A is prescribed insulin for diabetes.
He requires regular blood glucose monitoring to determine whether blood glucose goals are
achieved by the current medication current regime.
The PAPE documents diabetes.
Mr. A does not have Peripheral vascular disease or peripheral artery disease.
How would you code section I?
Talk at your table and come up with an answer.
Would you check A, peripheral vascular disease or peripheral arterial disease?
Check I2900 diabetes, check C, both I0900 and I02900.
Or D check none of the above.
That was quick.
(Laughter) So everybody chose the answer B. That is correct.
This would be considered the active diagnoses because the PAPE documents, the diabetes diagnosis
and because there's ongoing medication management and glucose monitoring.
We'll try one more practice coding scenario.
Mrs. I underwent a below the knee amputation.
She requires dressing changes to the stump and monitoring for wound healing.
Peripheral pulses are being monitored.
The nurse practitioners notes document peripheral vascular disease, below the knee amputation
and uncontrolled diabetes.
Blood sugars are being monitored and insulin doses are being adjusted.
Use your coding device.
Would you check A PVD or PAD, B diabetes, C both PVD or PAD and diabetes?
Or D, none of the above?
All right.
Let's see what everybody has.
Perfect.
100%, everybody chose C both I0900 and I2900.
Both of them would be checked because peripheral vascular disease and diabetes are considered
an active diagnoses.
The nurse practitioner documented it both in her progress notes, the peripheral pulses
and blood sugars are being monitored and insulin regime is being adjusted.
There's the rationale for that.
In summary, Section I is only coded at admission.
This section is not new, just consolidated.
There must be in the medical record documentation from authorized licensed staff.
And you also want to remember that your ICD 10 codes in Item 24 of the IRF-PAI may not
match your Section I diagnoses.
Let's take out your Action Plan.
The following are some ideas to get you started.
Think about how you currently complete the Active Diagnoses Section.
Does your process work or are there opportunities for improvement?
Maybe review your current documentation.
Does it align with the changes of 1.4?
As I always say to my kids, practice makes perfect.
So practice coding a variety of scenarios.
Any questions about Section I?
We're going to need you to go over to the microphone.>>>>Could
you just explain a little bit more why Section 24 in Section I wouldn't match?
>>>>So both of those sections have different rules and that's why they would not necessarily
need to match.
Are there any other questions?
>>>> Would you provide some additional examples of what we need for someone to document to
classify PVD or PAD as "active"?
Checking pulses may not be ordered.
Can you look at medication for anticoagulation, ABIs?
We need some more examples for active diagnoses.
>>>> Sure.
I can confer with the staff and we can come up with some more examples for you for active
diagnoses.
>>>> My question is sometimes we get a patient with amputation -- our physician would say
that the condition is already resolved with the amputation, so do we still code that?
Or -- because amputation was due to that condition.
But physicians will say, now with the amputation, it's already resolved.
So can we still code that or no?
>>>> So, what I'm gathering your question is that a patient has come in, they had a
history of peripheral vascular disease in one limb only.
They had an amputation and now your physician is saying, it's no longer active.
>>>> Right.
So that in that case we wouldn't code it because supposedly it's been resolved with amputation,
even though it's what led to the amputation?
>>>> Correct.
Okay.
Any other questions?
>>>>>Excuse me.
I would ask for additional clarification on that response, because to address the question
that the lady posed here, peripheral vascular disease is systemic, so if it's present in
one of the extremities it's going to be present in the other, unlike arthritis which might
be due to an injury to one knee.
To fix a total joint you’ll fix that arthritis, whereas PVD will be present in both extremities
and not just the one.
>>>>Is it the same injury or vascular area -- when I clarified her question, it was you
need to refer back to your physician is saying.
When I clarified her question, the question was that once the amputation took place the
physician is documenting that peripheral vascular is no longer present.
So if your physician is documenting that, then you can't code that.
While I agree with you, that usually peripheral vascular disease is systemic and both limbs
would be affected if your physicians saying it's gone -- it's gone.
(Laughter) Are there any other questions that I can answer for you today?
Thank you very much.