-: Thank you, Kristie. So hello again.
For those of you who weren't on earlier, I'm Brenda Karkos,
and I'll be presenting Section O:
Special Treatments, Procedures, and Programs.
I am a registered nurse
with experience in direct patient care, education,
and nursing administration.
And my experience includes inpatient care,
outpatient oncology, home health and hospice settings.
And currently, I'm an associate
at Abt Associates in Cambridge.
So I'll just start by explaining the implications
for each setting for this item O0110.
So for the IRF setting, this is a completely new item,
and this is a bit different for LTCH because LTCH,
there were already some data elements for O0110.
However, most of these data elements
are also completely new for the LTCH setting.
One element that was in the LCDS was O0110N,
total parenteral nutrition, and this has now been removed.
So the intent of these items in this section
is to identify any special treatments, procedures,
and programs that apply to the patient on admission
and then again on discharge.
And this is just a screenshot of the items
with all the procedures and treatments listed
that would be checked on both admission and discharge,
and the actual items that has a column A for admission
and column C for discharge.
And just for your reference,
hopefully you're following along with your own item set,
but this item is located on page 16 and 17 for the IRF-PAI
and on pages 21 and 22 for the LCDS.
So here's our first practice scenario for O0110.
This patient was discharged from the hospital
following an acute care inpatient stay for pneumonia.
On admission to post-acute care setting,
the patient requires continuous oxygen and IV antibiotics
for five days through a peripheral line
in addition to some respiratory therapy for chest PT.
Now let's go to our first polling question.
So how would you code O0110 for this patient?
Is it A, C2 continuous, H3 antibiotics and O2 peripheral?
Or B, C1 oxygen therapy,
C2 continuous, H1 IV medications, and H3 antibiotics?
Or C, C1, C2, H1, medications, H3 antibiotics,
O1 IV access, and O2 peripheral?
Or is it D, C1, H1 IV medications, and O1 IV access?
And I'll give you a few more minutes to consider that
and respond to the poll.
Well, it looks like most of you checked C.
And if you did, that answer was correct.
65% of you chose the answer C.
So you would check oxygen therapy, continuous,
the IV medications, as well as antibiotics,
IV access, and O2 peripheral.
And here's the rationale.
On admission, this patient is receiving
the continuous oxygen, has a peripheral IV line,
and is also receiving IV antibiotics.
Okay, so now let's look at practice scenario number two.
This patient was admitted to a PAC facility
after being discharged from acute care hospital
following a pathologic vertebral fracture
related to osteoporosis.
While hospitalized, the patient was also transfused
with two units of packed red blood cells
to treat a new diagnosis of severe anemia.
At the time of admission, the referral documentation
and physician orders only include
pain medication with Tramadol,
anti-osteoporotic medications, and physical therapy.
Lab work to evaluate the anemia
is scheduled to be repeated in two days.
So now let's look at a polling question.
How would you code O0110 for this patient?
Is it A, H10 other and I1 transfusions?
Is it just I1 transfusions or is it Z, none of the above?
I'll give you a few seconds to answer that.
Okay, so it looks like most of you,
more than half of you answered Z, none of the above,
and that would be the correct answer.
And let's look at the rationale for that.
So this patient is receiving medications
for pain and osteoporosis.
Physical therapy is also ordered.
However, neither medication is being given IV
and PT is not listed under special treatments,
procedures, and programs.
So the transfusion that occurred is in the past
and it's not currently included in her orders either.
So therefore, the response would be Z1, none of above,
that's the best answer.
Okay, how about practice scenario number three?
This patient was admitted to a PAC facility
after surgery for a fractured hip.
They have a history of sleep apnea and have been independent
with their CPAP device for many years.
Due to the mobility issues, the staff will need to set up
the humidifier element of the CPAP for this patient.
However, the patient can put on the mask
independently at bedtime.
The admission orders include oral medications
for high blood pressure, high cholesterol,
and an anticoagulant, in addition to PT.
I'll give you some time to consider this
and then we can move on to the question.
So how would you code O0110 for this patient?
Is it A, F1 invasive mechanical ventilator
and H10 other under medications?
B, G1 noninvasive mechanical ventilator
and H10 other under medications?
Or C, G1 and also G3 CPAP?
Or G1, H4 anticoagulation and H10 other?
Okay, I think we can close,
so it looks like most of you went between C and D,
but the majority 63% answered C,
which is the correct answer, excellent.
And the rationale is that
although this patient is on an anticoagulant,
O0110H4 anticoagulation is not checked
because this is given orally
and not through the IV for this patient.
They're also currently using the CPAP machine at bedtime,
so G1 for this item may be checked if the patient places
or removes their own CPAP,
or even if the staff applies it for the patient.
And you would also check G3 for the CPAP.
Okay, here's a continuation of this very same patient
in scenario number three.
This patient did well with rehab
and was independently ambulating with a cane for safety.
However, just prior to discharge from the facility stay,
an infection developed at the surgical site
resulting in a need for IV antibiotics.
The patient still wish to return home as planned,
so the peripheral line was replaced
with a heparin lock to maintain access
for the last four doses of IV antibiotics.
Discharge to home with a local home health agency
was arranged and included orders for the CPAP,
IV antibiotics, as well as the oral medications
for high blood pressure, high cholesterol,
and the anticoagulant.
So how would you code O0110 for this patient on discharge?
Is it A, G1 non-invasive mechanical ventilator
and H1 IV medications?
Or B, G1, G3 CPAP, and H3 antibiotics?
Or C, G1, H1 IV meds, H3 antibiotics, and H4 anticoagulant?
Or D, G1, G3 CPAP, H1 IV medications, H3 antibiotics,
O1 IV access, and O2 peripheral?
Please take a few seconds to answer that poll.
Okay, I think we can close the poll.
All right, so it looks like most of you, 75%,
answered D, which is actually the correct answer.
And the rationale is that O0110H3 antibiotics is checked
because this is given IV.
The oral medications are not checked.
This patient is still using the CPAP machine at bedtime,
so you would check G1 and G3 for the CPAP.
And in addition, the patient's returning home
with a peripheral line,
so you would also check O1 and O2 peripheral.
Okay, so let's go through one more
practice scenario, number four.
This patient was admitted to the LTCH facility
after an acute care hospitalization related to chest pain
and difficulty swallowing.
The diagnosis was esophageal cancer.
They were discharged to your facility
with orders for radiation and IV chemo via a central line.
The medications are carboplatin and paclitaxel.
There are also orders for physical therapy
to improve strength and function
and promote as much independence as possible.
So in this scenario,
how would you code O0110 for this patient?
Is it A, A1 chemotherapy, A2 IV, B1 radiation,
O1 IV access, and O4 central?
Or B, both A1 chemotherapy and A2 IV?
Or C, A1, A2 IV, and H1 IV medications?
Or D, A1, A2 IV, B1 radiation,
H1 IV medications, O1 IV access, and O4 central?
I'll give you a few seconds to consider that.
Okay, I think we can close the poll.
And it looks like most of you answered D.
However, the answer is A, A1 chemotherapy,
A2 IV, B1 radiation, O1 IV access,
and O4 central would be checked.
And the rationale for this
is the patient is currently receiving IV chemotherapy
via a central line in addition to the radiation.
The IV access would also be checked
along with the route, a central line.
IV medication is included in the chemotherapy response,
so you would not check IV medication.
Physical therapy would not be included
since it is not a choice in this item.
And just a few key insights to close on coding Section O.
Complete O0110 items as close to the admission
and discharge as possible.
Services provided solely in conjunction
with a surgical procedure or a diagnostic procedure
should not be included, such as an IV medication.
Medication should be evaluated to determine its route
and the reason for use before coding.
Bi-level positive airway pressure, a BIPAP,
or a CPAP may be coded if the patient places
or removes their own mask.
And IV medication and blood transfusions
administered during chemotherapy are not recorded
under O0110H1 IV medications.
So thank you for your attention
and hope you enjoyed these coding scenarios today.