ࡱ>  4bjbj wf{{, NNNNN$rrrr<rs:::::sssssss$$vxz9sN9sNN::Ns   N:N:s s  ah:O֦dHrds0sePyI`PyhhPyNkx 9s9s`sPy : Finger Lakes Regional Perinatal Data System Regional Perinatal Center U of R Medical Center 601 Elmwood Avenue Box 668 Rochester, NY 14642 Phone: 585-275-4930 Dept. of Public Health Sciences 265 Crittenden Blvd. Cu420644 Rochester, NY 14642-0644 Phone: 585-276-3349 Fax: 585-424-1469 1/13/2016 Coder Meeting Minutes Present 5 Coders representing 4 FLR hospitals -Introduction of Coders -Handout from Dr. Glantz regarding the importance of vital records see attachment Data Integrity Learning points (review): Keep lines open to your Billing Dept -Community insurance is Medicaid -Blue Cross Option is Medicaid -Community care is other -Insurance handout (not updated since originally distributed) -Fidelis (doesnt usually have a CIN#) -Preeclampsia=GHTN Continue to keep in mind that if PreE is marked you also have to mark GHTN -When maternal exhaustion is noted as the reason for C-sect or vacuum extraction code as failure to progress. Genetic screening- Revised Handout see attachment Comparing 2015 and 2014 data Dr. Glantz found that some hospitals still do not understand the difference between genetic screening and genetic testing. Dr. Glantz suggests that the coding is not difficult once one gets past the semantics: Amnio, CVS, karyotyping = testing; All other genetic tests = screening. Dr. Glantz: The Guidelines define testing this way, although have not, to my knowledge, been revised to include NIPT (non-invasive patient testing) in the section on MSAFP/Triple Screen (itself antiquated terminology, given that the triple screen was replaced years ago by the quad screen). Dr. Glantz has been discussing a revision to the Guidelines with DOH. Nonclassifiable reports -Letter was sent from Dr. Glantz to OB chiefs Asking that PNC info be available for Coder to code. Coders, present at the meeting, have not yet notices an improvement in the completeness of prenatal information.. -Tobacco: When possible, find out when and # of cigarettes smoked but when its not possible to get this information continue to use 99 as needed. Its important to code mother as Yes if she is a smoker even if you dont know the amount or timing. This field will continue to be reported on the unclassifiable reports in 2015 (so 99 will appear as missing) but after 2015 the reports will change and this may not be an issue in the future. We discussed how the info was obtained and as could be expected there were 5 coders in attendance with 5 different answers. In this case there was no wrong answer (. From a researcher It is most important to know that the woman smoked It is a bonus to know how many cigarettes. Coding decision -Hookahs & tobacco: The ruling stands with NCHS, they only want tobacco use delivered by traditional cigarettes, so hookah usage would not be reportable. Could be one of the reasons behind their ruling,it would probably be very unreliable to be able to distinguish between tobacco-based hookahs and those that involve water or other substance. So tokeep things simplified, just the number of regular tobacco-based cigarettes smoked. -Hookahs-It the mom admits to using a hookah. Ask what she fills it with. If it is not tobacco you may want to enter a yes for illegal drugs. Discrepancy reports L Schoens 12/15 email stated that NYSDOH understands the difficulty coding Medicaid due to time constraints for filing BC and changes in payment status during/after mothers hospitalization. He asks that when the next discrepancy report is issued coders make corrections according to what SPARCs has coded for insurance, checking at least some of their records to ensure that they are not making coding errors (due to internal processes), thats once identified could be corrected making future coding more accurate. Barb has sent a question to the state for further clarification as when we reviewed a discrepancy report the self pays were compared to Medicaid rather than SPARCs. More info to follow. Barb response from L Schoen about makingMedicaid corrections in thefuture is as follows. He clarifiedhis original note saying thatin futurethe SPARCs columnon the report will containMedicaidinformationwhich we can consider when recoding the primary payor on thebirth certificate. December scenario reviewed N=18 A mother with a past history of 2 prior C-sections was admitted to the hospital at 35 weeks gestation complaining of severe pain at the site of the previous c-section scar. Mother was not having any contractions. A repeat c-section had been planned at 39 weeks. Babys heart rate was found to be 100 to 110 BPM with occasional decels.Physician suspected a threatened uterine rupture and decided to perform an immediate c-section. 78% correctly coded Fetus at Risk, 61% correctly coded Maternal Condition Pregnancy Related, 33% correctly coded Elective and 83% correctly coded previous c-section. This data tells the story of a c-section delivery to a woman with history of previous c-section (classical scar or 2 or more prior C-sections) who had planned to deliver by c-section (elective) who was delivered at 35 weeks due to a maternal condition (pain at site of previous scar) and fetus at risk (decels, possible uterine rupture). January 2016 scenario reviewed N=10 A 36 yr old mother accepts NIPT (Non-Invasive Prenatal Testing); the results led her obstetrician to recommend CVS (Chorionic Villus Sampling) A 20 year old mother accepts the recommendation to have MSAFP/ triple screen and NIPT (Non-Invasive Prenatal testing) 80% correctly coded the 1st two areas, 70% correctly coded the third spot, 100% coded the next two area correctly and 50% coded the 6th spot correctly with 50%answering yes to (_no, other reason) rather than leaving it blank The responses highlight the continued need for clarification of the data requested by the Birth Certificate workbook as new tests are introduced or tests are renamed. At the risk of being too repetitious, per Dr Glantz, if amnio, CVS, or karyotyping are not mentioned all testing is to be listed as screening even if Test is in the name. I am also working on the wording for increased clarity. If after accepted I had add and with results documented in her chart, I may have been able to decrease some confusion. Plz, keeping cuing me on how to help you ( Review of specific (difficult) BC coding fields- Prenatal Fields Genetic testing fields: If an amnio or CVS were offered to a pregnant woman and the test was actually done both the Fetal Genetic Testing field and the was fetal genetic testing offered field would be yes for women 35 and older. If the woman was under 35 and either amnio or CVS was done then just the Fetal Genetic Testing (in the OB procedure field) would be yes. SMH has been coding AJHC as other. Clarification offered and they will now be coding as MD. WIC refers only to mothers prenatal care. TABs are often missing all or part of the date. If the year is all that is available enter it. Dr Glantz is addressing lack of info in prenatals as a continuing challenge to coders who are seeking CDC mandated data Rosemary has asked Dr. Glantz to review the section re: High Risk Referral. The section seems to imply transfer of care, the word referral implies consultation. Dr. Glantz is being asked to review his previous response in light of our confusion. As this is a judgement call that Coders do not have the qualifications / knowledge to make. While some referrals are merely question concerns, many require the assessment of the Perinatalogist to ascertain if there is an issue of concern, we should continue coding all interactions with referrals for any type of concern as high risk referrals Prenatal Care screen Infections Dont code herpes if the mother is only on preventative care. Code only if there is an active lesion. Other Risk Factors Subutex and Suboxone are prescription drugs used to treat addiction to illegal drugs. Dont code them as illegal Obstetric Procedures Tocolysis Many times the 1st action taken in preterm labor is ingestion of a large amount of water PO followed or accompanied by IV therapy. If these interventions were user code yes for tocolysis. Per Dr. Glantz PO hydration is not tocolysis. He gave me a beautiful description of PTUA vs PTL and the tocolysis involved. The bottom line is that if a tocolysing drug is given, that is the only time we code tocolysis. Obstetric Procedures External Cephalic version Code this if there is an attempt to externally rotate the baby from any position other than vertex presentation, i.e. a transverse lie. Serological testing When possible record the 1st RPR (VDRL) during the current pregnancy with the understanding that you may not have that date for transfers. Interview Questions Be sure the mom knows that the questions A-H are related to information she received during prenatal care at her doctors office. Interview Questions The prenatal can be your information source New Birth Registration Screen NYS will be asked why the place of work and address are required for the father Statewide Perinatal Data System Update On Wednesday, November 18, 2015 several important updates to the Health Commerce System (HCS) were implemented. The new features included in this update are as follows: 1. My Notifications feature 2. Security Protocol upgrade 3. New York State Health & Human Services (HHS) branding style Due to NYS application and data security requirements, we will discontinue HCS support for unsecured Internet browsers and operating systems in the near future. Specifically, this change will target older versions of Internet Explorer (versions 6, 7, 8 and 9) and the Windows XP operating system. Windows XP reached its end-of-life on 08 April 2014 and has not received security updates for over 19 months and is therefore considered unsecure. Microsoft has announced that "beginning January 12, 2016, only the most current version of Internet Explorer available for a supported operating system will receive technical support and security updates" Discussion points Coders have altered the Sequencing of the BC workbook to allow easier data collection. Coders are asked to bring a sample of their workbook break downs to the March meeting. Sharing what works for one may be helpful for all Acknowledgement of Paternity. Coders need to compare the name in the notebook with that inserted into the Acknowledgement to validate agreement between forms. - see attachment A Question came up re: how to code a primary C-sect when a laboring mom strongly requests a C-sect and none of the implications seem applicable. The question was sent to NYS and CNY. These are usually situations in which pain relief has not worked or there is maternal exhaustion despite appropriate progress of dilation V. Data Download: We have all hospital data for the 1st 6 mo of 2015. 2014 data corrections (discrepancy reports) are complete VI. We will be holding our next Coder Meeting March 9 at Barnes & Noble (RIT campus). Coders, please, bring a sample of your BC workbook break downs to the March meeting. P.S. If you want any of the other handouts or more info on any topic included, plz, let me know. 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