ࡱ>  -7bjbjAA wj++/  PPPPP$tttP|@Ttxoooxxxxxxx$1{}z&xPooooo&xPP;xoPPxoxeNm]p~hJwQx0xi:]~]~NmNm]~Ppooooooo&x&xoooxoooo]~ooooooooo : 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: 585-276-8737 Fax: 585-424-1469 3/9/2016 Coder Meeting Agenda Introductions -Introduction of Coders Highland, Noyes, Strong, and Unity were represented Data Integrity A question came in re: the Interview Portion of the workbook. I initially answered it poorly so here goes!! All portions of the workbook are worth our best effort at completion. Some of the questions in the interview feel too invasive. One solution is to be sure you explain to the women, as you are talking with them, that the info is declassified and that these particular questions are not seeking the womens answers but, rather, if the info was shared at their prenatal visits. If you have any different thoughts, please, write or call me. Learning points (review): I was still confused re: billing so I asked, again, for help clarifying Fidelis. Darlene Waters, Strongs new lead Coder, who came to us from OB Billing and previously Ophthalmology billing, helped with our understanding. With Medicaid income determines if the woman is in straight Medicaid or enrolled in a Medicaid Managed Care program Fidelis as a Medicaid Managed Care Plan has its own policy number beginning with 742XXXXXX and a CIN# on the presented card. All that is necessary is the CIN# and the insurance is entered as Medicaid. If the card looks different it may be Fidelis Metal Tiers plan (an Exchange Product) - no CIN# just the 9-digit policy number. It is then entered as Private Insurance. This change occurred with the advent of Obama Care Contact info update. As there was interest expressed Ive attached the most current Coder list, the Coder Supervisor list and the NYS names and as best I know their position and contact info. You dont need these but they may be a handy resource tool PLEASE, look at them and make the necessary corrections and send them back to me!!! One of my reasons for requesting this info is to allow me to, after discussing it with you, advocate for and with you to your supervisor and staff. What you do and how you do it is important to have others know the what and why as a part of their knowledge base. You all are and have been very resourceful in obtaining the needed information. I feel that there should be more acknowledgement or just plain knowledge of what you do. And on another page, many of us are graying out. Just because we leave doesnt end the grant. Someone will need to fill you shoes and to be able to jump in fairly rapidly with the correct training. It may help staff and supervisors understand how important your work is if there was a monetary discussion. The State can fine the hospitals $3500.00 / day for each set of Birth Information not filed in 5 days! Non-classifiable reports based on the answers to the February scenario Im reviewing this again -Tobacco: When possible, find out when and # of cigarettes smoked but when its not possible to get this information continue to use 99 in the # of cigs blanks, as needed. Its important to code mother as Yes if she is a smoker even if you dont know the amount or timing. NYS Coding decision -Hookahs & ecigs: The ruling stands with NCHS. They only want tobacco use delivered by traditional cigarettes, so neither hookah nor ecig usage would be reportable. One of the reasons behind their ruling could be thatit would probably be very unreliable to be able to try to distinguish between tobacco-based hookahs and those that involve water or another substance. So, tokeep things simplified, just the number of regular tobacco-based cigarettes smoked. And then to complicate it again if a woman says she uses a hookah, ask her what she smokes as it may require illegal substance abuse to be coded Discrepancy reports: If you havent already sent me the results of your discrepancy correction, please, do so. As our discrepancy reports are all available I reviewed the info from Larry Schoen and came up with the following: From Larry Schoen in December 2015 and January 2016 (greatly summarized) Re: SPARC and Medicaid - If they are the same then assume that it is Medicaid and change the SPDS data. Ideally check all but d/t the added burden it involves, check at least some to be sure that there is not a problem on the Coders end. If SPARC and Medicaid are different you need to check each record and make any needed changes Scenarios in general Please give me some feedback on their content. Ive learned some but Im still in school. Feedback on my presentation of the scenarios is generally positive. So, Im still open to constructive criticism. i.e. Januarys would have been clearer if there had been a sentence saying that the test results were in the pt. chart January 2016 scenario reviewed N=10 of 26 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) Number of coders who participated% correct answers Q1% correct answers Q2% correct answers Q3% correct answers Q4% correct answers Q4% correct answers Q4N=16(75%)(75%)(87.5%)(100%)94%)(68.7%)(31.3% equiv) The February 2016 scenario reviewed N=20 of 26 Mom had left hospital and could not be reached for clarification: 1st piece, info was that she smoked but not how much 2nd point was that she had quit in the pregnancy but not when 3rd was that she drank before knowing she was pregnant 4th was about hookahs and ecigs. Number of coders who participated% correct answers Q1% correct answers Q2% correct answers Q3% correct answers Q4% correct answers Q4% correct answers Q421 w/1xcue100%55% and 2 halves100%50% and 2 halves3% and 11 w/ wrong #65% As with myself many of us had never heard the word hookah. I now know why my son was upset when his pretty glass vase got broken. March scenario 16 folks have responded thus far and its interpretation and my wording that are making it difficult. The tough question seems to be Is the infant alive? Be sure to check the guidelines whenever you have a question. Infant born at 38 weeks gestation to a type 1 diabetic mother, the baby suffered a brachial plexus injury during vaginal delivery at a level 1 hospital. The infant required PPV for 30 seconds immediately post-delivery and was described as lethargic. The infant was immediately transferred to Arnot Ogden Medical Center. Outreach visits: Workbooks: I have copies of several workbooks which I will share if you want any of them As expected there are a variety of methods of retrieving and entering the info: Noyes nurses code the delivery on paper at the time of delivery. Some of the hospitals have a certifier. The attending signature is not required just the name. Noyes has created a nurses helper guide. Noyes also gives the patient a cheat sheet to help them know why we are asking for and how the info is used. Highland has created a cheat sheet that has all of the info in the workbook but flows more easily into the online forms. At Highland, Medical Records initiates the data input by getting the babies name in the system At Highland, Unity, Strong, and Noyes the workbooks are separated into mother and abstractor pieces. At Strong, the abstractor portion is printed on a separate color paper. It is then put back together for entry into the system. All present visit the mom as often as needed until the info collection is achieved. Abstraction is generally done by the Coders. Highland has developed a program through which they can access data that is requested by their in-house teams. The paper copy of the parent input is sent with the chart to Medical Records. This helps when the parents attempt to dispute the Birth Certificate. Unity added highlighted areas that are easily missed to their paper workbook. Their nurses hand out the parent portion. The nurses ask marital status and pull the AOP from the packet on married moms. A courier transports the records to the Vital Statistics. Most agreed that verification is only given on request. All agreed that Medicaid and NICU are given priority. Those who are traveling within days are given priority as well. Family history areas can present a challenge but continued is made to encourage completion. Strongs OB offices hand out the parent portion these can be returned with pre-admission paperwork and then it is collected by Care Management. Strong separates and color codes the portions. It is put back together before data entry I done. Answers to Coder questions: These are the questions that came in since the last meeting: If there were three eggs implanted and at the 9 week u/s one was an empty sac. There was no pregnancy it would not be coded as a loss The mom had Kell sensitization is an indication for possible early delivery but not necessarily for a C-sect. If there are blood transfusions mentioned in the notes be sure to check who they are for the mother or the baby. Re: referral to high risk as we are not trained to discern betw a consultation that involves major and minor reasons for the consult request, Dr. Glantz recommends that we continue coding all notes of a high risk visit as yes When a father names his baby as a junior he can add senior to his name on the paper work. Adding Junior will also be accepted for female names, i.e. Jane Doe, Jr. The only anomalies tracked are those specifically mentioned in the workbook. I suspect that the others would be noted in the NICU Module. Per both Drs. Glantz and Wissler both types of anesthesia are used in C-sections Coding of feeding at time of d/c is that which the infant is currently doing not what is intended. It was changed from intention to whats happening now. When a laboring woman without other complications says she now wants a C-sect and her request is granted the reason for C-sect is other If a mom presents affidavits from the sperm bank that she wants included in the BC info they can be accepted and sent to vital records with the Birth Certificate and a note of explanation similar to sending the AOP paperwork A father called and said that the FOB signature/name was not his on the certificate. Remember that you are witnessing that the person whose name on the AOP is the person doing the signing. You are not responsible for knowing who that person is. They are signing a form that states that perjury can be prosecuted. Moms packet trumps the AOP per Kristy Winters, AOP trumps the packet per the Office of Vital Statistics. This highlights the importance of being sure that the babys name is completely correct and the same on both forms. A baby was diagnosed with two anomalies not on the list. - They are not coded as the only ones currently followed are those listed The woman comes to the hospital in labor and during the intrapartum period she changes Her mind and requests and is granted a C-sect Eileen Shields says, Code as other as it was not pre-determined as stated in the Guidelines. A woman was admitted to ICU w/ a non-pregnancy problem, went into labor, was transferred to L&D for delivery,, transferred back to ICU post-partum and then to a hospital that offered a higher level of care Code: transfer to ICU and Transfer to a higher level of care Healthy People data review We reviewed a part of the data that I receive so as to illustrate how our data is used. Noyes got a Maternity of Distinction award for their success in reducing elective C- sections before 39 weeks. We will be holding our next Coder Meeting May 11th at Barnes & Noble (RIT campus). 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