ࡱ>  4bjbj wd,     $....lT.HLJɇɇɇɇɇɇ$΍z   UUUv  LJULJUUbsl|0(ׄj?WwV0HwHH||H  UHH : Finger Lakes Regional Perinatal Data System Regional Perinatal Center U of R Medical Center 601 Elmwood Avenue Box 668 Rochester, NY 14642 Phone: 585-275-4200 Fax: 585-256-1416 Dept. of Public Health Sciences 265 Crittenden Blvd. Cu420644 Rochester, NY 14642-0644 Phone: 585-276-8737 Fax: 585-424-1469 5/11/2016 Coder Meeting - 5 hospitals represented Introductions -Introduction of Coders all knew each other September Meeting Dr. Glantz will be joining us AND it will be a dessert meeting to be held at Strong actual location TBA. He is being asked to readdress High Risk Referral, Other Serious Chronic Illness, and Subutex. Are there other topics you would like addressed??? I will be asking for RSVPs for this meeting!! Data Integrity The High Risk Referral is a nebulous area. He said that a consultation with follow-up and/or a transfer would be what he considers a High Risk Referral. An NST or U/S b/c the home hospital is not sure of what they saw w/ the outcome being a nml U/S, he would not consider High Risk Referral If the pt declines services offered code referral For fetal growth issues - If there are successive NSTs or U/Ss code referral If after consultation, the pts. care is retnd to the attending w/out further visits to the perinatologists But these are judgement calls If you are comfortable delving in a bit deeper to attempt discerning the difference, mark it as you previously have done. If youre not sure you can mark yes or call me with a question. Other Serious Chronic Illness this is a question needing more resolution. It is a recurring thor n. It was raised is the illness requiring treatment ever, such as Hospitalization for asthma 2 yr. before the pregnancy or is it only illness that are treated within the pregnancy, i.e. depression which results in a hospitalization for suicide attempt while pregnant? AOP vs Birth Cert This feels like a sticky issue. I will be creating a HELPERS Guideline appendix I will send this out under a separate cover as I can formulate it better. Tocolysis per Dr Glantz, PO & IV hydration not tocolysis You remember correctly: Hydration often was/is used initially, but I think its more temporizing than therapeutic. The theory was that dehydration causes release of ADH (ADH is structurally similar to oxytocin and can cause contractions), and that rehydration would counter this. Perhaps that might be true if the woman in Triage has been vomiting non-stop or just came in from a long trek in the desert, but thats not the case for most of our contracting patients. Because most of the women who respond to hydration probably were not really in preterm labor, water seemed to work pretty well! Of course, even actual tocolytics are not all that effective against true labor, making water essentially a placebo. Yes: preterm uterine activity is preterm contractions that dont change the cervix. Perhaps they are accentuated Braxton-Hicks, or so-called false labor. Some of these eventually do cause cervical change, but most of the time the uterine activity resolves on its own. I would not consider water (or a shot of terb) for PTUA to be true tocolysis, and so would not code it as such. As often is the case, the Guidelines are not as specific as one would like. They state that Tocolysis" should be coded if a any agent" is given for suppression of contractions, not specifically for treatment of preterm labor. In that context, I would consider it appropriate to check Tocolysis for terbutaline given for PTUA. I still would not code water as tocolysis thoughits not a tocolytic, even though it ostensibly is being given because of the contractions. SO, If Brethine (Terbutaline), Procardia (Nifedipine), Magnesium, Inderal (Propanolol) are administered then tocolysis is coded. Scenarios: April Scenario The patient pushed for 2 hours and brought the vertex to +2 station but without further descent. A cesarean section performed, but the head was deeply wedged in the pelvis and the surgeons hand could not get around it. The surgeon tried using a forceps blade as a head elevator, without success. Ultimately the uterine incision was extended verticallyand, in concert with a nurses hand in the vaginaelevating the infants head from below, the breech was pulled upwards through the superior portion of the fundal incision, successfullydelivering the infant. I found the two possibly conflicting sources but if you look again at #2 youll note that it talks about a wrong pre-delivery diagnosis. This baby was vertex throughout the labor therefore would still be coded as vertex presentation. The second answer was found in the Coder Manual and therefore would not have forceps coded. Found in Section #3 L&D I p.10 The use of forceps or vacuum to extract the baby from the uterus during a C-section is NOT coded There were two twists in this scenario. You made it through the first one but the 2nd was a nasty speed bump! Forceps use is not coded. The answer be found in the Coder Modules Section #3 L&D I p.10 The use of forceps or vacuum to extract the baby from the uterus during a C-section is NOT coded Number of coders who participated# correct answers Q1 presentation# correct answers Q2 Trial of labor# correct answers Q3 C/S reason# correct answers Q4 Forceps21/2618/2121/2118 and (3) s9 May scenario - So far 9 folks have responded to the May Scenario. Therefore Im not gonna post the results yet. So, plz, take a few minutes and do the Scenario if you havent. Its proving to be tougher than I expected Modules: We began the update process. We started on Module 3, again under a separate cover I will sending you the suggested changes and additions. After you receive them I would asked that you reread the Module and HELPER Guideline to see if there is anything that has popped up in your practice which should be included or excluded. I will restate my requests when I send out the altered forms for both this and for the AOP appendix Coder questions: Baby transfers - Is the baby alive on transfer? Per Deb Madaio, code at the time of transfer. Place of Employment - Why are the addresses of places of employment requested? Per Deb Madaio and Dr. Alio parents spend significant amounts of time in these areas whose environment may have deleterious effects on health. C-sect + - Pt had a scheduled C-sect for breech. She ROMd and started CTX at home 4 days before her scheduled date. During her C-sect, her bladder was nicked. She went to the main OR for repair. Code??? PROM, Elective, Malpresentation, Maternal Condition - preg. related, spinal, Unplanned OR procedure. Subutex use to be discussed further with Dr. G at Septs meeting but there are currently two suggested answers to coding. 1st no true way to document. 2nd. Per a 2010 Coder Mtg. minutes it was suggested to be coded as other serious chronic illness This one is bit stickier as Subutex does not affect the pregnancy but does affect the care of the neonate. Ive asked Dr Glantz and the State to weigh in on this one. Late decels - The Coder notes lates during the laboring process but not near delivery, there was no mention fetal concerns, and the only intervention found was maternal position change occasionally in the record should NRFHR be coded? According to the guidelines YES Gestational age - Two gestational ages are in the record which should be recorded? Per Dr. G and the HELPER Guidelines the EDD on the prenatal generally determined by the last LMP. It was suggested that if the prenatal, also, had an adjusted or working date that the office was using, we needed to use that date. Chronic Serious Illness There are too many chronic illnesses to address individually but if there is an illness presented and it required hospitalization or emergency treatment DURING the pregnancy it should be included. This is a topic that I have asked Dr. Glantz to address at our September Mtg. Onset of labor - If no specific time is given, is there a way for the Coder to determine onset of labor Per Dr. G IF there is no documentation of when labor began, use time of admission. Induction vs Augmentation - A woman came into the hospital contracting at 5cm dilation. She was AROMd within minutes of arrival. The note said induction. We discussed that the difference would come depending on how long the woman had been 5cm. i.e. if shed been 5cm for a few days it could be induction but if she had been 4cm an hour before in the MDs office it would have been augmentation. How to code?? Per D. G unless there was documentation that she had been 5 cm. earlier code as (AROM) as augmentation. AOP - Mom was transferred to another countys hospital before completing the AOP. Per Amy B. She can take the form to her countys Office of VS at any time until the child is 18 yr. of age. Does it cost at any time?? Coding forceps & vacuum - Why not code forceps or vacuum used during a C-sect. SPDS is only interested in forceps or vacuum use in vaginal deliveries. C-sect, elective+ - If a woman comes in laboring before her scheduled, elective C-sect what is coded? -If it is a 3rd or greater section and before the scheduled date I would mark elective and maternal condition preg. related. But if it is C-sect 1 or 2, and your hospital does VBACs, code other and maternal cond. - preg. related. A woman at less than 39 wk., who is a previous C-section x1, presents in active labor. For non-VBAC hospitals, we code elective, other, & maternal cond. preg. related. AOP filled out. Mother is legally separated. - It is NYS law that if the woman is legally married (separated doesn't count) she has to list her husband or leave the FOB blank. The FOB can have a paternity test, take it to court and have the judge rule on who can be listed on the Birth Cert. If an AOP is created and it is determined that the Mother is legally married to someone else, the AOP needs to be destroyed. Cervidil - Mom admitted to hospital in labor. After 3 hours she was still 3 cm dilated. Cervidil was administered. The delivery summary stated it was used as augmentation. - Cervidil is for pre-induction cervical ripening, not for augmentation. The package insert states: INDICATIONS AND USAGE: "Cervidil Vaginal Insert (dinoprostone, 10 mg) is indicated for the initiation and/or continuation of cervical ripening in patients at or near term in whom there is a medical or obstetrical indication for the induction of labor." I would do what is right and code this as an induction. 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