ࡱ> kmj u/bjbjR|R| b00u'"""""$FFFFldF94,,,,9999999$;>zA9"A9"",,V9? ? ? .",",9? 9? ? +|,,R5^',9l9099,>>$,,4>"30? A9A99> : 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 Data Coordinator 265 Crittenden Blvd. Cu420644 Rochester, NY 14642-0644 Phone: 585-276-8737 Fax: 585-461-4532 September 14th, 2016 Coder Meeting Minutes Introductions: 8 of the 9 hospitals were represented with 12 Coders in the room and 2 more on conference call along with Dr. Glantz and R. Varga Agenda items: Due to our guest we may not be able to cover all of the agenda items. Some of the items request feedback. In order for me to continue helping you do your jobs to the best of all of our abilities, please, send me your thoughts on the areas requesting help! Guest Speaker: Dr. Christopher Glantz Topics: Other Serious Chronic Illnesses There are judgement calls needed here. If someone was hospitalized for treatment of an otherwise chronic illness during their pregnancy code it. There are some instances where the illness will affect the delivery even if there is no hospitalization the most prominent ones are cardiac disease, paralysis, eye illness and cancer not in remission or in remission but still being actively followed, transplant patients. There are others and each case needs to be addressed separately. If you have a question you can contact me. If I cant answer it I will contact Dr. G Subutex a synthetic opioid- is a drug that helps decrease the physical withdrawal symptoms of legal and illegal opioid use. It does not control the pain but does have a slight opioid effect which the opioid may have been led the woman to continue seeking illegal drugs. As a person on Subutex many times leads to illegal drug use and more importantly the effects of opioids addiction Subutex and methadone use and the use of street drugs all have the same deleterious effect on the baby the baby needs to go through withdrawal please, code anyone who is on Methadone or Subutex (or Suboxone, a less used med) as using illegal drugs whether they admit to it or not. A tox screen on the baby is not a good place to determine illegal drug use High Risk Referral Dr. Glantz feels that the intent is to be sure that a risk evaluation was done. One way of determining this is whether or not the woman was sent to a high risk group. What if the woman is sent to a high- risk group for a maternal medical issue? Bottom line at this point is that Rosemary will contact the state as attempt to get their interpretation of the field and the guideline description. Coding EFM In attempting to interpret what is being asked for. Dr. Glantz interpretation is that EFM should be coded if it is used continuously, not intermittently. It should also not be coded if only used as doptones and to determine reactivity through a 20 min. tracing. It is a more difficult point to code. A progress note can be used for determination. We will question the ability to add a field where the doctors can check what type of monitoring is used. Finger Lakes 2010 -2015 Power point presentation- the slides are available on the Finger Lakes Perinatal Program web page  HYPERLINK "/finger-lakes-regional-perinatal-program.aspx%20" /finger-lakes-regional-perinatal-program.aspx on the Program Data page. This presentation explains how some of our data is used. He thoroughly encouraged Coders to attend the Outreach visits at their hospitals. Some of the slides are self-explanatory but they all allow the providers to see trends in practice. Epidural placement has gone up, primary C-sect rates have gone down, TOLAC (trial of labor after C-sect) have gone up, episiotomies are greatly decreased as are operative deliveries. Malpractice can influence a doctors choice of delivery methods. C-sect rate in the mid-2000s went up as woman were empowered to request elective primary sections. Of interest, note the juxtaposition of hospitals with hospitals in the data collected fields. Delivery volumes have declined; Medicaid participation has increased over the past 10 years. He poses the question of socio-economic change impact. Data Integrity Interview questions I need some feedback. I would still like a bit more thought process and possibly some feedback on a couple of these issues! Weve touched on this in the past. This is a difficult portion of the Birth Certificate workbook d/t needing to get the moms to answer the questions. They are so busy with their newborn - and their willingness or ability can be compromised by socio-economic situations - that this seems like a major burden along with their being unable to understand why. Is there a way to add the questions that dont get answered well in our other resources i.e., prenatal care dates re: this topic we will leave it as stated below under the scenario, for the remainder that I have noted here, would you consider altering the forms you give to the moms to include these questions. Some of you have already do this w/ moderate to good success in getting better data. So, let me know if you make any adjustments to your presentation re: pre-pregnancy weight, # cigs, did you watch the AOP video + + + Scenarios: It was determined before my time that the Coder faxes and then scenarios were to be a method of ongoing learning for Coders. The faxes went away d/t the difficulty in accessing actual chart segments. The scenarios seemed a good alternative. They only take a few minutes and attempt to pose situations that could cause some confusion when coding is done. The number of coders completing the scenarios fluctuates but is never all and sometimes not even the majority of those attempting to produce accurate data for the potential use by the MDs and researchers using our data to hopefully, improve the health care provided to our moms and their babies. (How was that for a run-on sentence?) Is there something I can do to help you feel more inclined to use this learning tool? Now, for the response to the past two months scenarios: July Prenatal visits When counting total number of prenatal visits- Does an OB consult count as a prenatal visit? Yes_X_ No___ Per the state and Dr. G OB consults count How about the office visit for a pregnancy test, does that count as a visit? Yes___ No_X_ Per the state and Dr. G a visit for a preg. test even if vital signs are included does not count How do you determine how many visits the woman had after her prenatal was faxed to the hospital? Make an educated guess? ___ Ask her? ___ Other___ (plz., explain) This brought a variety of answers re: the total # of visits. Adequacy of care is considered 13 prenatal visits before delivery. If the counting stops at 36 weeks all women will have inadequate care documented as evidenced by two different researchers work. The researchers have no way to surmise the number of visits not documented, i.e., the last 4-6 weeks of weekly visits. The state only requires that we use the prenatal that is readily available to us. But the best way is to seek out the other info. In the larger hospitals this may seem an impossible task (calling the respective offices for the remaining dates), but that would seem to be the most accurate. I did hear that several of the hospitals do this. I will leave it to you as the state has given us their guideline. We will handle it from the request end if a researcher requests this info we will let them know what is requested by the state and that they need to be aware of the last prenatal date listed and the delivery date to take adequacy of care into account. Number of coders who participated# correct answers Q1 OB consult?# correct answers Q2 Preg test?# correct answers Q3 total # visits25 0f 32 7 23 25 August: AROM augmentation, induction, process of labor- How is it coded? The woman was 9 cm dilated and labor was progressing well. The membranes were ruptured. Characteristics of Labor and Delivery _x_ None 2. The woman arrived at the hospital at 41w 3d without CTX. After initial work-up, her membranes were ruptured. Characteristics of Labor and Delivery _x_ Induction of LaborAROM 3. The woman was laboring, progressing slowly but consistently in dilation. Her membranes were intact. The babys heartrate was being very difficult to monitor externally during CTX. In the processing of applying a fetal scalp electrode for more careful monitoring, the membranes were ruptured. Characteristics of Labor and Delivery _X_ External Electronic Fetal Monitoring _X_ Internal Electronic Fetal Monitoring 4. The woman was laboring and dilation was not following the normal curve. AROM was performed to encourage a more functional labor. Characteristics of Labor and Delivery _x_ Augmentation of Labor Number of coders who participated# correct answers Q1 none# correct answers Q2 induction# correct answers Q3 none# correct answers Q4 augment 22612 & 3-1/2s4 & 10-1/2s11 & 4-1/2s Coder questions: It was a quiet month Sterilization What if only one tube was removed Its a question of semantics. The procedure was for sterilization and the doctor believed that the other tube was completely blocked d/t scar tissue therefore the coding would be sterilization. Dr. G did add that he would hope that the doctor would so follow up testing which could prove complete blockage. Hypotension after epidural If a C-sect occurs d/t to severe hypotension with fetal heart rate deceleration after an epidural is placed, code only fetus at risk. The mothers condition did not nor would it warrant a C-sect. Her B/P could have been managed. It was solely b/c the baby deceled. We will be holding our next Coder Meeting Thursday, November 10th, 2pm! again at the Saunders Research Bldg., Crittenden Blvd. on the Strong Hospital Campus. Anne-Marie Yeates from the Child Health Support Office will join us for a presentation on Acknowledgement of Pregnancy. -./I   seXKXXhJhCJOJQJhJhstCJOJQJhJho)5CJOJQJhJh(5CJOJQJhJh*45CJOJQJhJhWbVCJOJQJhJho)OJQJhJhuBOJQJhJhWbV5CJOJQJhWbV5CJ,OJQJhJhWbV5CJ,OJQJhJhWbV5CJ8OJQJhJh*45CJ8OJQJhJhWbVOJQJ.I  3 E F G H s t    & FgdJh^hgd]gd ]^ ]^ L]^L  ^gd   * - . 2 3 6 7 < D F G H T V ̿p^L>.hJhh5CJH*OJQJhJhh5CJOJQJ#hJhWbVOJQJmHnHsH u#hJhInOJQJmHnHsH u hJho)CJOJQJmH sH  hJhWbVCJOJQJmH sH  hJh,8CJOJQJmH sH h,8CJOJQJmH sH hJhWbV5CJOJQJhJh|*CJOJQJhJhH+CJOJQJhJhWbVCJOJQJhJhstCJOJQJhJhCJOJQJV X [ ] k r s t    ǼrfQB7hJhOJQJhJh>[CJOJQJaJ(h$h,85B*CJOJQJaJphp0h,8CJOJQJaJhJh&ECJOJQJaJhJhCRCJOJQJaJhJh+9PCJOJQJaJhJhBoCJOJQJaJhJhc5CJOJQJh,85CJOJQJhJhmZ[5CJOJQJhJh5CJOJQJhJh'5CJOJQJhJho)5CJOJQJ   e l t |    # ; < C J K j k  ȽرvnvfZNZBhB*OJQJphp0h B*OJQJphp0hC0B*OJQJphp0hC0OJQJhUeOJQJhJhC0`OJQJhJh>[OJQJhJhpOJQJhUehhCJOJQJaJhJhOJQJhJh5OJQJhJh9(OJQJh9(OJQJh?HOJQJhJh+OJQJhJh+5OJQJhUeh+5CJOJQJaJ   < K 23F^gd(gdh^gd=wh^hgdUe^gd-:^gdkzC^gd$^gdC0h`hgdUe & FgdJgd & FgdJ BgwELkŹŹŹwkw\M>hkzChkzCB*OJQJphp0hkzCh-:B*OJQJphp0hkzCh=wB*OJQJphp0h-:B*OJQJphp0h=wB*OJQJphp0h=wOJQJh1>OJQJhJhOJQJhC0h$B*OJQJphp0hB*OJQJphp0hkzCB*OJQJphp0h$B*OJQJphp0hC0B*OJQJphp0hC0OJQJhJhC0`OJQJhC0hC0B*OJQJphp0koqr0123=@r5WƾyjbSGS;hUB*OJQJphp0h(B*OJQJphp0hUhUB*OJQJphp0hhOJQJh1>h&EB*OJQJphp0h=wB*OJQJphp0h1>B*OJQJphp0h1>OJQJhJhOJQJhJh1>OJQJh=wh-:B*OJQJphp0h-:OJQJh-:h-:B*OJQJphp0hkzCh-:B*OJQJphp0hkzChkzCB*OJQJphp0hkzCB*OJQJphp0Wuv~)*+-DKXC[ɸɤՋՋsdThUehC0`5CJOJQJaJhUh IB*OJQJphp0h1>B*OJQJphp0h IB*OJQJphp0h(B*OJQJphp0hU0hU00JOJQJ&jhU0B*OJQJUphp0 jhU0B*OJQJUphp0hU0B*OJQJphp0hUB*OJQJphp0hU6B*OJQJphp0 hUhU6B*OJQJphp0+` j f!g! d`gd%+ dgd%+gd%+gd?H  & F^gda & FgdJ^gdF^gdUe & FgdUe^gd(&35diCE`acdt÷Ϭϡϙϡwo`oTowLwh9(OJQJhC0B*OJQJphp0hC0h,8B*OJQJphp0h?HOJQJhUeOJQJhUeh$OJQJh,8h,8B*OJQJphp0h,8OJQJhUehUeOJQJhUeh,8OJQJh(B*OJQJphp0h,8B*OJQJphp0hUehC0`OJQJhUehhOJQJhUehC0`5OJQJhUehUeCJOJQJaJtw|*+Zk2:_`b̽ulu`WPEAh%+hS0h?HOJQJ h?Hh?Hh4V5OJQJhah4V5OJQJhUe5OJQJhJhUe5OJQJh?H5OJQJhJha5OJQJhJh&E5OJQJhaCJOJQJaJh lZh%CJOJQJaJh lZhWCJOJQJaJh lZhF5CJ^JaJhUehhOJQJhUeOJQJhUeh$OJQJh?HOJQJ 8 { !e!f!g!"#"###$$$%!%$%4%!&"&#&ȽȽșsesTM hh%+ h$h6B*CJaJphp0h$6B*CJaJphp0h"6B*CJaJphp0h9(h"6CJaJh9(h6CJaJh9(h%+6CJaJhOJPJQJhh%+6OJPJQJh6OJPJQJhh%+OJPJQJhh%+OJPJQJ\hh%+5OJPJQJhh5OJPJQJg!!"$"&#&E&f&&&$! &#$/Ifb$gdM=gd%+gd%+ dgd%+ #&&&&&&&&&'''*(Q(m(r())L)R)))))))********n+ȿѳ}}ѦqeWhJh:<5OJPJQJhJh:<5CJaJhJha5CJaJhJhaOJQJ hJh:<5B*OJQJphhJhaOJQJ^JhJh:<OJQJ^JhJh:<5OJQJhUe5OJQJh%+5OJQJhJh:<OJQJh:<OJQJhM=h%+OJPJQJhM=h%+5OJPJQJ"&&&&&:&&&$! &#$/Ifb$gdM=kd!$$Ifl\F{F{{{ t 6! 0644 lBae4p(ytM=&&&&&!gd:<kd$$Ifl\F{F{{{ t 6! 0644 lBae4p(ytM=$! &#$/Ifb$gdM=&&&&&0'1''''',(R(n(o())*******h^hgd:<h^hgda & FgdJh^hgd:<gd:<**+7+Q+n+o+p+Tkd$IfK$L$l]] t 6`"]644 lae4p ytJ$"&`#$/Ifb$gdJK$$"&`#$/Ifb$gdJn+o+p+q++++++++++++2-3-4-P-_...~s~c~T@&h~h~56>*B*OJQJphhU0hsjB*OJQJphhM=h95CJOJQJaJhM=hOJQJhM=h9OJQJh9h95CJOJQJaJhh75CJOJQJaJh5CJOJQJaJhCJOJQJaJh lZhh7CJOJQJaJh lZh"OJQJh lZh:<OJQJhJh:<5OJPJQJhJh:<OJPJQJp+q+"kd$$Iflr%F{F{{{{ t 6`"0644 lBae4p2ytJq+t+v++++$"&`#$/Ifb$gdJ+++"gd:<kd$$Iflr%F{F{{{{ t 6`"0644 lBae4p2ytJ+++3-^._.u/ & Fgd*B*OJQJph&h~h56>*B*OJQJphH/ =!"#$% P0 @  5 01:p9/ =!8"8#8$% !DyK yK https://www.urmc.rochester.edu/finger-lakes-regional-perinatal-program.aspxyX;H,]ą'c$$If!vh#v{:V l t 6! 065{/ Be4p(ytM=$$If!vh#v{:V l t 6! 065{/ Be4p(ytM=f$IfK$L$l!vh#v]:V l t 6`"]65]e4p ytJ$$If!vh#v{#v5:V l t 6`"065{/ Be4p2ytJ$$If!vh#v{#v5:V l t 6`"065{/ Be4p2ytJ^  002 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH 8`8 Normal_HmH sH tH @@@  Heading 1$@& CJ$OJQJT@T  Heading 2$L@&]^L5CJ8OJQJH@H  Heading 3$h@&^h 5OJQJ8@8  Heading 4$@&5H@H  Heading 5$ & F@& 5OJQJD@D  Heading 6$@&5CJOJQJT@T  Heading 7$@&^`5CJOJQJ@@@  Heading 8$@& CJ OJQJH @H  Heading 9 $ & F@& 5OJQJDA D Default Paragraph FontVi@V  Table Normal :V 44 la (k (No List LC@L Body Text Indent h^hOJQJ0U`0 Hyperlink>*B*2B@2 Body TextCJH@"H Iv Balloon TextCJOJQJ^JaJHZ@2H T \0 Plain TextCJOJPJQJ^JaJNoAN T \0Plain Text CharCJOJPJQJ^JaJN^@RN  F@0 Normal (Web)dd[$\$ CJPJaJ@c   Table Grid7:V0CJOJPJQJ^JaJf@rf D1 List Paragraphd^m$CJOJPJQJ^JaJOc : Table Grid17:V0CJOJPJQJ^JaJOc m Table Grid27:V0CJOJPJQJ^JaJT`T Ww( No Spacing$CJOJPJQJ_HaJmH sH tH Oc N Table Grid37:V0CJOJPJQJ^JaJOc 4V Table Grid47:V0CJOJPJQJ^JaJOc cP Table Grid57:V0CJOJPJQJ^JaJOc :< Table Grid67:V0CJOJPJQJ^JaJOc %+ Table Grid77:V0CJOJPJQJ^JaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] Fu'bJb V  kWt#&n+.u/ "#$&+0 g!&&&*p+q+++u/!%'()*,-./ ) u'X8@0(  B S  ?joU&\&w'@J15GN!!w'3333333BgEk l o q 2 3 3 =  ~ * + - &&&&&&s't'w'BgE2 3 3 =  ~ * + - &&&&&&s't'w'\N}ĝn6 BF:2(.CCvW P&XiR`3  ^ `o(.h 8^8`hH.h ^`hH.h  L^ `LhH.h  ^ `hH.h x^x`hH.h HL^H`LhH.h ^`hH.h ^`hH.h L^`LhH.ZF0F^F`0o(.^`o(.h pL^p`LhH.h @ ^@ `hH.h ^`hH.h L^`LhH.h ^`hH.h ^`hH.h PL^P`LhH.^`o(. ^`hH. pL^p`LhH. @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PL^P`LhH.h 8^8`hH.h ^`hH.h  L^ `LhH.h  ^ `hH.h x^x`hH.h HL^H`LhH.h ^`hH.h ^`hH.h L^`LhH.h ^`hH. ^`hH.pL^p`LOJPJQJ^J. @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PL^P`LhH.:2(\N}&XiBCCvW         z<                   J       1(cEd n7. F7.Xjf j7.y.)7.G v !-~B"7.)7.,&.7.{12OD8&yg8*n<7.DA7. BvEB>Eh"F9F;HDHnsM''UWI$X2lnZn]x `a`7.}Id}d7.z\d7.AWSf"f7.Mjmo? t7. uXYu7.Uv7.{7./.|"JS!f.Z Fx Ilg-+-:Ab =?HK5byWy d Q  !7 8 H"9(?|nq9%D\h{!FRY\*5IPlsZ8"Ld/Cr3TKiMY,Iv/&CL9 ! !pD!7}!Y"A"rm" #)#$Ym$ z$D%S&' L'w'|'B("b(b(Ww(o)r*|*++ Y+g++,8,{,R-Hw./$/^/s/(0I0U0V0D1M1 2 2>2*4Aq4H5Q6vH6=7R778I9 :;c<<o< =H>3>9?>S>w>x>? F@e@XJA B !BYBuBCCPCPbCkzC$DOE&EVE>FlF"hHIgI}dJDLL4M$N(N0oNprNq}O+9PTPZPcPQ,QJQ0RJFRyR?S-SPT2wTf}TU%U4V_6V,FV[VWbVdVrVn+W"NX^\X;Y Y~6Y<Z lZc:[:[>[mZ[T \z\/\C\]<*]8^?^Y^g _-_C0`=`*bc cc7c-YdUefXhisjj kk("kHlPl)mdmdnOrn6oBo=oopwq rurrs0s%s tB$t:tHttt|u~w0w=w)Jw@Uwk2x2x3?xCRL]stb&{!C)w:}B\c79;[e-S0Aap.7n LPT"auJFkuWaq :I{((k`{p#-NT|bhK=*1>Z4?Dpz Y_%+9)J\?@l|([p:zDLXBUj (!-W51h:<BCO$_ d;-L ;*J8eZy(oO(&(~*}X!tp%| #r?HUgl (Ia7QW [t!=,u{5#pC05COJrG/I'X'hUy'?Dm20h7_jQS n}ehiU,8<8`+2e.\f*"I:8tg[y,Tc$m ,KPPv!J0ZFInjEF XZiV{+;$IzdWjUc=3B>; 7P mw)%4QY'(m;i T\B}LH6To];!Rf7[R{H+1hJNM=eg9v"R_\F> )Uj3+sdu'w'@_%_%_%_%u'@Unknown G*Ax Times New Roman5Symbol3. *Cx Arial7.@Calibri9Garamond5. .[`)TahomaY CG TimesTimes New Roman9=  @ ConsolasA$BCambria Math"qhGzIIjAg!G!G24a'a' 3QHX?+,2!xx  Finger Lakes Lafferty;DawnVarga, Rosemary$      Oh+'0  4 @ L Xdlt|Finger LakesLafferty;DawnNormalVarga, Rosemary4Microsoft Office Word@0@N@c R@dR!՜.+,D՜.+,D hp  RHI Group, Inc.Ga'  Finger Lakes Title 8@ _PID_HLINKSA49Lhttps://www.urmc.rochester.edu/finger-lakes-regional-perinatal-program.aspx  !"#$%&'()*+,-./013456789;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXY[\]^_`acdefghilRoot Entry F/RnData 21Table: ?WordDocumentbSummaryInformation(ZDocumentSummaryInformation8bCompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q