MCCG212 – Portfolio Project Final Submission -Jodi Camp

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Bryant and Stratton College, Buffalo *

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Mechanical Engineering

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Apr 3, 2024

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1 Week 7: Final Submission to ePortfolio Title: Comprehensive Training Program for Medical Coding Team Summary: The primary objective of the training program is to comprehensively enhance the skills, expertise, and proficiency of the medical coding team within the organization. By focusing on continual learning and development, the program aims to elevate the capabilities of the team members to ensure the implementation of precise, thorough, and compliant coding practices across various healthcare scenarios. Through a structured curriculum, participants will delve into intricate coding scenarios, navigate through complex coding guidelines, and establish clear performance expectations. The overarching aim is to not only refine the accuracy and integrity of coded data but also to foster a culture of excellence and continuous improvement within the medical coding department. By empowering team members with advanced knowledge and practical insights, the training endeavors to optimize coding efficiency, minimize errors, mitigate compliance risks, and ultimately contribute to the delivery of high-quality healthcare services. Training Timeline: Week 1-2: Pre-Training Preparation  Distribute training materials including coding scenarios from weeks 3 and 5, coding guidelines, and rubric for performance evaluation.  Schedule individual meetings with team members to discuss training objectives and expectations.

2 Week 3-4: Training Sessions  Conduct training sessions covering coding scenarios from weeks 3 and 5, emphasizing accurate code assignment and rationale.  Review coding guidelines and provide examples to demonstrate their application in real- life scenarios.  Encourage active participation and discussion to ensure understanding of concepts. Week 5-6: Evaluation and Feedback  Assign coding exercises based on the training material for team members to complete independently.  Provide constructive feedback on coding accuracy and adherence to coding guidelines.  Review any areas of confusion or difficulty and provide additional clarification as needed. Week 7: Performance Evaluation  Evaluate team members' performance based on coding accuracy, adherence to coding guidelines, and understanding of coding principles using the rubric provided.  Provide individual feedback and identify areas for improvement.  Recognize and reward exemplary performance to motivate team members. Coding Scenarios Integration:  In Week 3, coding scenarios such as acute respiratory failure due to emphysema exacerbation (ICD-10-CM) and crack cocaine overdose leading to acute respiratory

3 failure (ICD-10-CM) will be incorporated into the training sessions. The accurate codes and rationale will be discussed, emphasizing the importance of sequencing and coding guidelines. (All Week 3 examples have been attached)  In Week 5, scenarios involving sepsis due to MRSA infection (ICD-10-CM) and acute respiratory failure secondary to Pneumocystis pneumonia in AIDS patients (ICD-10-CM) will be included to further reinforce coding principles and guidelines. (All Week 5 examples have been attached) Coding Guidelines:  Throughout the training program, emphasis will be placed on key coding guidelines such as sequencing of diagnoses, use of manifestation codes, and coding conventions.  Examples and case studies will be utilized to demonstrate the application of coding guidelines in different clinical scenarios. Performance Evaluation Rubric: The performance evaluation rubric serves as a structured framework for assessing and quantifying the proficiency and competency of participants in medical coding practices. The rubric encompasses three core domains, each weighted according to its significance in gauging coding excellence: 1. Coding Accuracy (0-5 points): o This domain evaluates the precision and correctness of the participant's coding outputs. Points are awarded based on the accuracy of assigned codes in reflecting the documented diagnoses, procedures, and services within healthcare records.

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4 Precision in code selection, avoidance of errors such as incorrect sequencing or inappropriate code assignment, and alignment with coding conventions contribute to a higher score in this category. 2. Adherence to Coding Guidelines (0-5 points): o Adherence to coding guidelines is a critical determinant of coding integrity and compliance. Participants are evaluated based on their adherence to established coding guidelines, including principles such as proper sequencing of diagnoses, utilization of manifestation codes, and compliance with coding conventions outlined by authoritative coding authorities. Consistent application of guidelines, avoidance of deviations or omissions, and alignment with industry standards contribute to a higher score in this domain. 3. Understanding of Coding Principles (0-5 points): o A comprehensive understanding of coding principles is essential for proficient coding practices. This domain assesses participants' comprehension of fundamental coding principles, including disease classification systems, code hierarchy, and coding conventions. Points are awarded based on the depth of understanding demonstrated in applying coding principles to varied clinical scenarios, discerning coding nuances, and exercising sound judgment in code selection and interpretation. Scoring in each domain ranges from 0 to 5 points, with higher scores revealing superior performance and proficiency. The cumulative scores across all domains provide a holistic assessment of the participant's coding proficiency and readiness to navigate complex coding challenges effectively.

5 By employing this performance evaluation rubric, the training program aims to provide participants with clear performance expectations, facilitate objective assessment of coding competence, and foster continuous improvement and refinement in medical coding practices. Continued Education Plan: After the initial training, two tasks will be performed to help the team maintain their skills: 1. Monthly Coding Challenges: Distribute coding challenges to team members based on real-life scenarios encountered in their work. Provide feedback and discuss solutions during team meetings to promote continuous learning and improvement. 2. Quarterly Coding Updates: Organize quarterly training sessions to review any changes or updates to coding guidelines and regulations. Encourage team members to share their experiences and challenges for collaborative learning. The comprehensive training program outlined above aims to equip the medical coding team with the necessary skills and knowledge to excel in their roles. By integrating coding scenarios, coding guidelines, and performance evaluation, the program will ensure consistent and compliant coding practices, ultimately contributing to the accuracy and integrity of coded data.

6 Week 3 & 5 Scenario Examples: Week 3: ICD-10-CM Refresher for Outpatient and Inpatient Services Outpatient Scenario 1: After years of being a transcriptionist, Mary suffers from numbness and tingling in her hands. Her provider performs an EMG and determines that Mary has bilateral carpal tunnel. syndrome in her hands. Select the correct ICD-10-CM code(s) for this visit and provide the appropriate rationale. The correct ICD-10-CM code for Mary's doctor’s visit should be G56.03 Carpal Tunnel Syndrome, Bilateral, upper limbs. Mary suffers from numbness and tingling in her hands. Her provider performs an EMG and determines that Mary has bilateral carpal tunnel syndrome in her hands. I looked up the word “Syndrome” in the ICD-10-CM book. Once located, I looked up the term “Carpal Tunnel”. This gave me code G56.0-. I went through the ICD-10-CM code book and found the code G56.0-. Under this code the code G56.03 shows to be Carpal tunnel syndrome, bilateral upper limbs. This is the diagnosis that was given to the patient after EMG was performed. The coding guidelines were followed in this scenario since it is the most correct code for this scenario which corresponds with bilateral carpal tunnel syndrome in the upper limbs however, no specific or other non-specific coding guidelines were applied to this scenario. This is what is known and encountered at the time of the patient’s visit. Outpatient Scenario 2: Tina recently began using essential oil diffusers in her office during the day. Recently, Tina

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7 has noticed an increased cough and shortness of breath. During her regular visit, Tina discussed these symptoms with her doctor. Upon further workup, it was determined that Tina had pneumonitis due to inhalation of oils and essences. Select the correct ICD-10-CM code(s) for this visit and provide the appropriate rationale. The correct ICD-10-CM code for Tina’s visit should be J69.1 Pneumonitis due to inhalation of oils and essences. The instructional notation listed underneath the code asks us to code first the identity of the substance from sections (T51-T65). After searching this particular section of the book, I located the code T65.894. This code requires a 7th character, so the correct code is T65.894A, Toxic effect of other specified substances, undetermined, initial encounter. Since the documentation didn’t further discuss the type of oils these were, it was impossible to code for the actual substance contained in the oils. The initial encounter also did not state if accidental, intentional, or assault, therefore I am using undetermined code. Inpatient Scenario 1: A patient was admitted to the hospital with unstable angina that had been increasing in severity since the previous day. He was placed on best rest and telemetry and IV nitroglycerin was administered. An EKG showed paroxysmal tachycardia as well, so IV heparin was added to his medication program. His angina returned to normal status, and the tachycardia was not shown on repeat studies at the end of one week. Select the correct ICD-10-CM code(s) for this visit and provide the appropriate rationale . In this scenario, the admitting diagnosis for the patient is unstable angina. Post-

8 admission, the patient had an EKG which revealed paroxysmal tachycardia, which is acute in nature at the beginning and end of hospital stay. Based upon this information, the two correct codes for this particular scenario are I20.0 Unstable Angina, followed by the code I47.9 Paroxysmal tachycardia, unspecified. The sequencing of these codes is as such due to ICD-10- CM guidelines which instruct us to code the admitting diagnosis followed by manifestations/other issues. Inpatient Scenario 2: The patient is admitted to the hospital for the third round of chemotherapy for her acute lymphoblastic leukemia. On the second day of hospitalization, the patient develops severe nausea and vomiting. Select the correct ICD-10-CM code(s) for this visit and provide the appropriate rationale. The initial admission is for the patient’s third round of chemotherapy to treat her acute lymphoblastic leukemia. During the stay, the patient developed complications, which were severe nausea with vomiting. The correct code assignment for this scenario would be Z51.11, C91.00, R11.2. Per the ICD-10-CM guidelines: when a patient is admitted for chemotherapy and develops complications such as severe/uncontrollable nausea and vomiting, chemotherapy should be the first-listed diagnostic code. Therefore, the first-listed code for this scenario is Z51.11 Encounter for antineoplastic chemotherapy. The notations in this section of the tabular list instruct to "code also condition requiring care," by which the next code in the sequence is C91.00 Acute lymphoblastic leukemia. The final code in the sequence is R11.2 Nausea with vomiting, unspecified.

9 Week 5: Advanced ICD-10-CM for Outpatient and Inpatient Services Outpatient scenario 1: Joseph noticed he was having a difficult time remembering and becoming more easily confused. After discussing this with his doctor, Joseph was diagnosed with onset Alzheimer’s dementia. Select the correct ICD-10-CM code(s) for this visit and provide the appropriate rationale. The correct codes for this scenario are G30.9, Alzheimer’s disease, unspecified and F02.80, Dementia in other diseases classified elsewhere without behavioral disturbance. The reason I chose these codes is because the documentation does not elaborate on what stage, as it only states “onset” vs. “early or late onset,” and there isn’t mention of there being any type of behavioral disturbances. Therefore, I felt that these are the most appropriate codes for this case. Alzheimer’s varies from person to person as far as signs and symptoms, therefore coding as unspecified is the best choice since documentation doesn’t support early onset or otherwise. To locate these codes, I searched the index under diseases, then Alzheimer's, then to the tabular list to look for specific guidelines regarding these codes. This is where I saw that under the G30.9 code it states also code F02.80. I then looked up this code in the tabular to make sure that it was indeed accurate coding. ICD-10-CM Codes:

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10 G30.9 - Alzheimer’s disease F02.80 - Dementia in other diseases classified elsewhere without behavioral disturbance Outpatient scenario 2: Jackie is a 23-year-old female who was injured at school playing soccer. Jackie presented to the Emergency Department and was diagnosed with an acute on chronic complex left medial meniscus tear/injury. Select the correct ICD-10-CM code(s) for this visit and provide the appropriate rationale . For this case, I searched the index under tear, then meniscus, medial, then complex (S83.23-). I turned to the tabular lists to search for specific guidelines regarding this section. The official guidelines state that the guidelines within the tabular and index take precedence over the official coding guidelines when establishing principal diagnoses. Therefore, the code I have selected for this case is: S83.232A, Complex tear of the medial meniscus, current injury; left knee. I added the seventh character to the diagnosis code as instructed by guidelines as this is the current injury/initial encounter for this injury or an injury actively being treated. I then looked under the external causes section, activity, soccer, I chose code Y93.66, Activity, soccer, and then under place of occurrence I chose Y92.219, unspecified school as the place of occurrence of the external cause due to it did not specify what type of school she was at. ICD-10-CM Codes: S83.232A - Complex tear of the medial meniscus Y93.66 - Activity, soccer

11 Y92.219 - unspecified school as the place of occurrence of the external cause Inpatient scenario 1: Adam has been in the hospital for the past 3 days due to cellulitis that formed from a cat bite on his right hand. A midline catheter was placed because of difficult IV access. On the 4 th day of admission, the patient developed a nosocomial gram-negative bacilli sepsis/blood stream infection, due to the midline catheter. Select the correct ICD-10-CM code(s) for this visit and provide the appropriate rationale. First, I coded for the cellulitis which is L03.113, Cellulitis of the right upper limb. I found this code by looking under the index for Cellulitis and then hand. It states to go to Cellulitis, upper limb (L03.11-). I then went into the tabular section and found L03.113. I then went under the external causes and found bite, cat (W55.01) After looking up in the tabular this code shows a X+7 th to be added. In this case the cause of the injury that led to cellulitis was bite by cat-initial encounter W55.01XA. Then for the nosocomial infection, under infection in the index and catheter-related bloodstream (T80.211). After looking up this code in the tabular section it shows that a 7 th character is needed, therefore the appropriate code would be T80.211A. (A) meaning that this is the initial encounter. Under the index I also found Sepsis, gram-negative, A41.5. After looking up code in the tabular the best choice that I saw was code A41.59, Other Gram-negative sepsis. This started with

12 cellulitis since that is the current issue, followed by what caused this all to happen in the first place. Then due to the skin graft, there was a midline placed, followed by the sepsis due to the infection after placement of the midline. ICD-10-CM Codes: L03.113 - Cellulitis of the right upper limb W55.01XA - bite by cat, initial encounter T80.211A – infection, catheter-related bloodstream, initial encounter A41.59 - Other Gram-negative sepsis Inpatient scenario 2: Mr. Schultz was admitted to the hospital on Monday after being diagnosed with a neuroendocrine tumor of the colon with metastatic disease to the liver. Select the correct ICD-10-CM code(s) for this visit and provide the appropriate rationale. Since Mr. Schultz (cancer) neuroendocrine tumor of the colon metastasized to the liver, I first code for the tumor of the colon, followed by the metastatic disease to the liver. In this case, the following codes apply: C7A.029, Malignant carcinoid tumor of the large intestine; unspecified portion, and C7B.02, Secondary carcinoid tumors of liver. C7A.029 accurately represents the primary tumor site as a malignant carcinoid tumor in the large intestine (colon). The code C7B.02 is a billable diagnostic code indicating the presence of secondary liver adenocarcinomas. ICD-10-CM Codes:

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