Cert - ANSWER-Comprehensive error testing rate
Cpt - ANSWER-Current procedural terminology. The amas list of 5 digit codes used to report outpatient
... [Show More] hospital and Physicians Medical and surgical services. CPT is used to report outpatient or Physician Office claims only and is updated annually in January.
Hac - ANSWER-Hospital-acquired conditions are defined as for discharges occurring on or after October one 2008 ipps hospitals will not receive additional payment for cases when one of the selected conditions is acquired during hospitalization. In such cases payment will not be driven Higher by the secondary diagnosis if it is identified as an h a c.
Qio - ANSWER-An organization responsible for determining whether care and services provided were medically necessary and meet Professional Standards regarding eligibility for reimbursement under Medicare and Medicaid programs.
Rom - ANSWER-The anticipated likelihood of dying
Soi - ANSWER-Severity of illness supportive documentation reflecting objective clinical indicators of a patient illness and the extent of physiologic decompensation or loss of organ system function.
Wbc - ANSWER-Normal range for WBC is 5 to 10 mm 3. The critical value for this lab value is less than 2.5 or greater than 30.
Hgb - ANSWER-Hemoglobin for males normal range is 14 through 18 for females normal range is 12 through 16.
Hct - ANSWER-Hematocrit normal range for males is 42 to 52. Normal range for females is 37 to 47.
Platelets - ANSWER-Normal range 150000 to 450000 mm 3
Cardiac markers include - ANSWER-CPK normal value 25 to 200. C K - MB normal value less than 12 if total CK less than 400. Troponin normal value less than 0.4. BNP normal value less than 100. However in patients with chronic renal failure or heart failure Base Line levels will be higher.
Blood chemistry normal values - ANSWER-Sodium 1:36 to 1:45. Chloride 98 through 106. Potassium 3.525. Carbon dioxide 23 to 30. Calcium 8.5 to 10.5. BUN 7 to 20. Creatinine 0.5 to 1.5. glucose 8220. Hemoglobin A1c less than six. Ammonia 10 to 40 amylase 25 to 150. Lipase 0 to 1:40. Albumin 3.5 to 5.
Abgs - ANSWER-pH normal 7.35 to 7.45. Paco2 35 to 45. Pao2 80 to 100. Hco3 21 to 28. O2 saturation 95 to 100%.
Assigning the drg - ANSWER-Identify the principal diagnosis. Identify the secondary diagnosis. Validate that all DX findings nurses notes lab values treatments and medications ordered are explained in documentation. Identify procedures. Assign the ms-drg for all appropriate options.
Secondary diagnosis that impact severity of illness and risk of mortality - ANSWER-Acidosis, alkalosis, apnea, autoimmune diseases, awaiting transplant status, BMI, bundle branch block, CHF, CKD stages 2 or 3, COPD, dementia, dependence on oxygen, dependence on ventilator, diabetes linked to manifestation such as neuropathy and nephropathy, dysphagia, hematuria, hemiplegia, history of cardiac arrest, hypocalcemia, hypokalemia, hypomagnesemia, hypotension hypoxia, mitral regurgitation, malnutrition, morbid obesity, obesity, pressure ulcer, residual from CVA, thrombocytopenia, trach status, transplant status
Hrrp Hospital readmission Reduction - ANSWER-The hrrp program is administered by CMS as part of its inpatient Quality Reporting program, or IQR and was authorized under the Affordable Care Act of 2010 to link quality (readmission rates) to medicare payment. Under this program Hospital readmission rates are measured retrospectively via a three-year rolling of data.
How are Hospital readmissions tracked? - ANSWER-Seven types of admissions including acute and I, heart failure, ammonia, COPD, total hip arthroplasty, total knee arthroplasty, CAbg.
What is all-cause readmission? - ANSWER-As previously noted this is not part of the hrrp program and currently hospitals are not assessed penalties based on excess admissions but this information is being tracked and is publicly available on the CMS Hospital compare website. The outcome for this measure is all cause unplanned readmissions within 30 days. Patients are divided into six mutually exclusive specialty cohorts for appropriate readmission risk assessment classification. These include medicine gynecology cardiorespiratory cardiovascular and neurology. The index admission criteria is the same as for the hrrp program and includes patients enrolled in Medicare fee-for-service, age 65 or over, DC from non-federal acute care hospital or VA Hospital alive, not transferred to another acute care facility, and enrolled in part A & B Medicare for the 12 months prior to the date of the index admission. Index ignitions excluded from the measure include admission to PPS exempt cancer hospitals, admission without at least 30 days post DC enrollment in ffs Medicare, DC Ama, admit for primary psych diagnosis, admit for Rehab, admit for medical treatment of cancer.
Ekg rhythms - ANSWER-Common EKG rhythms include sinus rhythm, atrial fibrillation, atrial flutter, AV pacing, ventricular tachycardia, ventricular fibrillation, and agonal rhythm
Conditions associated with dehydration - ANSWER-Renal failure, CHF, respiratory insufficiency, Burns, dka, hhn see, siadh, intestinal obstruction, gee I lost, post-operative state
Conditions associated with hyper natremia - ANSWER-CHF, hhnc
Conditions associated with metabolic acidosis - ANSWER-CHF Burns dka intestinal obstruction GI loss post-op state
Conditions associated with metabolic alkalosis - ANSWER-CHF GI loss post-op state
Conditions associated with respiratory acidosis - ANSWER-Respiratory insufficiency Burns intestinal obstruction post-op state
Linked diagnosis - ANSWER-Alcohol needs to be linked with cirrhosis hepatitis. Anemia needs to be linked with the specified type. Chronic renal failure needs to be linked with diabetes or other causes of CRF except hypotension. Complications need to be linked with either post-op and or due to device. CHF needs to be linked with acute chronic and diastolic or systolic, diabetes needs to be linked with all manifestations. Drug and alcohol use needs to be linked with abuse or dependency. Fractures need to be linked with terms such as pathological, stress, non-traumatic. Hypertension needs to be linked with a cardiovascular diagnosis. Infections or slut sepsis needs to be linked with due to device, specific organism, or post-operative. Pneumonia needs to be linked with a specified type organism Gram stain or aspiration.
Hcc - ANSWER-Hcc's are hierarchical condition categories and were developed by CMS in 2004 to adjust Medicare capitation payments to the Medicare Advantage Plans part c.
Raf - ANSWER-RAF score or risk adjustment factor is a total score of all relative factors related to one patient for a total year submitted from the following sources: principal diagnosis hospital inpatient secondary diagnosis hospital inpatient Hospital outpatient Physician's Clinic Lee trained non-physician such as a psychologist or podiatrist. In addition scores are adjusted for age, living Arrangement, Medicaid disability status and interaction with age and sex, HCC category, interaction between certain disease condition in categories, and interaction between certain disease categories and disability status.
Psi - ANSWER-Patient safety indicators are used by a wide range of organizations and initiatives. Safety indicators include psi2: death rate and low mortality diagnosis groups,ps3 pressure ulcer rate, PSI for death rate among surgical in patients with serious treatable conditions, PSI 5 retained surgical items or unretrieved device fragment count, PSI 6 pneumothorax rate, PSI 7 venous catheter related bloodstream infection rate, PSI 8 in hospital fall with hip fracture rate, PSI 9 perioperative Hemorrhage or hematoma rate, PSI 10 post-operative acute kidney injury requiring dialysis, PSI 11 post-operative respiratory failure rate, PSI 12 post-operative pulmonary embolism or deep vein thrombosis rape, PSI 13 post-operative sepsis rate, PSI 14 post-operative wound dehiscence rate, PSI 1500 unrecognized abdominopelvic accidental puncture or laceration rate, PSI 16 transfusion reaction count, PSI 17 birth trauma rate in neonate, PSI 18 obstetric trauma rate vaginal delivery with instrument, PSI 19 obstetric trauma rate vaginal delivery without instrument.
Icd 10 PCS root operations - ANSWER-Alteration bypass Change Control creation-destruction Detachment dilation division drainage excision extirpation extraction fragmentation Fusion insertion inspection map occlusion reattachment release removal repair replacement reposition resection restriction revision supplement transfer transplantation
Icd 10 coding guidelines - ANSWER-
CMS coding guidelines and directives - ANSWER-Published annually and include rules for code sets code assignment sequencing guidelines and chapter specific guidelines. Directives include instructional notes such as code first code additional and excludes notes. In addition the AHA Central coating offices published icd-10-cm and icd-10-pcs coding handbook and coding clinics four times a year. [Show Less]