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Inside this Issue:

President’s Message

These are unprecedented times. As our country navigates the roller coaster that is COVID-19 and adjusts to a new normal, America’s workforce is adapting to virtual meetings, virtual physician visits, and the virtual office. Many industry groups have had to convert their in-person conferences into virtual offerings, MSHIMA included. Our profession is poised to lead this transition as our expertise is vital to steer our colleagues through the confidentiality rules as practitioners begin to use a new medium for many patient and business needs. As I take office this year, one of my goals is to visit every region. I also think it is important to highlight many of our HIM colleagues in the state and their employers and will strive to cover at least one on every newsletter. Communication is vital today more than ever and I am always available if you ever have a question or concern or need any assistance. We will be developing a strategic plan very soon for 2020-2021 and I hope to create offerings that expand our expertise in addition to our standard fare. Your association is here to serve you and I look forward to serving you this year.

- Kory Hudson, Incoming President, RHIA

MSHIMA Awards Annual Scholarship

The Mississippi Health Information Management Association is pleased to announce that Tanya Shirley, a student in the HIM Program at Meridian Community College, is the organization’s 2020 scholarship recipient. Tanya was a certified dental assistant with Dr. Bill’s Pediatric Dentistry in Hattiesburg before leaving to stay home with her three children. Tanya then returned to work as an Interventionist at Clarksdale Middle School. She later determined that HIM was her desired future, and she returned to school at Meridian Community College in August of 2019 to pursue a degree in health information management. Tanya is currently an active member of AHIMA/MSHIMA.

Rebecca Higginbotham, RHIA, CCS, writes about Tanya, "I truly believe she will be an asset to our field as she takes pride in her work, has a thirst for knowledge, and enjoys the challenges of learning about new technology.”

Tanya writes that, “my passion has always been for excellence in all that I pursue, and this includes making a difference, excelling, and loving my career. Once I receive my HIM degree, I fully know I will be pursuing my passion by lowering healthcare costs, maximizing healthcare efficiency, eliminating avoidable mistakes, and helping people.”

MSHIMA congratulates Tanya and wishes her the best in her future as an HIM professional!
Photo of Tanya Shirley

VERISMA Offers MSHIMA Free Educational Webinars

MSHIMA is partnering with Verisma, a healthcare disclosure management company, to offer you five free educational webinars that will award you one continuing education credit hour per webinar. Thank you to Verisma for this service!
Learn More & Register

Tips for a Successful Interview

Speaking as a person who has conducted many, many interviews and has been interviewed her fair share of times, I want to take this opportunity to provide a few points to those currently job hunting to help you nail that interview. Some of these may seem like common sense but I assure you, I mention them because these are things that have left a lasting impression on me and explains why candidates were not selected.

Make sure your resume is up-to-date and use spell check. A resume with grammar mistakes and/or misspellings is a beacon reflecting lack to detail and an uncaring attitude. Your resume is your very first impression on a potential employer; make the most of the words on the page. Once you are offered an interview, bring a copy of your resume and provide references. This shows that you’ve prepared for the interview and are well organized. Also, spend a few dollars to get some nice paper. It does make your resume stand out from other applicants.

A neat appearance is crucial. You should be dressed as if you were going to work with the potential employer. If it is an office setting, dress business appropriate. Your appearance should reflect professionalism and confidence. Inappropriate attire for an interview can speak louder than the conversation held with your potential employer.

The person conducting the interview may have fragrance sensitivities or allergies. Please be careful with the application of perfume/cologne. NO GUM! I cannot stress that enough. It shows a lack of respect to the interviewer, and it makes you appear sloppy and juvenile. If you have facial piercings, remove them. You want the interviewer to focus on your words not a ball bouncing around your mouth as you speak. Ladies be conservative in your make-up application. Your appearance should be professional, not reflecting your talent to use all the make-up samples you have collected.

Be prepared to sell yourself. It is your interview. Use tact and be honest. Remember, your references could be asked regarding comments you make during your interview. If you have accolades, allow them to shine. Report them on your resume or, if the topic comes up, bring up how you were awarded the honor. Be factual and modest in your discussion.

Be ready to answer some tough questions. Every interviewer uses different tactics to see how a potential candidate will react to questions that they were not prepared to answer. You can refuse to answer any question, especially those that would infringe upon race, religion, or sexual orientation which are not allowed to be asked by any employer, at any time. Think about the following questions and how you’d answer them:
  • If I were to call your former/current employer, what sorts of things would they share with me?
  • Where do see yourself in 5 years? 10 years?
  • (one of my favorites) Tell me about an instance where you played a part in making a significant change in either rules/policies that were for the benefit of many people?
  • Professionally, what keeps you up at night?
LISTEN!! I have found that candidates read the job description but don’t fully understand the expectations of each point in the job description. The key is to hear out what the interviewing person is sharing. They may share insight with you that would determine if the job responsibilities are amply compensated by the pay or if you are well suited for the position.

Lastly, relax. You’re being interviewed because they have a need to fill a job. Good candidates will come across as knowledgeable, professional and able. Rest well the night before, be on time for your interview and allow your skills and knowledge to take center stage to reflect your ability to do the job.

Good Luck!

- Jeanette Taylor, RHIT, CPC

Former Graduate Praises Itawamba Community College HIT Program

As a graduate of the HIT program at Itawamba Community College, I can say that I am truly grateful for this program. I originally started the program a while back, but life happened, and I couldn’t complete the program. However, I decided I wanted to go back to school to get my degree, so I enrolled in the program again. This time I was going to be a full-time student along with working full time. I knew it would probably be difficult, but I was determined that nothing was going to get in my way of finishing and getting my degree. The instructors were very knowledgeable in the subjects that they thought. I liked that they tried to use real world experiences to help us understand the material. It also gave us a perspective as to how things could be in the HIM field. Of course, through any program, there are topics that can be difficult to understand but the instructors always did their best to make sure we understood the information. They would make a time to meet us one-on-one or give us an extra assignment related to that topic if needed.

There was a point during the program where I didn’t feel I was doing as well as I wanted to but I was still making it. With the help and encouragement from the instructors, I stayed in the program and finished. They also helped us learn that HIM wasn’t just about coding or working at a hospital or clinics. There are some that think HIM is just coding or release of information. However, that isn’t the case. Of course, there are things that they can’t teach you from the books, it just takes on the job experience…like a national pandemic. The instructors always believe in and encourage the students all that they can. I can honestly say I probably wouldn’t be where I am today in my career if it hadn’t been for them.

While in the program, I stated that one day in my career I wanted to be a director. Well I graduated in May and in July, an instructor reached out to me about a director’s job at a critical access hospital. I was afraid to put in for it. But with the encouragement from the instructors, I went for it. I later received the job. I have also now received a job as Revenue Integrity Analyst based on the experience I had as a director of medical records. Not only are the instructors there for you during the program but they will still be there after you complete the program. Goodness knows, I’ve asked a lot of questions after the program. If anyone is interested in a program where you get education along with care and encouragement along the way, then HIT at Itawamba Community College is one I recommend.

- Ashley Stanford, Revenue Integrity Analyst, Monroe Regional Hospital

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Two women sitting and writing together

COVID-19 Highlights HIM’s Advanced Care Planning Expertise

By Mary Butler

The documentation detailing a person’s wishes for the care they receive at the end of their life is amongst the most sensitive data that health information management (HIM) professionals will ever handle. But for the providers that use that data to make life or death decisions, those records are frequently incomplete, contradictory, or missing entirely. In a pandemic where patients are making decisions isolated from their families and advocates, healthcare professionals are looking at advance care planning (ACP) documentation with new urgency.

This urgency has compelled healthcare organizations to take a more proactive approach to ensuring ACP documentation is as accessible and accurate as possible, whether that means partnering with a vendor or manually reviewing all of the documentation currently on file. HIM professionals have long had ownership over where ACP documentation is stored and how it’s shared, which makes them integral in these efforts. Their expertise around the many types of documentation in this category—which includes advance directives, do-not-resuscitate orders, living wills, durable power of attorney, and medical orders of life sustaining treatment (MOLST) forms—has made HIM a critical part of organizations’ COVID-19 pandemic response.

Over the last several years, as the Affordable Care Act and other reforms began to prioritize ACP, vendors have developed electronic registries and interoperable technologies to make this type of care planning more seamless. Those vendors have seen demand for their solutions skyrocket as at-risk individuals and providers have grappled with a new disease that has required patients to be intubated or put on ventilators at unprecedented levels. While COVID-19 is testing the American healthcare system in new ways every day, it’s also hastening conversations that have been on the backburner for too long.

Prioritizing High-Risk Patients

In response to the high volume of critical COVID-19 patients in Boston, MA, Partners Healthcare turned to its HIM department for help figuring out the healthcare proxy status of patients with a higher risk of contracting COVID-19. The electronic health record (EHR) system that Partners uses has an ACP module where all of a given patient’s documents reside. When Partners started treating a lot of COVID-19 patients, its palliative care and critical illness team started to find that many patients had two healthcare proxies listed—or they had no proxy listed at all, according to Jackie Raymond, RHIA, director, enterprise HIM, at Partners Healthcare. In ACP, a healthcare proxy is the document that names the person or “agent” responsible for making healthcare decisions on the patient’s behalf.

Raymond says her HIM team was asked to complete an analysis on the proxy status of these at-risk patients to find the current state of the landscape. Once that was finished, they were asked to do a cleanup on all of the accounts that had more than one proxy listed. Raymond and Shanda Brown, senior manager of business services, worked with Partners clinical teams to identify which patients were high risk.

“We’ve worked through those first and then we sort of stratified medium-risk, low-risk, and we’re working through those queues. And we’ll get through as many as we can during the crisis and then from a HIM perspective, we’ll look at what’s left when we get out of this crisis and figure out how we’re going to finish cleaning up the rest of them. This project is sort of a hybrid of taking something that we were currently doing and expanding the scope of it,” Raymond said.

Concurrent to HIM’s task to update patients’ proxy status, clinicians who are a part of Partners’ serious illness team are also prioritizing the collection of MOLST forms, which in Massachusetts is a document based on an individual’s right to accept or refuse medical treatment, including treatments that might extend life. Given that patients with COVID-19 can deteriorate rapidly, clinicians treating them must walk a fine line in preparing them for difficult end-of-life care conversations without frightening them.

“The one thing that actually has happened with this is, at least across Partners, they created a subgroup that has really just focused on having these conversations and have created like a consultant line to say, ‘If you do need to have a serious illness conversation, call this number,’” Raymond said. “…Sometimes there’s a concern about having the conversation too soon and making things a little worse emotionally for the patients and their families.”

Raymond and Brown both acknowledge that in the absence of a vaccine for COVID-19, the efforts they’re making to ensure ACP documentation is complete is going to be a priority for a long time.

“It’s certainly highlighted, it certainly highlighted the importance of these documents and our role in it is just so much more important now that we’re able to help with this project,” Brown said.

Online Registries Bring Peace of Mind

In response to the COVID-19 pandemic, online registries for ACP documentation are gaining traction. Care Directives and ADVault are two such registries that providers can partner with, or which patients and their family members can access directly to store advance directives, living wills, POLST/MOLST forms, and other related documents.

Susie Flores, CEO of Care Directives, first experienced ACP when she worked in hospitals as a social worker and saw the turmoil that could arise when advance directives were misplaced or lost in patients’ homes or when the documents didn’t follow a patient from one care setting to another. Flores hears from providers who readily admit their own EHRs make these documents hard to track.

“Just this morning we had a large healthcare system that said ‘We can’t find our own documents let alone share them.’ That obviously presents a big challenge—forget sharing them with the nursing home down the street or physician who’s seeing the patient,” Flores said.

Care Directives created a patient-facing portal where patients themselves can upload ACP documents, as well as a cloud-based registry to which providers can subscribe that leverages existing data exchange standards, such as Carequality, Commonwell, Direct Trust, FHIR, HL7, and APIs.

Jhyl Mumford, RN, VP of clinical operations at Butterfly Hospice Care in Upland, CA, says the adoption of online registries for these documents has been a gamechanger in the hospice world, where patients are admitted from numerous types of settings, such as hospitals, their homes, assisted living, and skilled nursing facilities. When patients are admitted from their homes, hospice staff and EMS workers are trained to check the patient’s refrigerator, where key documents are frequently kept so as to be in plain sight.

“The problem is they get misplaced, grandkids take them off, they never get put there. Because it touches so many hands it can be a long process before we get a document that’s signed and that’s uploaded to the patient’s chart,” Mumford said.

Having documents that are stored online and accessible to hospice staff and to patients’ families helps to ensure everyone is on the same page when decisions need to be made, according to Mumford.

Maria D. Moen is a member of AHIMA’s long-term and post-acute care practice council and is the director of platform innovation at ADVault, a platform that allows individuals to upload or create, store, and share their advance directives, advance care plans, and portable medical orders. Moen sees platforms and services such as ADVault and Care Directives as fulfilling the goals of providing patient-centered care through innovation and technology. That’s even more important during a pandemic.

“So, whether it’s end-of-life or just a normal emergency or health crisis, having your decisions and priorities and goals documented is more important than it ever was,” Moen said. “Certainly, it’s important at end-of-life. We deserve to have our end-of-life be on the same terms that we’ve lived our lives. And so I definitely think it’s brought advanced care planning and end-of-life … to the forefront.

“I look at some of the seniors that we work with, and they are perfectly able to speak their mind. They are not currently in a health crisis. And the question is, if you are suspected to have become ill with the coronavirus and you may not be able to speak for yourself at that point in time, what do you want your healthcare journey to look like? And because it is so real and is so omnipresent, I think perfectly lucid [and] healthy seniors are saying, ‘Yeah, you know what? That could happen to me, so let me just document this.’”
Arrows and gadgets

Mississippi Set to Launch State-Wide Health Information Exchange

The new state-wide health information exchange already has two of Mississippi’s largest health systems in the fold.

By Christopher Jason

June 01, 2020 - The Mississippi Hospital Association (MHA) has established a state-wide health information exchange (HIE) that aims to increase interoperability and enhance the connection between Mississippi hospitals and physicians as they transition toward value-based care.

With three regional hospitals and two of the largest health systems in the state already involved, the HIE is set to launch within the next month. The organization said it expects additional hospitals to join over the summer.

To get the exchange going, MHA partnered with Care Continuity to utilize its navigation technology and patient advocacy technology to its committed health systems across the state.

“Our partnership with Care Continuity allows all Mississippi providers to deliver care to their patients fully aware of key events impacting them, such as a visit to an emergency department, while also ensuring that all members of the patient care team are working from the same set of information,” Timothy H. Moore, president and CEO of MHA, said in a statement.

“This will help our hospitals address one of the greatest challenges in health care — delivering the right care at the right time.”

First, the HIE will feature inpatient admissions, emergency department visits, and post-acute care transition notifications for providers.

Once the HIE is launched, health systems will eventually be able to access capabilities such as, secure clinical document exchange, provider-to-provider referral management, and support for collaboration within patient-centered care teams and payers. Physicians will also be able to access customizable text or email admission notifications for all connected health systems.

Along with the additional HIE capabilities, the state-wide exchange aims to reduce costs and improve patient care by lowering the chances of duplicative testing and linking providers throughout the state. It also meets the recent Medicaid and Medicare service standards, which awards health systems that can show they are reducing hospital re-admissions and improving care quality.

“Providing the data infrastructure to enable health systems to track patients through their individual journey will ensure patients are receiving quality care in a timely manner,” said Andrew Thorby, CEO, Care Continuity.

Mississippi’s HIE was announced just days after Connecticut launched a state-wide HIE when it inked its first client, Connecticut State Medical Society’s CTHealthLink.

Over the past decade, Connecticut’s government leaders found out the hard way how difficult it is to implement a state-wide HIE.

First, the state attempted to launch the HIE four times prior to this connection, costing the state millions of dollars. More recently, a Connecticut Health Foundation report said the state’s organizers must develop long-term financial plans for sustainability and attract participants before launching the HIE.

Now that the HIE is connected to CTHealthLink, the two organizations aim to improve patient care, enhance interoperability throughout the state, and upgrade Connecticut’s healthcare delivery system.

“Good information is critical for good healthcare; the HIE will help providers get patient information quickly and that improves care, reduces redundant testing, and lowers costs,” Vicki Veltri, executive director of the Office of Health Strategy, said in a statement.

“Individual and public health awareness is front page news – and Connecticut is now officially on the path that 45 other states have already traveled, with a more effective healthcare delivery model to show for it. The Connecticut State Medical Society’s CTHealthlink represents thousands of providers across the state and we welcome them to the HIE.”

The HIE said it aims to introduce the benefits of the new exchange system, while prioritizing patient privacy and security.

“Improving healthcare delivery for Connecticut residents should be a constant goal for health leaders and I’m ecstatic to see this platform up and running,” said Connecticut senator, Mary Daugherty Abrams. “It will reduce costs and improve efficiency, both of which are sorely needed. Especially amid the current COVID-19 crisis, this will undoubtedly improve healthcare across our state.”
A man and woman looking at a screen of data

AHIMA and AHA FAQs: ICD-10-CM Coding for COVID-19

UPDATED: June 4, 2020

The following FAQ on ICD-10-CM coding for COVID-19 was jointly developed and approved by the American Hospital Association’s Central Office on ICD-10-CM/PCS and AHIMA.

Question #1: What is the ICD-10-CM code for COVID-19? (rev. 4/1/2020)

Answer: ICD-10-CM code U07.1, COVID-19, may be used for discharges/date of service on or after April 1, 2020. For more information on this code, click here. The code was developed by the World Health Organization (WHO) and is intended to be sequenced first followed by the appropriate codes for associated manifestations when COVID-19 meets the definition of principal or first-listed diagnosis. Specific guidelines for usage are available here. For guidance prior to April 1, 2020, please refer to the supplement to the ICD-10-CM Official Guidelines for coding encounters related to the COVID-19 coronavirus outbreak.

Question #2: Is the new ICD-10-CM code U07.1, COVID-19, a secondary code? (rev. 4/1/2020)

Answer: When COVID-19 meets the definition of principal or first-listed diagnosis, code U07.1, COVID-19, should be sequenced first, and followed by the appropriate codes for associated manifestations, except in the case of obstetrics patients. However, if COVID-19 does not meet the definition of principal or first-listed diagnosis (e.g. when it develops after admission), then code U07.1 should be used as a secondary diagnosis.

Question #3: Are there additional new codes to identify other situations specific to COVID- 19? For example, codes for exposure to COVID-19, or observation for suspected COVID-19 but where the tests are negative? (rev. 3/20/2020)

Answer: No, at the present time, there are no other COVID-19-related ICD-10-CM codes. However, the Centers for Disease Control and Prevention’s National Center for Health Statistics, the US agency responsible for maintaining ICD-10-CM in the US, is monitoring the situation. The off-cycle release of code U07.1, COVID-19, is unprecedented and is an exception to the code set updating process established under the Health Insurance Portability and Accountability Act (HIPAA).

Question #4: We have been told that the World Health Organization (WHO) has approved an emergency ICD-10 code of “U07.2 COVID-19, virus not identified.” Is code U07.2 to be implemented in the US too? (rev. 3/26/2020)

Answer: The HIPAA code set standard for diagnosis coding in the US is ICD-10- CM, not ICD-10. As shown in the April 1, 2020 Addenda on the CDC website, the only new code being implemented in the US for COVID-19 is U07.1.

Question #5: How should we code cases related to COVID-19 prior to April 1, 2020, the effective date of ICD-10-CM code U07.1, COVID-19? (rev. 4/1/2020)

Answer: Please refer to the supplement to the ICD-10-CM Official Guidelines for coding encounters related to the COVID-19 coronavirus outbreak. After April 1, 2020, refer to the Official Guidelines for Coding and Reporting found here.

Question #6: Is the ICD-10-CM code U07.1, COVID-19 retroactive to cases diagnosed before the April 1, 2020 date? (rev. 3/20/2020)

Answer: No, the code is not retroactive. Please refer to the supplement to the ICD- 10-CM Official Guidelines for coding encounters related to the COVID-19 coronavirus outbreak for guidance for coding of discharges/services provided before April 1, 2020.

Question #7: Is code B97.29, Other coronavirus as the cause of diseases classified elsewhere, limited to the COVID-19 virus? (rev. 3/20/2020)

Answer: No, code B97.29 is not exclusive to the SARS-CoV-2/2019-nCoV virus responsible for the COVID-19 pandemic. The code does not distinguish the more than 30 varieties of coronaviruses, some of which are responsible for the common cold. Due to the heightened need to uniquely identify COVID-19 until the unique ICD-10-CM code is effective April 1, providers are urged to consider developing facility-specific coding guidelines that limit the assignment of code B97.29 to confirmed COVID-19 cases and preclude the assignment of codes for any other coronaviruses.

Question #8: What is the difference between ICD-10-CM codes B34.2 vs. B97.29? (rev. 3/20/2020)

Answer: Diagnosis code B34.2, Coronavirus infection, unspecified, would generally not be appropriate for the COVID-19, because the cases have universally been respiratory in nature, so the site of infection would not be “unspecified.” Code B97.29, Other coronavirus as the cause of diseases classified elsewhere, has been designated as interim code to report confirmed cases of COVID-19. Please refer to the supplement to the ICD-10-CM Official Guidelines for coding encounters related to the COVID-19 coronavirus outbreak for additional information. Because code B97.29 is not exclusive to the SARS-CoV-2/2019-nCoV virus responsible for the COVID-19 pandemic, we are urging providers to consider developing facility-specific coding guidelines that limit the assignment of code B97.29 to confirmed COVID-19 cases and preclude the assignment of codes for any other coronaviruses.

Question #9: Does the supplement to the ICD-10-CM Official Guidelines for coding encounters related to the COVID-19 coronavirus outbreak apply to all patient encounter types, i.e., inpatient and outpatient, specifically in relation to the coding of “suspected”, “possible” or “probable” COVID-19? (rev. 3/20/2020)

Answer: Yes, the supplement applies to all patient types. As stated in the supplement guidelines, “If the provider documents “suspected”, “possible” or “probable” COVID-19, do not assign code B97.29. Assign a code(s) explaining the reason for encounter (such as fever, or Z20.828, Contact with and (suspected) exposure to other viral and communicable diseases.”

Question #10: The supplement to the ICD-10-CM Official Guidelines for coding encounters related to the COVID-19 coronavirus outbreak refers to coding confirmed cases in a couple of instances, but it does not specify what “confirmation” means similar to language in guidelines found for reporting of HIV, Zika and H1N1. Can you clarify whether the record needs to have a copy of the lab results or what lab tests are approved for confirmation? (rev. 3/20/2020)

Answer: The intent of the guideline is to code only confirmed cases of COVID-19. It is not required that a copy of the confirmatory test be available in the record or documentation of the test result. The provider’s diagnostic statement that the patient has the condition would suffice.

Question #11: Should presumptive positive COVID-19 test results be coded as confirmed? (rev. 3/24/2020)

Answer: Yes, Presumptive positive COVID-19 test results should be coded as confirmed. A presumptive positive test result means an individual has tested positive for the virus at a local or state level, but it has not yet been confirmed by the Centers for Disease Control and Prevention (CDC). CDC confirmation of local and state tests for the COVID-19 virus is no longer required.

Question #12: How should we handle cases related to COVID-19 when the test results aren’t back yet? The supplementary guidance and FAQs are confusing since sometimes COVID-19 is not “ruled out” during the encounter, since the test results aren’t back yet. (rev. 3/24/2020)

Answer: Due to the heightened need to capture accurate data on positive COVID-19 cases, we recommend that providers consider developing facility-specific coding guidelines to hold back coding of inpatient admissions and outpatient encounters until the test results for COVID-19 testing are available. This advice is limited to cases related to COVID-19.

Question #13: Based on the recently released guidelines for COVID-19 infections, does a provider need to explicitly link the results of the COVID-19 test to the respiratory condition as the cause of the respiratory illness to code it as a confirmed diagnosis of COVID-19? Patients are being seeing in our emergency department and if results are not available at the time of discharge, we are reluctant to query the physicians to go back and document the linkage when the results come back several days later. (rev. 4/1/2020)

Answer: No, the provider does not need to explicitly link the test result to the respiratory condition, the positive test results can be coded as confirmed COVID-19 cases as long as the test result itself is part of the medical record. As stated in the coding guidelines for COVID-19 infections that went into effect on April 1, code U07.1 may be assigned based on results of a positive test as well as when COVID- 19 is documented by the provider. Please note that this advice is limited to cases related to COVID-19 and not the coding of other laboratory tests. Due to the heightened need to uniquely identify COVID-19 patients, we recommend that providers consider developing facility-specific coding guidelines to hold back coding of inpatient admissions and outpatient encounters until the test results for COVID-19 testing are available.

Question #14: We are unsure about how to interpret the newly released COVID-19 guidelines in relation to the uncertain diagnosis guideline which refers to diagnoses “documented at the time of discharge” stated as possible, probable, etc. Can we code these cases as confirmed COVID-19 if the test results don’t come back until a few days later and the patient has already been discharged? (rev. 4/1/2020)

Answer: Yes, if a test is performed during the visit or hospitalization, but results come back after discharge positive for COVID-19, then it should be coded as confirmed COVID-19.

Question #15: Since the new guidelines for COVID regarding sepsis just say to refer to the sepsis guideline, is that then saying that sepsis would be sequenced first and then U07.1 for a patient presenting with sepsis due to COVID-19? (rev. 4/1/2020)

Answer: Whether or not sepsis or U07.1 is assigned as the principal diagnosis depends on the circumstances of admission and whether sepsis meets the definition of principal diagnosis. For example, if a patient is admitted with pneumonia due to COVID-19 which then progresses to viral sepsis (not present on admission), the principal diagnosis is U07.1, COVID-19, followed by the codes for the viral sepsis and viral pneumonia. On the other hand, if a patient is admitted with sepsis due to COVID-19 pneumonia and the sepsis meets the definition of principal diagnosis, then the code for viral sepsis (A41.89) should be assigned as principal diagnosis followed by codes U07.1 and J12.89, as secondary diagnoses.

Question #16: What is the difference between code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out, and code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, in relation to COVID-19? Can you provide examples on how to apply the codes? (rev. 4/16/2020)

Answer: Code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out, should be used if a patient is asymptomatic and there is a possible exposure to COVID-19 and the patient tests negative for COVID-19. Per the instructional note under category Z03, codes in this category may only be used if a patient has no signs or symptoms.

Code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, should be used if a patient has a known or suspected exposure to COVID- 19, is exhibiting signs/symptoms associated with COVID-19, and the test results are negative, inconclusive, or unknown. According to guideline I.C.21.c.1 Contact/Exposure, Z20 codes may be used for patients who are in an area where a disease is epidemic. Therefore, due to the current COVID-19 pandemic, when a patient presents with signs/symptoms associated with COVID-19 and is tested for the virus because the provider suspects the patient may have COVID-19, code Z20.828 may be assigned without explicit documentation of exposure or suspected exposure to COVID-19.

If the test results are positive, code U07.1 should be assigned instead of either code Z03.818 or Z20.828. An example of the application of code Z20.828 is a patient with respiratory signs or symptoms, testing for COVID-19 is negative, and the patient is determined to have another condition (e.g. flu, pneumonia). Codes should be assigned for the condition (e.g., flu, pneumonia) and code Z20.828 should be assigned as an additional diagnosis.

Question #17: Please provide guidance on correct coding when the provider has documented COVID-19 as a definitive diagnosis before the test results are available, and the test results come back negative. (rev. 4/16/2020)

Answer: Coding professionals should query the provider if the provider documented COVID-19 before the test results were back and the test results come back negative. Providers should be given the opportunity to reconsider the diagnosis based on the new information.

Question #18: Please provide guidance on correct coding when the provider has confirmed the documented COVID-19 after the test results come back negative. How should this be coded? (rev. 4/16/2020)

Answer: If the provider still documents and confirms COVID-19 even though the test results are negative, or if the provider documented disagreement with the test results, assign code U07.1, COVID-19. As stated in the Official Guidelines for Coding and Reporting for COVID-19, “Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider… the provider’s documentation that the individual has COVID-19 is sufficient.”

Question #19: When a patient who previously had COVID-19 is seen for a follow-up exam and the COVID-19 test is negative, what is best code(s) to capture this scenario? (rev. 4/16/2020)

Answer: Assign codes Z09, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm, and Z86.19, Personal history of other infectious and parasitic diseases.

Question #20: How should an encounter for COVID-19 antibody testing be coded? (rev. 4/28/2020)

Answer: For an encounter for antibody testing that is not being performed to confirm a current COVID-19 infection, nor is being performed as a follow-up test after resolution of COVID-19, assign Z01.84, Encounter for antibody response examination.

Question #21: If a patient has both aspiration pneumonia and pneumonia due to COVID-19, may code J12.89, Other viral pneumonia, be assigned with code J69.0, Pneumonitis due to inhalation of food and vomit? There is an Excludes1 note at category J12, Viral pneumonia, not elsewhere classified, that excludes pneumonia not otherwise specified (J69.0). (rev. 4/28/2020)

Answer: Yes, both codes may be assigned, as aspiration pneumonia and pneumonia due to COVID-19 are two separate unrelated conditions with different underlying causes. This meets the exception to the Excludes1 guideline as a circumstance when the two conditions are unrelated to each other.

Question #22: For a patient who has HIV/AIDS and is diagnosed with COVID-19, the guidelines don’t assume a relationship between COVID-19 and HIV, so does the provider need to link the two conditions for coding? (rev. 4/28/2020)

Answer: Any immunocompromised patient (which would include HIV patients) is at higher risk for becoming infected with COVID-19, but HIV does not cause COVID-19. Code both conditions separately, with sequencing depending on the circumstances of admission – just like a patient suffering from diabetes or any other chronic condition that puts them at higher risk for the COVID-19 infection.

Question #23: Is there a timeframe for considering the COVID-19 as history of, or current? For example, if a patient is documented as having had COVID-19 four weeks ago and during the current encounter the patient no longer has COVID-19, do we use the personal history code? (rev. 4/28/2020)

Answer: There is no specific timeframe for when a personal history code is assigned. If the provider documents that the patient no longer has COVID-19, assign code Z86.19, Personal history of other infectious and parasitic diseases.

Question #24: When a patient is diagnosed with COVID-19, we understand that signs and symptoms are not manifestations and would not be separately coded. We also understand that Guideline I.C.18.b. states that “signs or symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.” When a patient diagnosed with COVID-19 presents with both respiratory signs/symptoms (e.g. shortness of breath, cough) and non-respiratory signs/symptoms (e.g. gastrointestinal problems, dermatologic or venous sufficiency issues), may the non-respiratory signs/symptoms/conditions be coded separately since they are not routinely associated with COVID-19? (rev. 4/28/2020)

Answer: Because COVID-19 is primarily a respiratory condition, any other signs/symptoms would be coded separately unless another definitive diagnosis has been established for the other signs or symptoms. This is supported by Guideline IC.18.b, “Codes for signs and symptoms may be reported in addition to a related definitive diagnosis when the sign or symptom is not routinely associated with that diagnosis.”

Question #25: How should we code neonates/newborns that test positive for COVID-19? (5/26/2020)

Answer:  When coding the birth episode in a newborn record, the appropriate code from category Z38, Liveborn infants according to place of birth and type of delivery, should be assigned as the principal diagnosis. For a newborn that tests positive for COVID-19, assign code U07.1, COVID-19, and the appropriate codes for associated manifestation(s) in neonates/newborns in the absence of documentation indicating a specific type of transmission.  For a newborn that tests positive for COVID-19 and the provider documents the condition was contracted in utero or during the birth process, assign codes P35.8, Other congenital viral diseases, and U07.1, COVID-19.

Question #26: What is the correct sequencing for a patient who is status post lung transplant admitted for management of respiratory manifestations of COVID-19?  (6/4/2020)

Answer: Assign code T86.812, Lung transplant infection, as the principal or first-listed diagnosis, followed by code U07.1, COVID-19. This sequencing is supported by the Tabular List note at code T86.812 to “use additional code to specify infection.” The ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.19.g.3.a. state that “a transplant complication code is only assigned if the complication affects the function of the transplanted organ.” The COVID-19 infection has affected the function of the transplanted lung.
Woman outline surrounded by the "5 T's"

The 5 T’s of a Best-in-Class HIM Compliance Program

by Deborah Hsieh, Ciox Chief Policy & Strategy Officer | Jun 1, 2020 | Security & Compliance

In response to the urgent need to address COVID-19, the Centers for Medicare and Medicaid Services (CMS) has introduced multiple policies to allow providers the flexibility to focus attention on care delivery.

One such type of flexibility is the 1335 waiver, which allows CMS to waive sanctions and penalties against a covered hospital for certain actions. As part of this action, CMS announced it is waiving a Condition of Participation related to Patient Rights for hospitals that are considered to be impacted by a widespread outbreak of COVID-19. Specifically, that “the patient has the right to access information contained in his or her clinical records within a reasonable time frame…”

While there may be waivers of sanctions for certain actions, it’s important to understand that the HIPAA Privacy Rule, the HIPAA Security Rule, and the confidentiality provisions of the Patient Safety Rule are still in effect.

Compliance is always a critical component of medical record release, but the importance of a best-in-class compliance program is highlighted in environments like the COVID-19 pandemic when providers are faced with rapidly changing regulatory policies.

Ciox fulfills over 100 million record requests each year and we have taken what we have learned to develop a framework for a best-in-class compliance program. Learn more about the 5T’s of Compliance in this article featured in the Journal of AHIMA.
Details about best in class compliance
Compliance will remain a critical challenge for HIM and complexity is only increasing as expectations for HIM and interest in health information intensifies. Establishing a compliance program framework with these five components will help providers deliver excellence in health information management.

MSHIMA Job Board

The MSHIMA website contains a job board available for those seeking employment and those looking to hire qualified HIM professionals in Mississippi. The job board is free to use for all MSHIMA members. Click here to access this great membership tool.

MSHIMA Legal Manual 

The MSHIMA Legal Manual is still available for purchase and download. This manual includes state and federal guidelines and policies for health information management. Stay up-to-date on the latest info on policy and download your copy today!
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