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"The Link" Newsletter of WHIMA

February 2018

Inside this Issue:

Vicky Wolf, RHIT, CPHQ

Editor's Note

Vicky Wolf, RHIT, CPHQ
Link Editor

Today it feels like spring is just around the corner and you know what that means. You are correct. It is time for the WHA Advocacy Day, the ROI workshop and looking forward to the Annual conference. In this issue, we bring you a sneak peek of the headliners for both of the WHIMA events and they look awesome. Our workshop and annual conference teams have gone all out as usual. I cannot wait. If you have not registered, the time is now! Visit the website today!

In addition, we have an Advanced PCS Coding Corner focusing on knee replacement and Betty Rockendorf shares with us what our HIM future will look like and how to prepare for it. Are you ready? Your future awaits…Let us Celebrate! The HIM profession and YOU! Yes…You! Be sure to celebrate HIP week this month with fellow peers and associates. ….Let them know what you do…Your contribution matters.

Vicky Wolf, RHIT, CPHQ is an Allied Health Instructor for Waukesha County Technical College and Team Lead for the Link Newsletter

President’s Message

Christine Williams

Welcome to the New Year and exciting news for WHIMA! The Board has been working very hard to identify ways to engage our members. Did you know we have over 2000 credentialed members in the state of Wisconsin? We are working hard to identify ways to use our organization to give back to the members that have served and our next generation. 

Some of the recent Board decisions have been to investigate opportunities to utilize our investment money for progressing our association. We have created a task force to identify different buckets theinitiatives will be separated into. For example, Leadership, Technology, Education, Marketing and most importantly – our members. 

If you were not planning to attend the 2018 Annual Conference, I encourage you to change your mind. Not only will this be an opportunity to network with your peers, but we will also be unveiling the great work the Board and AMN, LLC has been doing this past year. Please keep an eye out for the early bird specials we will running – some of the lowest prices in years. Also, the line-up of speakers can be named some of the best we have ever had!

As we transition into 2018, we can reflect that there are still many challenges facing the organizations we as HIM professionals work for. The Healthcare financial climate is still hot and will be for some time. Involving yourself in WHIMA is a great way to network, dive into educational opportunities and identify methods for success during these tumultuous times.

If you have ideas or want to reach out in an effort to provide feedback on how to engage our members – email me! – Call me!  cwilliams4@uwhealth.org 608-960-6888

Christine Williams, RHIA, is transitioning from Acting Executive Director to President this fiscal year for WHIMA and is Document Integrity Manager at UW Health, Madison, Wisconsin.​

Legal Resource Team – disbanded

Mary Faile, RHIA

The WHIMA Legal Resource Manual that has been a resource on confidentiality and the release of patient information for a number of years. Issues discussions and statutory reviews were included on many topics, as well as information to be taken in to consideration when creating procedures.

In recent years, we have seen an increase in the availability of online resources to get answers to questions. Also organizations will more often have access to a legal team who can advise them on issues and provide guidance, as well as final decisions on policy and procedures.

The number of subscribers to the Legal Resource Manual is relatively low, yet the membership of the Legal Resource Team spends many hours researching and investigating legal and regulatory topics in an attempt to keep the manual up to date. With limited volunteer resources in WHIMA, consideration was also given to the limited value returned by that relatively large effort of volunteer time that could be used in other areas.

For these reasons, the WHIMA Board has decided to disband the Legal Resource Team, and stop production of the Legal Resource Manual. WHIMA will honor current subscriptions through the respective expiration date.

WHIMA members can still reach out via the website with specific questions and the WHIMA Policy and Legislative Team will continue to watch for legislative news to share with members. 

Mary Faile, RHIA, is a member of the WHIMA Board of Directors and Manager of Health Information Services at Aurora St. Luke’s Medical Center

The Future of HIM

Betty Rockendorf, MS, RHIA, CHPS, CHTS-IM
 
As an AHIMA delegate I have the opportunity to participate in AHIMA’s Envisioning Collaborative with the Speaker of the House and delegates from other states. Recently we reviewed the findings from the 2017 Environmental Scan Report. This survey and report is conducted annually by AHIMA for purposes of informing and driving strategy to help plan for the future. The information collected includes “trends and priorities that can impact or influence the HIM profession in the next 5-10 years.” (AHIMA Envisioning Collaborative meeting). Here are a few highlights:
 
Business/Economic Climate: Healthcare is rapidly changing and we’ve already seen a lot of restructuring and mergers and acquisitions. According to AHIMA’s Environmental Scan, “HIM professionals will continue to play a vital role with decisions regarding operational issues. In addition, the safety of patient information and data is one of healthcare’s most pressing issues.” Also ranking high is the importance of interoperability of electronic health records. 
 
Demographics/Workforce: According to the Bureau of Labor Statistics, the HIM profession, as a whole, will grow in the next several years. Existing roles are expanding with more competencies required.  Some HIM functions and positions are being outsourced or replaced by technologies, such as Computer Assisted Coding. AHIMA stresses that these changes do present challenges to the HIM profession, but also present many opportunities. Skill sets and education are areas that will require updating. Did you know that in a listing of the five best healthcare IT certifications for 2017, many employers looking to hire coding positions listed the RHIA as the preferred certification? Both the RHIT and the RHIA appeared with high frequency on “several popular job posting sites”, according to Tom’s IT Pro.

Technology/Telehealth: Data breaches will continue and AHIMA reports that “some 64 percent of attacks [are] targeted at medical files and billing and insurance records, up from 45 percent.” 
 
Telehealth has expanded into not only primary care, but also specialty care, behavioral therapy, consumables, fitness and wellness, as well as veterinary. The AHIMA survey found “that almost all employers expect to offer telehealth by 2020.” 
 
Artificial intelligence (AI) “will hit $6 billion by 2021, having been at $600 million, just two years ago.”  In healthcare, AI is applied for data management and mining of all the healthcare data. The goal is to “organize patient routes or treatment plans better, and also provide physicians with all the information they need to make sound decisions.” 
 
Legislation/Regulation: Patient Matching will continue to be addressed by the U.S. Government Accountability Office (GAO). The 21st Century Cures Act is a highlight as provisions are necessary “to improve the overall flow of health information throughout the healthcare ecosystem.” 
 
I encourage you to read the article in the January 2018 Journal of AHIMA, “Eight Predictions for ‘18”.  Hot topics discussed include: Data Analytics, Informatics, Information Governance, Education and Workforce, Clinical Documentation Improvement, Inpatient and Outpatient Coding, Privacy and Security, and Rules and Regulations. This is very much in line with the 2017 Environmental Scan Report. 
 
Perhaps 2018 will be a year of “preparation” for HIM professionals. If you feel stuck, don’t give up hope. There are generally six stages of change: Pre-contemplation, Contemplation, Preparation, Action, Maintenance, and Termination.  Self-changes don’t typically occur in a linear fashion, but more of a spiral where people may go through the stages three to four times before finally achieving the goal and terminating the process. It may help to work with a coach or a mentor to push on through! The Future awaits!! 
 
Betty Rockendorf, MS, RHIA, CHPS, CHTS-IM is Program Director for the University of Wisconsin-Parkside Health Information Management and Technology program. She is also a certified life coach through the International Coach Federation and owner/operator of www.44thparallellifecoaching.com     
Sources: 
AHIMA’s 2017 Environmental Scan Report, available online at: http://bok.ahima.org/PdfView?oid=302420

Butler, Mary. "Eight Predictions for ’18:  Experts prognosticate the top HIM topics for the year ahead, and advise on how to prepare" Journal of AHIMA 89, no.1 (January 2018): 14-19.

Advanced ICD-10-PCS Coding Corner

Patricia Poli, RHIA

Each quarter a sample OP report will be presented with suggested ICD-10-PCS codes with rationale.
Suggested codes are based upon the information in the most current draft form of ICD-10-PCS and the Official Coding Guidelines and are subject to change when the final version is available.
 
PROCEDURE: RIGHT TOTAL KNEE REPLACEMENT
 
PROCEDURE DESCRIPTION: The patient was bought to the operating room and placed in the supine position. After induction of anesthesia, a tourniquet was placed on the upper thigh. Sterile prepping and draping proceeded. The tourniquet was inflated to 300 mmHg. A midline incision was made, centered over the patella. Dissection was sharply carried down through the subcutaneous tissues. A median parapatellar arthrotomy was performed. The lateral patellar retinacular ligaments were released and the patella was retracted laterally. Proximal medial tibia was denuded, with mild release of medial soft tissues. The ACL and PCL were released. The medial and lateral menisci and suprapatellar fat pad were removed. These releases allowed for anterior subluxation of tibia.
 
An extramedullary tibial cutting jig was pinned to the proximal tibia in the appropriate alignment and flush cut was made along tibial plateau, perpendicular to the axis of the tibia. Its alignment was checked with the rod and found to be adequate. The tibia was then allowed to relocate under the femur.

An intramedullary hole was drilled into the femur and a femoral rod attached to the anterior cutting block was inserted, and the block was pinned in appropriate position, judging correct rotation using a variety of techniques. An anterior rough cut was made. The distal cutting jig was placed atop this cut surface and pinned to the distal femur, and the rod was removed. The distal cut was performed.

A spacer block was placed, and adequate balance in extension was adjusted and confirmed, as was knee alignment. Femoral sizing was performed with the sizer, and the appropriate size femoral 4-in-1 chamfer-cutting block was pinned in place and the cuts were made. The notch-cutting block was pinned to the cut surface, slightly laterally, and the notch cut was then made. The trial femoral component was impacted onto the distal femur and found to have an excellent fit. A trial tibial plate and polyethylene were inserted, and stability was judged and found to be adequate in all planes. Appropriate rotation of the tibial component was identified and marked. The trials were removed and the tibia was brought forward again.

The tibial plate size was checked and the plate was pinned to plateau. A keel guide was placed and the keel was then made. The femoral intramedullary hole was plugged with bone from the tibia. The trial tibial component and poly placed; and, after placement of the femoral component, range of motion and stability were checked and found to be adequate in various ranges of flexion and extension.

The patella was held in a slightly everted position with knee in extension. Patellar width was checked with calipers. A free-hand cut of the patellar articular surface was performed removing any roughness and allowing space for the button. This was checked to ensure symmetry with the calipers. Sizing was then performed and 3 lug holes were drilled with the jig in place, taking care to medialize and superiorize the patellar component as much as possible, given bony anatomy. Any excess lateral patellar bone was recessed. The trial patellar button was placed in the lug holes and found to have adequate tracking. The trials were removed; and as the cement was mixed, all cut surfaces were thoroughly washed and dried.
 
The cement was applied to the components and the cut surfaces with digital pressurization, and then the components were impacted. The excess cement was removed from the gutters and anterior and posterior parts of the knee. The knee was brought into full extension with the trial polyethylene and further axially pressurized as cement hardened. Once the cement had hardened, the tourniquet was deflated. The knee was dislocated again, and any excess cement was removed with an osteotome. Thorough irrigation and hemostasis were performed.
 
The real polyethylene component was placed and pinned. Further vigorous power irrigation was performed, and adequate hemostasis was obtained and confirmed. The arthrotomy was closed using 0 Ethibond and Vicryl sutures. The subcutaneous tissues were closed after further irrigation with 2-0 Vicryl and Monocryl sutures. The skin was sealed with staples. Xeroform and a sterile dressing were applied followed by a cold-pack and Ace wrap. The patient was transferred to the recovery room in stable condition, having tolerated the procedure well.
 
Now let’s review the coding for this case. 
 
Root Operation:  Replacement

 
The definition of the root operation replacement is putting in or on a biological or synthetic material that physically takes the place and/or function of all or a portion of a body part.
Our index entry is under Replacement, Joint, Knee.  The example in Guideline B3.1b reminds us that “Resection of a joint as part of a joint replacement procedure is included in the root operation definition of Replacement and is not coded separately.”
 
In this case surgical incision is made into the right knee joint (parapatellar arthrotomy indicating an open procedure). 
 
The lower end of the tibia and upper femur are removed. A polyethylene part is snapped into the tibial tray and serves as a bearing for smooth movement of the knee prosthesis.  The patella is also replaced with a synthetic component.
 
Coding Clinic 1st quarter 2017, page 22 provides clarification regarding coding of a total knee replacement in regards to the patellar component.  When the patella is replaced as part of a total knee replacement the question arose as to whether or not a separate code should be assigned to represent the patellar replacement.  The patella is considered part of the total knee joint replacement.  For the lower bones body system the patella has its own body part value, yet does not have its own body part value for the lower joints body system.  For coding of total knee replacements, the patella is considered part of the knee joint, therefore the appropriate ICD-10-PCS body part values assigned would be value “C” for the right knee joint or value “D” for the left knee joint.  These body part values include the femoral, tibial and patellar portions of the total knee replacement procedure.
 
Based on guidance provided in Coding Clinic, first quarter 2017, page 22 we would assign body part value, C, knee joint, right. This includes the femoral, tibial and patellar portions of the total knee replacement.
 
Device Value J, Synthetic Substitute would be assigned for the “polyethylene component.”
 
A metal tibial tray is cemented onto the top of the tibia and a metal femoral component is cemented onto the lower femur, therefore Qualifier Value 9, Cemented is assigned.
Further clarification is provided in 3rd quarter Coding Clinic 2016, page 35 regarding the “Use of cemented versus uncemented qualifier for joint replacement”.  ICD-10-PCS provides three values for the 7th character qualifier for knee and hip joint replacement procedures; Value 9, Cemented, Value A, Uncemented, and Value Z, No Qualifier.  Coding Clinic advice directs us to assign Value Z, No Qualifier when the coder cannot determine from the medical record documentation if the prosthesis is “cemented” or “uncemented.”

ICD-10-PCS code suggestion:
So in summary, we would report the following code for this case.
0SRC0J9, Replacement of Right Knee Joint with Synthetic Substitute, Cemented, Open Approach 
 
 
If you have questions specific to this operative report only, you may submit them to Pat Poli at coding.roundtable@imedx.com
 
Patricia Poli, RHIA is the Senior Education Consultant in the Coding, Compliance and Quality Division for iMedX, Inc.

WHIMA Scholarship Team Updates  
          

The deadline for Scholarship applications is fast approaching!!

There are 3 Scholarships available for our members:

Undergraduate Scholarship: Applicants for this scholarship must be a student member of AHIMA and WHIMA, they must be enrolled in a CAHIIM accredited Health Information Administration program or Health Information Technology program. Scholarships will be granted for those students who have successfully completed the first semester of their program.

Karen Kohler Past President Memorial Graduate Scholarship: Applicants must be a member of AHIMA and WHIMA, enrolled in an accredited graduate program, and must have made contributions showing leadership, innovation and creativity within the HIM profession.

Established Professional Development Scholarship: Applicants must be a member of AHIMA and WHIMA; they must submit evidence of attendance at continuing education program and personal payment for program or successful completion of credentialing examination and have made contributions showing leadership, innovation and creativity with the HIM profession.

The Scholarship team is committed and working hard to provide funding for our future HIM professionals.

The Scholarship team is working for you!

Release of Information Workshop

 
Register today to attend the WHIMA 2018 Release of Information Workshop on March 29, 2018 at the Glacier Canyon Conference Center in Wisconsin Dells!  If you are a HIM Manager, Office Manager, Unit Clerk, ROI Specialist, AHIMA and CRIS Credentialed Professional or someone who handles PHI, you won’t want to miss this one-day workshop that is full of the latest information. 

Release of Information in an electronic record world and increased patient access to PHI can be challenging for any health care environment. You will learn from attorney’s who specialize in HIPAA & Wisconsin Law as well as from industry experts who work with healthcare facilities of all sizes in both urban and rural settings. You will also have an opportunity to ask and have your questions answered during the expert panel Q & A.

This workshop will not only address the release of information operational challenges that Health Information Management professionals face every day, but you will receive important legal updates from Washington, DC and Madison that have an impact on your facility’s daily processes.

Don't wait, Register Today!

WHIMA Webinars and Workshop Team continues to lead the way in bringing you the best in education.

Changes to 42 CFR Part 2 – Substance Use Disorder

Dawn Paulson, MJ, RHIA

The WHIMA Policy and Legislative Team is in the process of drafting guidance regarding recent changes to 42 CFR Part 2 regulations.  This guidance was not fully vetted at the time of this issue of the Link.  Membership can expect to see this guidance published in an upcoming WHIMA e-Alert, as well as the next Link newsletter.   

Any questions, feel free to contact your WHIMA Policy and Legislative Team:  Dawn Paulson at dpaulson@uwhealth.org, Chrisann Lemery at clemery@mhemail.org or Kerry Wolford at Kerry.wolford@hshs.org.
 
Dawn Paulson is currently Assistant Director at UW Health in Health Information Management and Coleader of the Policy and Legislative Team

Health Information Professionals Week Proclaims ‘Our Future Is Bright’ During 29th Annual Celebration

 
HIP Week Set for March 18–24, 2018
 
The American Health Information Management Association (AHIMA) will honor and celebrate health information professionals during the 29th annual Health Information Professionals (HIP) Week March 18–24, 2018. This year’s theme is “Our Future Is Bright.”
 
“It’s a transformational time for healthcare, and health information is at the heart of this transformation,” said Lou Ann Wiedemann, MS, RHIA, CDIP, CHDA, FAHIMA, interim senior vice president, member services. “In the midst of all this change, positive opportunities are being created. Health information management professionals understand clinical and financial data as well as information governance and data management—all tools that can help reward value, lower cost, and make the healthcare experience better for patients. It is a great time to be in the HIM profession, and we believe our future is bright.”
 
HIP Week 2018 will coincide with AHIMA’s Advocacy Summit and Hill Day, events where AHIMA members receive education specific to advocacy and visit Capitol Hill to share the importance of advancing HIM. Information governance and privacy and security continue to be key issues for HIM professionals; AHIMA will continue to provide guidance to the healthcare industry and government leaders seeking expertise and counsel.
 
During HIP Week, health information professionals will engage in focused activities in their organizations and the community to raise awareness of the important work they perform. Some of the activities include lunch and learns, displays in facility lobbies and lunchrooms, tours for elected officials, community seminars, and local media coverage. Facilities may recognize the accomplishments of their HIM team during HIP Week. Follow the social media hashtag #HIPWEEK18 to see how organizations celebrate across the US.
 
About AHIMA
The American Health Information Management Association (AHIMA) represents more than 103,000 health information professionals in the United States and around the world. AHIMA is committed to promoting and advocating for high quality research, best practices and effective standards in health information and to actively contributing to the development and advancement of health information professionals worldwide. AHIMA is advancing informatics, data analytics, and information governance to achieve the goal of providing expertise to ensure trusted information for healthcare. www.ahima.org

“Next Generation of Leadership!”

Susan Summerfield, MePD, RHIT

Wow... it is hard to believe but the WHIMA Spring 83rd Conference is just a few short months away.  The conference is May 9th – 11th at the beautiful Osthoff Resort in Elkhart Lake, WI.
The Annual Spring Conference team has been working hard at developing an outstanding educational conference for you.  We have speakers and sessions to meet everyone's needs (data analytics, coding, management, etc.) to name a few. Check out the line-up at https://www.whima.org/meeting/

We have also changed the format of the conference to provide more time for networking not only with your fellow HIM professionals but also with our vendors. 

The time to register is now at https://www.whima.org/meeting/

The Annual Conference Team cannot wait to see all of you at the conference!  

Susan Summerfield MePD, RHIT is an Instructor of Health Information Technology/Certified Coding Specialist Program at Western Technical College in LaCrosse, WI and Co-leader of the Annual Conference Team.

Faculty Development Opportunity

Betty Rockendorf, MS, RHIA, CHPS, CHTS-IM

The University of Wisconsin-Parkside is hosting AHIMA’s Faculty Development Regional Meeting on June 14th, 2018 from 8:30 AM to 4:00 PM. This is an opportunity for educators to learn how to teach Data Analytics.  Other workshop topics for the day include Academic Resources and Academic Affairs Updates, as well as On-line Teaching Strategies and Resources. The presenters are: Nathan Patrick Taylor, MPH, MS, CHDA, CPHIMS, Clinical Informatics Consultant, and Christi Lower, MS, RHIA, FAHIMA, Academic Affairs, AHIMA 

Educators are encouraged to join us!  Registration link can be found at: https://my.ahima.org/store/productdetail.aspx?id=64897.  The full-day workshop provides 5 continuing education units. 
 
The UW-Parkside campus is located at 900 Wood Road, Kenosha, WI  53141. AHIMA is also presenting this regional workshop in Maryland, Washington, and Texas. 
 
Betty Rockendorf, MS, RHIA, CHPS, CHTS-IM is Program Director for the University of Wisconsin-Parkside Health Information Management and Technology program

Don't Forget

Visit the Calendar
OUR FUTURE IS BRIGHT
Celebrate HIP Week
March 18 – 24, 2018
HIM Professionals Lead the Way to Quality Data –
We Celebrate YOU!

AHIMA Advocacy Summit

March 19-20, 2018
Washington, DC

Wisconsin Hospital Association Advocacy Day

March 21, 2018
Madison, WI

Health IT and Analytics Workshop

April 5, 2018
Mid State Technical College
Stevens Point, WI

Are You Engaged?

Are you using your WHIMA's Engage Community to gather, share ideas, ask questions, and network? You are encouraged to use the WHIMA community by posting discussion, events, or resources.

Accept this invitation to "get engaged" with your colleagues.

WHIMA on Facebook

Join in the conversation... WHIMA's Facebook Company Page
Visit the Job Board

ROCK THE VOTE!

Meet the Candidates

Candidate bios available in the WHIMA Member center
CAST YOUR BALLET – Voting opens March 19th

HIPAA COW

2018 Spring Conference
April 27, 2018
Pewaukee, WI

WHIMA Annual Conference

May 9, 2018 – May 11, 2018
The Osthoff Resort
Elkhart Lake, WI

WHIMA Fall Conference

September 13, 2018
Bridgewood Resort Hotel and Conference Center
Neenah, WI

2019 WHIMA Annual Conference

May 8-10, 2019
Central Wisconsin Convention and Expo Center

Do Something Amazing!


Accept this invitation to "get engaged" with your colleagues.

Volunteer for WHIMA

Become a Mentor or Mentee

If you are interested in becoming a Mentor or Mentee, go to the WHIMA website, click on Resources and choose Mentor Program for more information and links to signing up.
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