May 10, 2011 Approval Code: IN361

Ingenix InSite Provider User Group

Ingenix InSite User Group: Welcome

Administrative Reminders:

   This call is hosted in a listen only mode for participants until our Q&A segment.

Questions you may want to ask prior to the Q&A segment can be typed in our chat panel for the host to address Please keep your phones on mute during Q&A.

     The webex login password for this call is ‘insite’.

When logging into the webex please enter in your first and last name.

The user group presentation materials will be sent with the meeting minutes.

Ingenix InSite User Group Questions or Product Enhancement requests? Email [email protected]

.

Ingenix InSite Website Questions? Call or email the Ingenix Helpdesk 1-866 818-7503 or [email protected]

. © Ingenix, Inc. 2

Ingenix InSite User Group: Agenda

 10:00 AM  10:03 AM  10:10 AM Welcome InSite Operations Announcements CMS Payment Cycle: Walk through Sweeps, RAF and Payment  10:25 AM Documentation and Coding Focus On: Understanding the Coding for TIAs, CVAs, and Late Effect Conditions  10:45 AM Q & A © Ingenix, Inc. 3

InSite Operations Announcements

Presented By Jerry Gauchat

  

InSite Operations Announcements – Data Refresh Update

Data Refresh Update

– – Data refresh has been postponed for May Next monthly data refresh is scheduled for June 6th

The May data refresh will include the shifting of years on the following reports:

• Prevalence • • • Members with Declining RAF Patient Management PCP RAF –

HCC RAF Detail Report

• New value for FFS Normalization will appear in 2012 PY Column

Reports shifting years in InSite

– In January and April data, the new 2012 payment year or 2011 Dates of Service (DOS) will begin to be reported and InSite drops the oldest year of data. – Reports shift years on reports depending on which time period is the most actionable for the specific report.

© Ingenix, Inc. 5

InSite Operations Announcements – Q2 2011 Release



Upcoming InSite Updates

• New HEDIS/STARS PAF Versions – No changes to PAF Management functionality • Summary of Accepted HCCs (SOAH) – Modify query to access report more quickly – Upon export - HCC and description will match • Systematic User Entitlement • Learning & Resources Tab – Adding April, May & June 2011 Ingenix Insiders » Removing all 2010 Ingenix Insiders – – Removing 2010 ICD-9 Brochure Further docs to be added as they are approved © Ingenix, Inc. 6

InSite Operations Announcements – How to Access Reports After Completing Validation/Attestation



When in as Validation Approver, validate providers by accessing the Provider Validation tab



When validation is completed and you want to access reports: Select another role (not Validation Approver) re-select your group, click Apply

© Ingenix, Inc. 7



InSite Operations Announcements – Users with Access to Only One Role

If you only have access to one role, you will not have access to a role drop-down. The role you have access to will be automatically displayed.

© Ingenix, Inc. 8

Pam’s Tip #1

Export Reports Prior to Years Shifting

 Consider exporting the following reports this week – prior to the data refresh which will switch years – dropping off the oldest year  Prevalence  Members with Declining RAF  Patient Management  PCP RAF © Ingenix, Inc. 10

CMS Payment Cycle Walk Through Sweeps, RAF & Payment

Presented By Pam Holt

Sample CMS Payment Schedule

© Ingenix, Inc. 12

DOS

CMS 2011 Payment Year Cycle

July – Dec 2009 Jan – June 2010 July – Dec 2010 CMS Sweeps Payment Realized Sept 2010 Sweep March 2011 Sweep RAF Scores Change © Ingenix, Inc. 13 Jan – June 2011 Monthly payments Jan – June 2011 Each patient’s RAF score remains the same for this 6 month period Preliminary July – Dec 2011 Monthly payments + Retroactive "true-up" adjustment of Jan - Jun 2011 payment based on difference between Prelim & Actual RAF/Payment. Can result in payment or adjustment; if payment, is paid in lump sum in July July – Dec 2011 Each patient’s RAF score remains the same for this 6 month period •Actual •Adjusted •Elimination of Lag Jan – Dec 2010 Data sent after March 2011 sweep Jan 2012 Sweep August 2012 Final payment Lump sum Final Adjustment

Coding for TIAs, CVAs and Late Effect Conditions

Subacute stroke: Transcortical Aphasia Colette Singleton, CPC Sr. Provider Training & Development Consultant © Ingenix, Inc. 14

TIA vs. CVA

Difference between TIA & Stroke  A transient ischemic attach (TIA) has stroke-like symptoms that completely resolve within 24 hours.  A cerebral infarct that lasts longer than 24 hours but fewer than 72 hours is termed a reversible ischemic neurologic deficit or RIND.  A cerebrovascular accident (CVA) has persistent symptoms that last greater than 72 hours. © Ingenix, Inc. 15 National Stroke Association. Web. 25 Apr. 2011. .

Coding Tips: TIA

 If the documentation states that the patient had a TIA, code

435.9

should be assigned.  Impending CVA and intermittent cerebral ischemia should also be assigned code

435.9

.  Code V12.54 is reserved for patients who have a personal history of

TIA

. © Ingenix, Inc. 16

Documentation of Stroke

Simply Stated:

 When did the event occur?

 What deficits were left after the event that are evident today?

© Ingenix, Inc. 17

Stroke



Stroke is often seen documented in the generalized term:

“CVA”

– Diagnostic statements need to be specific site or type of CVA.

regarding – Concise documentation selection.

will lead to specified code • Example:    CVA due to cerebral embolism with infarction Hx of CVA with left-sided hemiparesis Cerebral artery occlusion © Ingenix, Inc. 18

Documentation of Stroke

When did the event occur?

 Document

Acute Stroke

434.91

on first admission to hospital only  Document

Residual Deficits of Stroke

following the acute incident –

438.XX

on office visits  Document

History of CVA

from a prior stroke code if there are no residual deficits

V12.54

© Ingenix, Inc. 19

Stroke: ICD-9-CM Coding Guidelines

The Coding of “Late Effects”

 A “

late effect

” is the residual effect (condition produced) after the acute phase of an illness or injury has terminated. – The “

late effects

” are in the past tense.

 The “

residual condition

” would be sequenced first – there is no time limit for the reporting of a residual.

 The “

late effect

” or resolved condition is indexed through the words “late effect” and then by the condition.

 Normally, this is a a two code scenario – Stroke can be the exception.

© Ingenix, Inc. 20

Stroke: Rules of Coding Stroke

is an exception to the typical coding of “Late Effects”

When the late effect code has been expanded at the 4 th and 5 th digit level to include the residual conditions, only the cause of the late effect is assigned. At present, only category way.

438

has been expanded in this © Ingenix, Inc. 21

Stroke: ICD-9-CM Coding Guidelines

Example:

Cerebrovascular accident two years ago with Residual hemiplegia

Code

:

438.20

“ Index ” Late Effects , Cerebrovascular Disease, with Hemiplegia, Unspecified Side © Ingenix, Inc. 22

Stroke: ICD-9-CM Coding Guidelines

Example:

Cerebrovascular accident five years ago with residual dysphagia

Code

:

438.82

“ Index ” Late Effects , Cerebrovascular Disease, with, Dysphagia Note: Use additional code to identify the type of dysphagia, if known (787.20-787.29) In this case we will use 787.20, Dysphagia, unspecified.

© Ingenix, Inc. 23

Documentation makes the difference

How the information is documented will affect how its coded.

Example:

Patient continues with left-sided weakness due to CVA 4 months ago 438.89

Patient continues with left-sided hemiparesis due to CVA 4 months ago

438.20

Documentation is key!!!

© Ingenix, Inc. 24

Coding Tips: Acute CVA

 Codes from category 434, Occlusion of cerebral arteries, are used on the admission to the hospital for the acute event: –

434.01

Cerebral

thrombosis

with cerebral infarction –

434.11

Cerebral

embolism

with cerebral infarction –

434.91

Cerebral artery

occlusion

, unspecified with cerebral infarction © Ingenix, Inc. 25

Acute but ill-defined, cerebrovascular disease

 Code

436

, Acute but ill-defined, cerebrovascular disease, should not be used when the documentation states stroke or CVA.  Code

436

is no longer used for acute stroke and is now reserved for conditions such as apoplexy or cerebral seizures.

© Ingenix, Inc. 26

Coding Tips: History & Late Effects

 Code V12.54 is reserved for patients who have a personal history cerebral infarction without residual deficits. – If a provider documents “

History of CVA

,” there is an assumption that there are no neurologic deficits and V12.54 is assigned.  If a patient has a history of CVA with residuals, it is important for the provider to document the residuals (e.g. history of CVA with resultant dysphagia). – The residuals of stroke are coded to the Late Effects category 438 – Late effects of cerebrovascular disease. © Ingenix, Inc. 27

History

Coding History



History of-

There are two types of history

V

Code, personal and family. Personal history codes explain a patient’s past medical condition that no longer exists and

is not receiving any treatment

, but that has the potential of recurrence, and therefore may require continued monitoring.

© Ingenix, Inc. 28 2011 Ingenix Professional ICD-9-CM for Physicians. 6th ed. 2 vols. Chicago, IL: Ingenix, 2010.

Case Sample



Chief Complaints/ Concerns Old CVA,

Occasional HA, still takes a few sec’s at times in order to initiate speech. Sometimes has trouble coming up with a right words every since her stroke.



Problem List Detail RHEUMATOID ARTHRITIS

Seeing Dr. last week. Had testing done and reportedly was ok. Pt report increased MCP pain.

Essential Hypertension Unsp

Patient reports the pressure has been under good control. Has not had high blood pressure nor orthostatic symptoms at home.

Major dep recurrent moderate

History of depression doing well and is not currently on medication.

© Ingenix, Inc. 29

Case Sample



Major dep recurrent moderate (ICD-9 Code: 296.32)

Depression under control. Continue to monitor. No medication needed at this time.

In remission? 296.35



Accident, cerebrovascular (ICD-9 Code: 434.91) NO

CVA was in September 2009.

(

DOS 10/12/10

) She still continues to have some mild aphasia and difficulty with words as well as word salads. Continue with Plavix 75 mg p.o. q.d. He did take Nexium 12 hours from last Plavix dose to help minimize interaction.

438.11

© Ingenix, Inc. 30

Pam’s Tip #2

Audit Code: 436

 ICD-9 code 436, when used to code the condition of stroke is inaccurate – Prior to 10/1/2004 it was the default code for stroke – It was simple to remember, and unfortunately, some physicians still use it when coding a patient who had a previous stroke  Recommendation: – Run a report of patients coded with 436 & include provider name – Audit the charts and educate any providers still using 436 to code for stroke – Re-audit 6 – 9 months later © Ingenix, Inc. 32

Upcoming Documentation & Coding Topics

June 2011 – Skin Ulcers July 2011 – VTE - Venous Thromboembolism Aug 2011 – Major Depression Sept 2011 – Peripheral Arterial Disease Oct 2011 (National Vascular Disease Awareness Month) – Cirrhosis (Liver Awareness Month) Nov 2011 – Dementia (National Alzheimer’s Disease Awareness Month) Dec 2011 – COPD © Ingenix, Inc. 33

User Group Feedback Survey

 We want your feedback!

 Survey is to be sent immediately after this call © Ingenix, Inc. 34

Question and Answer

© Ingenix, Inc. 35