question

1. All cases that were reviewed 2. Number of cases with queries 3. Nature of the query 4. Physician response to the query

answer

CDI program data includes:

question

1. If there is clinical evidence that the documentation is imcomplete or does not meet one of the seven criteria for high-quality clinical documentation. 2. By an individual with solid clinical knowledge. 3. In an open-ended manner (no yes or no questions) 4. In a nonleading manner. 5. To the individual whose documentaion is in question or who is responible for interpreting test results or other data in the patient's record.

answer

Queries should only be asked:

question

1. When queries will be asked. 2. Who will ask queries and to whom queries will be asked. 3. The hospital's responsibility in supporting the quering process. 4. The physician's responsibility in responding to queries. 5. Acceptable ways to responding to queries.

answer

Query process and procedure should address:

question

1. Documentation of reportable conditions or procedures is conflicting, ambigious, or is otherwise incomplete. 2. Abnormal diagnostic test results indicate the possible addition of a secondary diagnosis or higher specificity of an already documented condition. 3. The patient is receiving treatment for a condition that has not been documented. 4. Abnormal operative or procedureal findings are not documented. 5. It is unclear as to whether a condition was ruled out. 6. The pricipal diagnosis is not clearly identified.

answer

Examples of when a query is required may include:

question

A systemic disease with the presence and persistence of pathogenic micro-organisms or toxins in the blood. No longer considered synonymous with sepsis.

answer

Septicemia

question

Sepsis is SIRS due to an infection . Infection can originate anywhere in the body and be triggered by a bacterial, viral, parasitic, or fungal infection.

answer

Sepsis

question

SIRS due to infection with organ dysfunction. Sepsis associated with acute dysfunction in one or more organs. Organ dysfunction bay be cardiovascular, renal, respiratory, hepatic, hematological, central nervous system, or metabolic acidosis.

answer

Severe Sepsis

question

SIRS is the systemic response to infection or trauma. The systemic response is manifested by a variety of clinical signs and symptoms such as: Fever (>100.4 degrees F), Hypothermia (= to 12000 cellsmm3 (leukocytosis), WBC 90 bpm, respirations >20 breaths/minute or PcCO2 <32 mg of mercury, hypotension, altered mental status.

answer

SIRS

question

Sepsis with hypotension or a failure of the cardiovascular system. Endotoxic shock and gram negative shock are synomymous with septic shock, septic shock = severe sepsis

answer

Septic Shock

question

Bacteria in the blood without an associated inflammatory response. Denotes laboratory findings of viable bateria in the blood with no systemic manifestations. Progresses to septicemia only when there is a more severe infections process or an impaired immune system.

answer

Bacteremia

question

Infection confined to the urinary system. Refers to pyuria or bacteria in the urine (not in the blood). Query the physician to determine if the bacteria in the urine has progressed to septicemia or sepsis.

answer

Urosepsis

question

Legible Complete Timely Reliable Consistent Precise Clear

answer

7 criteria for high-quality documentation

question

Evidence Based Medicine-practicing medicine using only the best scientific data available.

answer

EBM

question

Design Performance Terminology Procedural

answer

Four kinds of standards in EBM

question

If the 7 criteria of high-quality clinical documentation are applied ot clinical documentation, then clinical documentation quality will be high and the accuracy of care, quality indicators, reimbursement, healthcare planning, and research will be improved.

answer

Theory of high-quality of clinical documentation

question

1982

answer

What year was TEFRA (Tax Equity and Fiscal Responsibility Act) implemented?

question

Developed by Yale in the 70's to describe all types of patient care in an acute care hospital. Implemented for Medicare IPP in 1983.

answer

DRGs

question

Implemented in 1987 by 3m. For NY non-Medicare discharges reimbursement program.

answer

AP-DRGs

question

Developed by 3m in 1990; addressed severity of illness and risk of mortality over all patient populations.

answer

APR-DRGs

question

FY2007 CY2008

answer

When did CMS adopt MS-DRGs to better recognize severity of illness (SOI) in Medicare IPPS?

question

A pre-existing condition which because of it's presence with the principal diagnosis will increase the LOS by at least 1 day in approximately 75% of cases.

answer

Comorbidity

question

A condition arising in a hospital that prolongs the LOS by at lease one day in approximately 75% of cases.

answer

Complication

question

1. MCC-Major complication/cormorbidity 2. CC-Complication/comorbidity 3. Non-CC

answer

What is the 3 tiered structure of MS-DRGs?

question

Sum of all of the DRG's relative weights/# of cases per time period

answer

How to calculate CMI

question

Medicare Code Editor-Addresses 3 basic types of edits that support MS-DRG assignment which are code edits, coverage edits, and clinical edits.

answer

MCE

question

Significant acute diseases, acute exacerbations of chronic significant diseases, advanced end-stage diseases, chronic diseases with extensive debility, consistnely greater impact on hospital resources.

answer

MCC/CC conditions consist of:

question

Stand alone DRGs (TIA), without a CC, with a CC, with a MCC.

answer

Levels of DRGS in each system: MS-DRGs

question

Stand alone DRGs (TIA), without a CC, with a CC, with a MCC.

answer

Levels of DRGS in each system: AP-DRGs

question

No stand alone DRGs, severity 1 (minor), severity 2 (moderate), severity 3 (major), severity 4 (extreme).

answer

Levels of DRGS in each system: APR DRGs

question

To craft a reimbursement system that considers not only severity and resouce utilization, but also quality indicators.

answer

What is the ultimate of the POA program?

question

Y = Present at the time of inpatient admission N = Not present at the time of inpatient admission U = documentation is insufficient to determine if conditions is present on admission W = provider is unable to clinically determine whether condition was present on admission or not

answer

POA Indicators and Definitions

question

MCC/CC conditions consist of: Significant acute diseases Acute exacerbations of chronic significant diseases Advanced end stage diseases Chronic diseases with extensive debility Consistenly greater impact of hospital resources

answer

MS-DRGs MCC/CC List

question

Two Major Factors with IPPS DRGs and CMI: -Medical record documentation -Coding Changes Changes in documentation and/or coding practices will affect the DRG assignment and thus the CMI Changes in the coding process for translating the diagnostic information into standard codes likewise affects DRG assignment.

answer

Key Facts to CMI

question

1970's: Yale University developed DRGs to describe all types of patient care in an acute care hospital. 1983: DRGs implemented for the Medicare IPPS. 1987: 3M developed AP-DRGs to address severity of illness and risk of mortality over all patient populations 2007: CMS adopted MS-DRGs to better recognize severity of illness in Medicare payment rates for acute care hospitals.

answer

The DRG System

question

Acute inpatient PPS (IPPS): DRGs Hospital Outpatient PPS (OPPS): APCs Home Health PPS (HH PPS): OASIS Skilled Nursing Facility PPS (SNF PPS): MDS Inpatient Rehabilitation Facility (IRF PPS): PAI

answer

PPS Examples

question

AHRQ via their annual report, CMS via Hospital Compare, and Leapfrog via the Individual Hospital website.

answer

Who makes quality measure available to the public?

question

AHIMA

answer

Who is recognized as the leading source of HIM knowledge?

question

National Center for Health Statistics (NCHS)

answer

Who serves as the WHO collaborating center for North America?

question

MS DRGs

answer

What did CMS introduce in 2007?

question

IPPS Quality Measures

answer

What resulted from the Medicare Prescription Drug Improvement and Modernization Act of 2003?

question

Physician Quality Reporting Initiative (PQRI)

answer

Created in 2006 by the Tax Relief and Health CAre Act this reporting measure has over 100 current measures.

question

AHA

answer

Which agency strives to advance the health of individuals and communities?

question

The Association of Clinical Documentation Specialists (ACDIS)

answer

What association is a part of HCPRO?

question

RAC

answer

Which external auditor began the audit revolution and returned over $240 million dollars to the Medicare Trust Fund in the first six months of 2011?

question

Hospital Outpatient Quality Reporting Program (HOP QDRP)

answer

What is the acronym for CMS's OPPS Quality Measurement program?

question

The Joint Commission (TJC)

answer

Which agency oversees the National Patient Safety Goals?

question

American Hospital Association (AHA)

answer

Which agency is the publisher for Coding Clinic for ICD-9-CM?

question

Office of Inspector General (OIG)

answer

Which agency, established in 1967 outlines it's focus areas in a "Scope of Work?"

question

Acute Myocardial Infarction, heart failure, and pneumonia

answer

Which diagnosis is a part of the CMS IPPS Quality Measures program?

question

Heart disease, obesity (HTN, DM), cancer, infectious disease, tuberculosis, HIV/AIDS, lower respiratory tract infections, COPD, influenza, and depression

answer

Top 10 diseases in the US

question

Electrocardiogram (ECG), Echocardiogram, stress tests, chest x-ray, nuclear imaging, CAT scan (SPECT), cardiac cauterization, angiography, doppler studies, blood tests, arterial blood gas

answer

Heart Disease Tests

question

Dietary modification, exercise, smoking cessation

answer

Lifestyle Modifications Heart Disease Tx

question

Vasodilators, Beta-blockers, Calcium channe blockers, Digoxin, Antihypertensive drugs, Adrenergic-blocking drugs, Angio-tensin-converting enzyme inhibitors, Diuretics, Anticoagulants, Cholesterol or lipid-lowering drugs

answer

Drug Therapy Heart Disease Tx

question

Coronary artery disease (CAD) -Arteriosclerosis/Atherosclerosis -Angina Pectoris -Myocardial Infarction (MI) Cardiac Dysrhythmias -Bradycardia/Tachycardia/Sick Sinus Syndrome (SSS) -Premature atrial contractions (PACs) -Atrial flutter/fibrillation -Heart block (1st degree, 2nd degree) -Bundle branch block -Ventricular tachycardia/fibrillation -Premature ventricular contractions (PVCs)

answer

Types of Heart Disease

question

Congestive Heart Failure -Left-side -Right-side Heart Failure -Systolic: weak heart contraction, decreased cardiac output -Diastolic: heart cannot fully relax

answer

Types of Heart Disease

question

Primary/Essential Secondary Malignant/Resistant/Accelerated

answer

3 major classification of Hypertension

question

Organ function studies - Kidney, liver, etc. Chest x-ray Liver profiles Culture - blood, urine, CSF CBC with differential Blood gases

answer

Sepsis Tests

question

Antibiotics, IV fluids, Oxygen, Blood transfusion, Steroids, Total parenteral nutrition, Mechanical ventilation, Central VAD insertion, Infusions of Dopamine/Vasopressors, Dialysis, Surgery

answer

Sepsis Tx

question

CMS

answer

Changes and updates to ICD-9-CM are managed by the ICD-9-CM Coordination and Maintenence Committee, a federal committee co-chared by representatives from the NCHS and who?

question

042-Human Immunodeficiency Virus (HIV) Disease 112.5-Candidiases, Disseminated

answer

Pateint has HIV and disseminated candidiasis, what is the correct code assignment?

question

038.11-Methiciliin Susceptible Staphylococcus Aureus Septicemia 562.11-Diverticulitis of colon (without mention of hemorrhage)

answer

A 68 year old woman was admittd to the hospital. She was diagnosed with septicemia secondary to staphylococcus aureus and abdominal pain secondary to diverticulitis of the colon. What is the correct code assignment?

question

Sepsis

answer

Which of the following terms equals SIRS?

question

Congestive Heart Failure

answer

What is the term for a condition in which the heart's functions as a pump is inadequate to deliver oxygen rich blood to the body?

question

Bronchodilators, Glucocorticoids, Antibiotics, Flu vaccine, Pneumonia vaccine, Oxygeyn Therapy

answer

Which of the following treatments would you expect to see in a patient admitted for COPD?

question

Vapriso

answer

Which of the following would be prescribed for a patient with hyponatremia?

CDIP – Flashcard

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards