Clinical and Coding Conundrums - ACDIS

Clinical and Coding Conundrums

Michael D. Teague, MD, SFHM, CCDS Associate Medical Director Hospital Medicine Service and CDI Physician Advisor

Our Lady of the Lake Regional Medical Center Baton Rouge, L1A

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Learning Objectives

? At the completion of this educational activity, the learner will be able to:

? Identify clinical clues and indicators for complex medical conditions

? Investigate these lesser-reported diagnoses to ensure they are supported in the record

? Explore clinical and coding insights for: ? Functional quadriplegia ? MI ? Complex pneumonia ? Malnutrition

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These materials may not be copied without written permission.

Functional Quadriplegia (MCC)

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Paralytic Syndromes

? Hemiplegia (CC): Complete paralysis of one side of body

? Hemiparesis (CC): Incomplete paralysis of one side of body

? Quadriplegia (MCC): Complete paralysis of all 4 limbs

? Quadraparesis (MCC): Incomplete paralysis of all 4 limbs--"see quadriplegia"

? Diplegia (CC): Paralysis (or partial) of upper limbs

? Paraplegia (CC): Paralysis (or partial) of lower limbs

? Monoplegia (not CC/MCC): Paralysis of lower limb

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Coding Clinic Insight for Functional Quadriplegia Fourth Quarter 2008 ? A new code was created in 2008 for functional

quadriplegia

? Not a true paresis ? Inability to move due to another condition

? Dementia (most common cause), rheumatoid arthritis, contractures

? Immobile due to severe frailty or physical disability ? Functionally the same as a paralyzed person

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2017 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved.

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These materials may not be copied without written permission.

Functional Quadriplegia (MCC): By the Book

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Clinical Indicators for Functional Quadriplegia

Signs and symptoms

Onset Functional status (same as paralyzed patient) Ambulatory or able to transfer Bedbound Can get into wheelchair? Supporting evidence from physical exam

Functional quadriplegia supported

Years

? Total care/complete immobility ? Maximum assistance required ? ADL-dependent

No

Yes

Yes--but requires total assistance (like spinal cord injury?induced quadriplegia)

Contractures, pressure ulcers, confusion

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Differentiating Quadriplegia by Etiology

Functional Parkinson's disease

Neurologic Traumatic spinal cord injury

Alzheimer's dementia

Metastatic disease to spine

Rheumatoid arthritis

Cervical epidural abscess

Severe contractures

Spinal cord infarction

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2017 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved.

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These materials may not be copied without written permission.

What About Impact on Quality Scores?

? Functional quadriplegia (MCC)

? Risk adjustment ? Steady current of CDI ? Affects physicians and hospitals

? Affects SOI and ROM ? "Expected" mortality, readmissions, complications, PSI ? Receive credit for challenging patients

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Does Functional Quadriplegia Exclude PSI?

Postoperative Resp Failure (PSI 11)

Pressure Ulcer (PSI 03)

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What About Post-Intensive Care Syndrome?

? Acute onset after severe illness requiring ICU stay

? Was functional quadriplegia POA?

? CC ? Affects SOI but not ROM ? Critical illness myopathy (G72.81) (CC)

? Includes ? Acute necrotizing myopathy ? Acute quadriplegic myopathy ? Intensive care (ICU) myopathy ? Myopathy of critical illness

? Critical illness polyneuropathy (G62.81) (CC)

? Includes ? Acute motor neuropathy

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2017 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved.

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These materials may not be copied without written permission.

What Is Not Functional Quadriplegia?

? Post-intensive care syndrome (G62.81 and G72.81) (CCs)

? Spastic quadriplegic cerebral palsy G80.0 (MCC)

? Muscle weakness, generalized (M62.81) (not CC/MCC)

? Quadriplegia G82.5 (spinal cord disease) (MCC)

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Query Example

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Query Example

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2017 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved.

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These materials may not be copied without written permission.

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