October 3, 2016

Clinical Documentation Impacts More Areas Than Reimbursement

By
Prescription Opioid and Heroin Epidemic Awareness Week was observed from Sept. 19 -25, 2016. Prescription painkillers have taken the lives of more than 165,000 Americans since 1999. And even more lives have been lost globally.

President Obama is asking for $1.1 billion in federal funding to address this healthcare and community issue. On Sept. 8, 2016, a photo posted on Facebook brought the issue to the forefront of the nation’s consciousness.  

The photo showed a pair of adults slumped over in the front seat of a car with an awake 4-year-old child with a dinosaur T-shirt on in his car seat in the back. The two adults were unconscious, having just taken doses of heroin.  The picture was released by the police chief of East Liverpool, Ohio, who stated “we desperately need some help here.”

The Centers for Disease Control and Prevention (CDC) has noted that there have been 10,574 deaths due to heroin in 2014, plus 18,893 deaths related to prescription pain relievers. According to the Ohio Department of Health, unintentional drug overdoses caused 3,050 deaths there in 2015, a figure that jumped up from 2,531 in 2014. At the end of August 2016, one major U.S. city (Cincinnati) recorded 174 overdoses in six days. I also checked the numbers for Pennsylvania (my state) at its Department of Health, which noted that there were a record 3,383 fatal overdoses last year, many of which were attributed to fentanyl and heroin addiction.

According to the California Department of Public Health, there are more unintentional deaths due to prescription medication overdoses there than deaths occurring due to traffic accidents. In California, opioid prescription medication deaths have increased 16.5 percent since 2006. And the numbers keep rising, with our children caught up in the epidemic.

Insurer payments for opioid abuse have increased thirteen-fold during recent years. Patients who are treated for opioid use disorder cost more than the average patient: $19,333 versus $3,435.

Does your clinical documentation reflect the severity of illness of these patients?

In ICD-10-CM, generic drug-related disorder is coded as F19.99 (Other psychoactive substance use, unspecified with unspecified psychoactive substance-induced disorder), which provides no information regarding the drug, the acuity of the condition, and any associated conditions that might be present.

We have the ability to further specify the type of drug use as use, abuse, and dependence. There are the Official Coding and Reporting Guidelines, which provide the coding rules when a combination of conditions involving the same drug is present.

Other conditions that would further specify the severity of illness include intoxication, intoxication with delirium, intoxication with perceptual disturbance, mood disorder, psychosis, psychotic delusions, psychotic hallucinations, sexual dysfunction, and sleep disorder. Dependence can be further specified with the previously mentioned conditions or these additional conditions: withdrawal symptoms and remission.

The documentation issue is that these words are used interchangeably, but they imply a different level of addiction, from a coding perspective.

In preparation for bundled payment methodology, we have a duty to provide quality data to ensure that this disease gets the attention of the policymakers. A three-day program at the local hospital is not enough treatment for opioid addiction.
Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer

Laurie M. Johnson, MS, RHIA, FAHIMA is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an American Health Information Management Association (AHIMA) approved ICD-10-CM/PCS trainer. She has more than 35 years of experience in health information management and specializes in coding and related functions. She has been a featured speaker in over 40 conferences. Laurie is a member of the ICD10monitor editorial board and makes frequent appearances on Talk Ten Tuesdays.

Related Stories

  • News Alert: CMS Releases ICD-10-PCS Changes for FY2019
    There will be 392 new PCS codes; eight revision titles; and 216 deleted codes.The Centers for Medicare and Medicaid Services (CMS) has released and posted the fiscal year (FY) 2019 ICD-10-PCS (procedural coding system) changes. The files contain information on…
  • Auditing Issues Uncovered in Physician Documentation: Part III
    Is your Electronic Medical Record (EMR) system helping you pass an audit or hurting you? Editor’s Note: This is the third piece in a four-part series that examines physician documentation issues as seen by an auditor. As we dive even…
  • CMS Issues RADV Blueprint for Handling Flawed Documentation
    New CMS document features gems that fill risk adjustment voids for coding rules. Coders love rules. In risk adjustment coding, we live by the Official Guidelines for Coding and Reporting, the ICD-10-CM conventions for code lookup, and the AHA Coding…