Coding & Quality Measures Tip: Coding for the Revised Stroke Mortality Measure (MORT-30-STK)
RHIA, CDIP, CCS, CCS‑P, CIRCC
Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador
Our Coding & Quality Measures Series discusses how coding may adversely affect your quality statistics and bottom line. For this weeks tip, our Executive Director of Education, Patricia Maccariella-Hafey, RHIA, CDIP, CCS, CCS-P, CIRCC explores what happens to your Hypertension Admission Rate quality metric when a coder erroneously reports hypertension. Patricia also provides key takeaways and best practices.
Is your facility reporting the R29.7– ICD-10-CM code for the National Institute of Health Stroke Scale (NIHSS) on patients diagnosed with a stroke? If so, are coders reporting these codes correctly?
What is the Revised Stroke Mortality Measure?
The refined Stroke 30-day mortality measure (MORT-30-STK) is a statistic defined as death occurring within 30 days of a diagnosed stroke. The Centers for Medicare & Medicaid Services (CMS) publicly reports a 30-day hospital-level stroke mortality measure on Hospital Compare as part of the Inpatient Quality Reporting (IQR) program. Measurement of patient mortality allows for a broad view of quality of care that encompasses more than what can be captured by individual process-of-care measures. The goal of outcome measurement is to identify institutions whose performance is better or worse than would be expected based on their patient case mix, by risk adjusting for patients’ conditions at the time of hospital admission. The goal of reporting a stroke outcome measure is to improve patient outcomes by providing patients, physicians, and hospitals with information about hospital-level risk-standardized mortality rates (RSMRs) following hospitalization for acute ischemic stroke.
Hospitals will receive confidential reports for the revised stroke mortality measure in CY 2021 using claims data from October 2017 to June 2020. Results in these reports will not be publicly reported or used for payment determination. CMS will implement the revised stroke mortality measure in the FY 2023 payment determination using claims data from July 2018 to June 2021.
***Hospitals should include the ICD-10-CM code for the NIH Stroke Scale score on submitted claims. The NIH Stroke Scale included in claims should be the first NIH Stroke Scale score documented in the medical record after the patient’s arrival at the hospital. Hospitals should use a POA code of “Yes” to capture the initial NIH Stroke Scale and POA code(s) of “No” to capture the other scores if multiple scores are available.
The NIH Stroke Scale revision only applies to the Stroke MORTALITY measure.
What is the Issue with the NIH Stroke Scale Code?
The problem is that many hospitals have not been reporting the NIH Stroke Scale ICD-10-CM codes as the Official Guidelines for Coding and Reporting have stated reporting of the code is optional. Here is what guideline I. C. 18. i. NIHSS Stroke Scale states:
“The NIH stroke scale (NIHSS) codes (R29.7- -) can be used in conjunction with acute stroke codes
(I63) to identify the patient’s neurological status and the severity of the stroke. The stroke scale codes
should be sequenced after the acute stroke diagnosis code(s).
At a minimum, report the initial score documented. If desired, a facility may choose to capture
multiple stroke scale scores.
See Section I.B.14 for NIHSS stroke scale documentation by clinicians other than patient’s provider”
Since the guideline above states can be used, many coders are not reporting the R29.7- – code.
Coders should be educated on what the NIHSS is and where in the record they can find this information to assign the correct code.
NIH Stroke Scale scores range from 0 to 42, with higher values indicating more severe strokes. The NIHSS is a 15-item neurologic examination stroke scale used to evaluate the effect of acute cerebral infarction/stroke on the levels of consciousness, language, neglect, visual-field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss.
The ICD-10-CM code book index entry is NIHSS (National Institutes of Health Stroke Scale) score R29.7- The NIHSS stroke score can be assigned based on provider or other clinicians’ documentation.
A link is provided below for the criteria used in determining the NIH Stroke Scale score. Coders should not calculate the score as it is to be calculated clinically by the patient’s clinician.
Coding take Away: Always report the NIH Stroke Scale code (R29.7–) on cases with an acute stroke/infarction (I63). Failure to report the code R29.7- – correctly, or at all, will impact the 30-day Stroke Mortality Measure. This data collected from claims since July 2018 will impact reimbursement. It may be a good idea to audit all stroke cases to ensure the correct NIH Stroke Scale code is assigned. Work with the facility’s quality department in determining data reporting periods.
Coding Clinic, Fourth Quarter 2016: Page 61
June 27 2018 Hospital Quality Reporting News Blast NIH Stroke Scale
The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
Last week, we looked at tidbits for reporting the ICD-10-CM codes for pregnancy/obstetric records. Now we will look at some for the ICD-10-PCS reporting of these records. In reporting the appropriate ICD-10-PCS codes a coder must know what is included in the terminology of products of conception (POC).
Chances are, we all know someone affected by heart disease and stroke, because about 2,300 Americans die of cardiovascular disease each day, an average of 1 death every 38 seconds. But together we can change that.
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When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them. This week, we talked with Allison Curry, RHIT, CCS, Coding Specialist at Health Information Associates, about the steps she takes to find her routine.
One way to shorten a lengthy query is by avoiding repetition in the supporting documentation. Does the same diagnosis really need to be mentioned multiple times in the clinical indicators? Is it necessary to list the results of a chest x-ray twice? Does listing the same documentation multiple times give further specification or explanation to the query?
Tobacco use can lead to tobacco/nicotine dependence and serious health problems. Quitting smoking greatly reduces the risk of developing smoking-related diseases. Tobacco/nicotine dependence is a condition that often requires repeated treatments, but there are helpful treatments and resources for quitting.
This is Part 5 of a five part series on the new 2019 CPT codes. For the remaining areas we will just briefly summarize the section. Due to the intricate nature of these sections in CPT, it is recommended that the coder read the entire section notes associated with the new codes.
This is Part 4 of a five part series on the new 2019 CPT codes. In this series we will explore the CPT changes for FY 2019 and include examples to help the coder understand the new codes. There is 1 new lymphatic code, 2 new digestive system codes with 3 deletions, 3 new urinary system codes with one deletion and 7 deleted nervous system codes with 2 revisions.
This is Part 3 of a five part series on the new 2019 CPT codes. In this series we will explore the CPT changes for FY2019 and include examples to help the coder understand the new codes. There are 9 new cardiovascular CPT codes added with 2 deletions and 3 revisions.
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them. This week, we talked with Tilina Sablan, RHIT, CCS, Coding Specialist with Health Information Associates, about the steps she takes to find her routine.
This is Part 2 of a five part series on the new 2019 CPT codes. In this series we will explore the CPT changes for FY2019 and include examples to help the coder understand the new codes. There are 4 new musculoskeletal CPT codes added with 2 deletions and 0 revisions.
This is Part 1 of a five part series on the new 2019 CPT codes. In this series we will explore the CPT changes for FY2019 and include examples to help the coder understand the new codes. There were 15 new integumentary CPT codes added with 3 deletions and 1 revision.
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The majority of the recommendations from DRG 190 (Chronic obstructive pulmonary disease w/MCC) was to DRG 189 (Pulmonary edema and respiratory failure) with re-sequencing of respiratory failure as the PDX or adding as a new code and sequenced as PDX.
The majority of the recommendations from DRG 853 (Infectious & parasitic disease with O.R. procedure with MCC) were to DRG 871 (Septicemia w/o MV 96+ hours with MCC) with deletion or revision of the PCS code. Some of these required physician query.
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Every year, we make plans to live a healthier, more organized, and balanced life. For some of us, we end up falling short of those expectations. This year, to keep us on track with our New Year’s goals, we have put together a few of the most common New Year’s resolutions along with their ICD-10 diagnoses codes. Check out our tips and tricks for a healthy 2019!
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When I start coding a chart, I enter all account information in log and do any abstracting—disposition, admitting, and attending—take care of all of that first. ED, H&P, consult, progress reports, and discharge summary.
Some Speed Reading Tips: Once you start reading, don’t stop! Read the text straight through. If you have any question after you have completed reading the material, go back and reread the relevant sections. Reread the marked sections of the text (the items you indicated that you didn’t quite understand). Write a small summary at the beginning of the chapter – consisting about 3-4 sentences.
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On December 1, 2018, the HIA team based at our headquarters in Pawleys Island, South Carolina received a visit from a surprise guest – meet Otis, HIA’s very own Elf on a Shelf. Otis will be sticking around until Christmas to keep an eye on all of us. We have a feeling he may get into some trouble! Check back daily to see what Otis is up to. #OtisOnOtisDrive
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our new series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them. This week, we talked with Crystal Junkins, CCS, CPC, Coding Specialist with Health Information Associates, about the steps she takes to find her routine.
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Tissue findings interpreted by a pathologist are not equivalent to the attending physician’s medical diagnosis based on the patient’s clinical condition. If the attending physician has not indicated the significance of an abnormal finding within a pathology report…