Coding & Quality Measures Tip: Coding for the Revised Stroke Mortality Measure (MORT-30-STK)
Pat Maccariella‑Hafey
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.
References
Coding Clinic, Fourth Quarter 2016: Page 61
June 27 2018 Hospital Quality Reporting News Blast NIH Stroke Scale
cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/Measure-Methodology.html
qualityreportingcenter.com/wp-content/uploads/2017/08/IQR_FY-2019_Hospital-IQR-Program-Reference-Checklist_Tool_8.21.2017_vFINAL.508.pdf
nihstrokescale.org/
saebo.com/nih-stroke-scale-nihss/
medicare.gov/hospitalcompare/About/Hospital-Info.html
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.
Popular Posts
Coding Tip: Coding Bowel Obstruction in ICD-10-CM
With the implementation of ICD-10-CM came different codes and coding rules for many diagnoses. One of these is the coding of bowel obstruction when the patient presents for this condition that is caused by another condition.
Part 5: New 2021 CPT Codes | Modifiers, Category III, Evaluation and Management, etc.
This is Part 5 of a five part series on the new 2021 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.
Part 4: New 2021 CPT Codes | Urinary, Nervous, Ocular and Auditory Systems
This is Part 4 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes in the urinary, nervous, ocular and auditory systems. There are 2 new urinary/male reproductive system codes with no revisions or deletions; 3 new female reproductive codes with 2 deletions, 0 new with 4 deleted nervous system codes with 5 revisions; 5 new eye category III codes; and finally a 2 new auditory codes with one deletion.
Part 3: New 2021 CPT Codes | Cardiovascular System
This is Part 3 of a five part series on the new 2021 CPT codes. In this series we will explore the cardiovascular system CPT changes. There are 5 new cardiovascular CPT codes added with 0 deletions and 4 revisions.
Part 2: New 2021 CPT Codes | Musculoskeletal and Respiratory Systems
This is Part 2 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include some examples to help the coder understand the new codes. There are 0 new musculoskeletal CPT codes added with 0 deletions and 2 major revisions along with an extensive update to arthroscopic loose body removal requirements. For the respiratory system, there were 2 new codes, one code deletion and no revisions.
Subscribe to our weekly newsletter
Latest News
Coding Tip: Coding Bowel Obstruction in ICD-10-CM
With the implementation of ICD-10-CM came different codes and coding rules for many diagnoses. One of these is the coding of bowel obstruction when the patient presents for this condition that is caused by another condition.
Part 5: New 2021 CPT Codes | Modifiers, Category III, Evaluation and Management, etc.
This is Part 5 of a five part series on the new 2021 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.
Part 4: New 2021 CPT Codes | Urinary, Nervous, Ocular and Auditory Systems
This is Part 4 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes in the urinary, nervous, ocular and auditory systems. There are 2 new urinary/male reproductive system codes with no revisions or deletions; 3 new female reproductive codes with 2 deletions, 0 new with 4 deleted nervous system codes with 5 revisions; 5 new eye category III codes; and finally a 2 new auditory codes with one deletion.
Part 3: New 2021 CPT Codes | Cardiovascular System
This is Part 3 of a five part series on the new 2021 CPT codes. In this series we will explore the cardiovascular system CPT changes. There are 5 new cardiovascular CPT codes added with 0 deletions and 4 revisions.
Part 2: New 2021 CPT Codes | Musculoskeletal and Respiratory Systems
This is Part 2 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include some examples to help the coder understand the new codes. There are 0 new musculoskeletal CPT codes added with 0 deletions and 2 major revisions along with an extensive update to arthroscopic loose body removal requirements. For the respiratory system, there were 2 new codes, one code deletion and no revisions.
Part 1: New 2021 CPT Codes | Integumentary System
This is Part 1 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include examples to help the coder understand the new codes. For 2021 in general, there were 199 new CPT codes added, 54 deleted and 69 revised.
2020: Year in Review | Coding Education
In January, new CPT codes were released. There were 248 new CPT codes added, 71 deleted and 75 revised. Most of the surgery section changes were in the musculoskeletal and cardiovascular subsections. These included procedures such as skin grafting, breast biopsies, deep drug delivery systems, tricuspid valve repairs, aortic grafts and repair of iliac artery.
Coding Tip: New COVID-19 Codes Effective January 1, 2021
We have seen many updates and changes to COVID-19 (SARS-CoV-2) since the pandemic started. On January 1, 2021 we will see even more changes as outlined in this post. Also the CMS MS-DRG grouper will be updated to version 38.1 to accommodate the changes.
New Technology Add-On Payments (NTAP) For FY2021 – Part 4
In the previous three parts of this four-part series, we discussed the new ICD-10-CM diagnosis code changes, ICD-10-PCS procedure code changes and FY2021 IPPS changes. In this last Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments for FY2021.
New ICD Codes and IPPS Changes for FY2021 (ICD-10-CM Diagnoses changes) – Part 3
In the previous two parts of this four part series, we discussed the new ICD-10-CM diagnosis code changes and ICD-10-PC procedure code changes. In this session we will review the major IPPS changes for FY2021.
New ICD Codes and IPPS Changes for FY2021 (ICD-10-CM Diagnoses changes) – Part 2
This is Part 2 of a 4 part series on the FY2021 ICD-10 Code and IPPS changes. In this part, the ICD-10-PCS procedure codes are presented. For FY2021 ICD-10-PCS there are 78,115 total codes (FY2020 total was 77,571); 556 new codes (734 new last year in FY2020)…
New ICD Codes and IPPS Changes for FY2021 (ICD-10-CM Diagnoses changes) – Part 1
This is Part 1 of a 4 part series on the FY2021 changes to ICD-10 and the IPPS. In this part, we discuss some of the new ICD-10-CM diagnosis changes. Here is the breakdown: 72,616 total ICD-10-CM codes for FY2021; 490 new codes (2020 had 273 new codes); 58 deleted codes (2020 had 21 deleted codes); 47 revised codes (2020 had 30 revised codes)
Coding Tip: Reporting “Flash” Pulmonary Edema
Acute pulmonary edema is the rapid accumulation of fluid within the tissue and space around the air sacs of the lung (lung interstitium). When this fluid collects in the air sacs in the lungs it is difficult to breathe. Acute pulmonary edema occurs suddenly and is life threatening.
Client S: $556 increase/record reviewed
“Client S” is a small, not-for-profit, 40 bed micro-hospital in the Southeast. HIA performed a 65-record review this year for Client S and found an opportunity with 15 of them. 9 had an increased reimbursement with a total of $43,228 found.
Coding Tip: Glasgow Coma Scale Coding OCG Update for FY2021
The coma scale codes (R40.2-) can be used in conjunction with traumatic brain injury codes, acute cerebrovascular disease or sequelae of cerebrovascular disease codes. These codes are primarily for use by trauma registries, but they may be used in any setting where this information is collected. The coma scale may also be used to assess the status of the central nervous system for other non-trauma conditions, such as monitoring patients in the intensive care unit regardless of medical condition.
Coding Tip: Cardiac Arrest and Cardiac Shock
In the past, there had been an Excludes1 note at I46.- Cardiac arrest that excluded R57.0, Cardiac shock. HIA had also received a letter from AHA on a case in the past that had stated that only I46.- Cardiac arrest would be coded if both were documented. In addition, the Third Quarter Coding Clinic page 26 had a similar case that asked if both could be coded, and AHA had instructed that only I46.9, cardiac arrest, cause unspecified would be coded if both were documented and that the CDC would be looking at possible revision to the Excludes1 note.
Client X: Let’s Talk Numbers
A higher CMI corresponds to increased consumption of resources and increased cost of patient care, resulting in increased reimbursement to the facility from government and private payers, like CMS. We know that documentation directly impacts coding.
Coding Tip: Endarterectomy During Coronary Artery Bypass
Lately we have seen several cases where the endarterectomy was assigned along with the coronary artery bypass (CABG) procedure when being performed on the same vessel to facilitate the CABG. A coronary artery endarterectomy is not always performed during a CABG procedure, so when it is performed it becomes confusing as to whether to code it separately or not.
Coding Tip: Update – Coding COVID-19 When the Test is Negative
Assign code Z20.828, “Contact with and (suspected) exposure to other viral communicable diseases” for all patients who are tested for COVID-19 and the results are negative, regardless of symptoms, no symptoms, exposure or not as we are in a pandemic.
New ICD-10-PCS Procedure Codes for COVID-19
The Centers for Medicare & Medicaid Services (CMS) announced new procedure codes for treatments of COVID-19 – effective as of August 1, 2020. Among the new codes are Section X New Technology codes for the introduction or infusion of therapeutics including Remdesivir, Sarilumab, Tocilizumab, transfusion of convalescent plasma, as well as introduction of any other or new therapeutic substances for the treatment of COVID-19.
New Rule Helps Medicare ACOs During COVID-19 Pandemic
One common element in many value-based programs is risk adjustment using Hierarchical Condition Categories (HCCs) to create a Risk Adjustment Factor (RAF) score. This method ranks diagnoses into categories that represent conditions with similar cost patterns.
Part 5: Reasons for AKI Denials and Prevention | AKI Series
Why are so many AKI records being denied? It’s hard to give one answer for why so many AKI records are being denied lately, but most appear to be due to the multiple sets of criteria available for use in determining if a patient has AKI, as well as physician documentation. As stated in Part 3 of this series, there are three main criteria/classifications used to diagnose AKI.
Part 4: Is Documentation Present to Report Acute Kidney Injury/Failure? | AKI Series
In previous parts of this series we looked at the definitions of AKI/ARF, causes, coding and sequencing, and the common clinical indicators that patients present with that are diagnosed with this condition. In Part 4, we will look at the documentation that should be present to report the diagnosis without fear of denial, as well as when a query is needed to clarify the diagnosis.
Part 3: Clinical Indicators for Acute Kidney Injury/Failure | AKI Series
In the first parts of this series we looked at definitions of AKI/ARF, causes, coding and sequencing. In Part 3, we will look at what clinical indicators would possibly be present to support the diagnosis of AKI/ARF.
FY2021 Proposed Rule and Code Changes Highlights
The FY2021 IPPS Proposed Rule is out and here are some highlights from it regarding ICD-10 Code proposals. We will know if these changes are permanent after the public comment period is over on July 10, 2020 and CMS prepares the Final Rule, usually out by August 1.
Part 2: Specificity Coding of Acute Kidney Injury (AKI) and Sequencing | AKI Series
As discussed in Part 1 of this series, AKI/ARF is a common diagnosis that coders see daily. In Part 2, we are going to focus on the different types/specificity of AKI/ARF. We’ll learn what they mean, as well as how to code the diagnosis.
Part 1: What is Acute Kidney Injury (AKI)? | AKI Series
This is part 1 in a series focused on coding of acute kidney injury (AKI) and/or acute renal failure (ARF). AKI/ARF is reported often, but is also one of the most common diagnosis found in denials.
Coding Tip: Covid-19 Diagnosis Coding Common Scenarios
With the proliferation of COVID-19 cases, we thought we would put together a quick reference listing of some of the common scenarios that coders have asked about. As with all coding, coders should follow Official Guidelines for Coding and Reporting and the COVD-19 Frequently Asked Questions document by the AHA.
Reporting Telehealth Services During the COVID-19 Emergency
Effective March 1, Medicare will pay physicians for telehealth services at the same rate as in-person visits for all diagnoses, not just services related to COVID-19. This great for providers whose patients are reluctant to visit the office.