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: Diagnosis Reporting for Routine Circumcision – Newborn
In HIA quality reviews we are finding that some coders are reporting Z41.2—Encounter for routine and ritual circumcision, during the male newborn birth admission, when circumcision is performed prior to discharge.
Coding Tip: GI Bleeding with Multiple Possible Sources
The cause/etiology of GI bleeding is not always easily determined. During procedures, to work the bleeding up, there are often multiple potential sources of bleeding found but not identified as the culprit. Many of these findings have “with” or “in” in the main or subterms.
Otis the Elf Visits HIA for Christmas 2018
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
Find Your Routine: Consistency is Key
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.
Coding Tip: What is COPD?
COPD is a respiratory condition where there is chronic obstruction to airflow in the lungs. Air is breathed into the lungs but a patient with COPD has trouble emptying air out of the lungs. This can also cause patients with COPD to have CO2 retention. COPD is an irreversible and progressive disease in which the lung function worsens as time goes on.
Subscribe to our weekly newsletter
Latest News
Coding Tip: Diagnosis Reporting for Routine Circumcision – Newborn
In HIA quality reviews we are finding that some coders are reporting Z41.2—Encounter for routine and ritual circumcision, during the male newborn birth admission, when circumcision is performed prior to discharge.
Coding Tip: GI Bleeding with Multiple Possible Sources
The cause/etiology of GI bleeding is not always easily determined. During procedures, to work the bleeding up, there are often multiple potential sources of bleeding found but not identified as the culprit. Many of these findings have “with” or “in” in the main or subterms.
Otis the Elf Visits HIA for Christmas 2018
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
Find Your Routine: Consistency is Key
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.
Coding Tip: What is COPD?
COPD is a respiratory condition where there is chronic obstruction to airflow in the lungs. Air is breathed into the lungs but a patient with COPD has trouble emptying air out of the lungs. This can also cause patients with COPD to have CO2 retention. COPD is an irreversible and progressive disease in which the lung function worsens as time goes on.
Query Tip: Query for Pathology Results
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…
CPT Coding: A Look at What’s Coming in 2019
It’s that time of the year where HIM professionals take a peek at what changes are coming for CPT in the new year, 2019. Did you know that CPT started in 1966 with about 3,500 codes? For 2019, there are a total of 10,294 CPT codes.
Find Your Routine: Set Your Own Schedule to Maximize Productivity
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 Amy Pang, RHIA, CCS, Coding Specialist with Health Information Associates, about the steps she takes to find her routine.
Coding Tip: New Code for Lacunar Infarction
For FY 2019, ICD-10-CM has added a new code for reporting of lacunar cerebral infarction. This is good news for coders since we see this specific type of cerebral infarction documented often. The new code that is reported for lacunar infarction is I63.81 —Other cerebral infarction due to occlusion or stenosis of small artery.
What is a Medicare Risk Adjustment Factor (RAF)?
In 2003, the Centers for Medicare and Medicaid Services (CMS) implemented Risk Adjustment Factors (RAF) and Hierarchical Condition Category (HCC) coding to identify individuals with serious and/or chronic illnesses and assign them a risk factor score that is based on a combination of demographic information and reported diagnoses.
Falling Case Mix Have You Confused?
The ICD-10-CM/PCS code changes – effective October 1, 2018 to September 31, 2019 – could be the culprit. Comparatively speaking, there are far less changes this year than in years past. The release includes: 279 new codes, 51 deleted codes,143 revised codes. But don’t let the smaller amount of changes fool you…
Coding Tip: Body Mass Index (BMI) Reporting in Pregnancy
With the publication of the new ICD-10-CM Official Guidelines for Coding and Reporting for FY 2019, we finally have an answer regarding reporting of BMI in pregnancy. The new guideline does state “do not assign BMI codes during pregnancy.”
Query Tip: What is Conflicting Documentation?
Conflicting documentation occurs when health care providers call the same condition different things. When none of the documented conditions are clearly ruled out by the physician, coders may find it necessary to query for the most appropriate diagnosis.
Are You Appealing?
In reviewing hundreds of contracts, the OIG found that insurers overturned 75% of their own denials upon appeal—approximately 216,000 denials each year. However, while the odds of winning an appeal are seemingly good, many providers simply don’t have the time or the internal staff and infrastructure needed to engage in the process.
Coding Tip: Bullying – What is it and how is it coded?
When coding a record with documented bullying, this is coded as child or adult psychological abuse (initial/subsequent encounter or sequela) either as confirmed or suspected. The encounter and whether this is confirmed or suspected is needed in order to assign the appropriate diagnosis code.
Halloween 2018 – 13 Spookiest ICD-10 Codes
It’s Halloween season! It’s time to overindulge on candy, fight over the best costume, become irrationally scared of things like the number 13, and have nightmares of your 6th birthday with that terrifying clown. As for us, we’re getting in the spirit with 13 spooky ICD- 10 codes! Beware – it’s scary out there.
Coding Tip: New Technology ICD-10-PCS Section “X” Drugs for FY2019
Section “X” is a separate place within ICD-10-PCS for certain new technology procedures (such as new technology drugs). Section “X” does not introduce any new coding concepts or unusual guidelines for correct coding and maintains continuity with the other sections in ICD-10-PCS.
Breast Cancer Awareness Month 2018 — Our Stories
October is #BreastCancerAwareness month. HIA wanted to share a few of our employees’ stories who battled or had personal experience with breast cancer.
Coding Tip: New ICD-10-CM General Coding Guideline — Coding for Healthcare Encounters in Hurricane Aftermath
With the Hurricane season in full swing, this new guideline will be helpful in reporting the external cause codes when an injury occurs as a result of the hurricane, and also help in determining sequencing of the reported codes.
Coding Tip: Coding Lobar Pneumonia
“Lobar” pneumonia references a form of pneumonia that affects a specific lobe or lobes of the lung. This is a bacterial pneumonia and is most commonly community acquired. Antibiotics are almost always necessary to clear this type of pneumonia.
Coding Tip: What is Hydronephrosis?
We have seen a lot of recommendations of late where the coders are coding hydronephrosis, UTI and ureteral stone separately or not with the correct code to include all conditions.
Coding Tip: Cerebral Infarction When Patient Has Carotid Stenosis
Coders have struggled for some time with the dilemma of when to assign the combination code of carotid stenosis, with cerebral infarction (i.e.I63.231) and when to assign separate codes for the specific cerebral infarction and carotid stenosis. (i.e. I66.01 and I65.21).
Query Tip: Be Careful Using Yes/No Query Format
Queries in a Yes/No format are limited to use in the four specific circumstances. This format may not be used when only clinical indicators of a condition are present, but the diagnosis has not been documented in the health record.
Coding Tip: Getting Control of Root Operation Control
Since the implementation of ICD-10-PCS in 2015, yearly changes have been made regarding the definition of, and guidelines associated with, the root operation Control. This has caused coding professionals much confusion in determining whether to assign a procedure to root operation Control, to assign another root operation, or to not assign a procedure code at all.
IPPS Final Rule: Here’s What You Need to Know
The policies in the IPPS/LTCH PPS final rule further advance the agency’s priority of creating a patient-centered healthcare system by achieving greater price transparency, interoperability, and significant burden reduction so that hospitals can operate with better…
Coding & Quality Measures: The Code Hard Truth
In this current, ever-changing healthcare climate, health systems face many challenges. Facilities large and small must be dedicated to improving documentation and reducing complications, HACs, infection rates, and readmissions as they endeavor towards value-based care. Coding inaccuracies can really undermine…
Achieve Sustained Results with HIA’s Coding Services
It’s imperative, in today’s challenging healthcare environment, that organizations demand complete and accurate coding practices from their vendors if they want: Appropriate and timely reimbursement; Representative quality measures; Improved CMI; Reduction in payor denials and; Mitigation of compliance risks.
Query Tip: Is Sepsis Present on Admission?
In addition to positive clinical indicators documented at the time of admission, any of these that occur within the few days after admission should also be included. This will support the fact that sepsis could have developed after admission. It is important that a POA query give equal attention to what supports POA yes, as well as POA no to avoid the appearance of a leading query.
CMS Releases Proposed Physician Fee Schedule Rule for CY 2019
This major proposed rule addresses changes to the Medicare physician fee schedule (PFS) and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute.