The Transition to What you need to know for Nephrology Date | Presenter Information

Tools Available Flat Screens in lounges AMGDoctors. com How can we reach our physicians? Intranet Blasts Physician Relations Team Website APP Newsletter Pocket Cards 2

Ongoing Support for ICD-10 Physician Advisors Clinical Informatics 3 -Public Reporting -Reimbursement -Physician Scorecards -Quality Improvement

What’s in it for me? Better reflection of the quality of the care you provided to your patient A more accurate assessment of the Severity of Illness (SOI) i.e. how sick your patient was during the hospitalization Improves your publicly reported quality measure scores Supports the improvement of your patient’s clinical outcomes and safety Enables a better capture of SOI (severity of illness) and ROM (risk of mortality) 4

What should be documented? 5 Reimbursement Admit HPI: tell “the story” PMH: all chronic conditions in as much detail as available (e.g., Chronic Systolic CHF) PSH: all surgeries (e.g., left hip arthroplasty) Assessment and Plan: Differential diagnosis Working diagnoses Other conditions being treated Daily Rule out or confirm differential diagnosis based on test results, imaging results and response to empiric treatment. Discharge All treated/resolved diagnoses should be documented. For diagnoses that are documented as suspected, possible, probable at the time of discharge should be listed in the discharge summary.

No Matter How Obvious it is to the Clinician It is not appropriate for the coder to report a diagnosis based on abnormal findings: –Laboratory –Pathology –Imaging A query must be sent to document a definitive diagnosis Only a physician can establish a cause and effect relationship between a diagnosis such as gastroparesis and diabetes Possible, probable and suspected conditions can be reported, but ONLY if documented at the time of discharge (for inpatient records) Outpatient Surgical and Observation Records: Enter as much information as known at the time. Patient with shortness of breath and lung nodule. Coded to shortness of breath and lung nodule. Patient with shortness of breath and lung nodule, suspected lung cancer with pathology pending. Coded to shortness of breath and lung nodule. We would not code a possible condition as an established diagnosis on outpatient records. What Coders are Unable to Assume 6

Key Changes Needed to Support ICD-10 Coding

Chronic Kidney Disease Document stage: –Stage 1-5 –End stage (ESRD) Document etiology, for example: –Diabetic CKD –Hypertensive CKD Document if patient is on dialysis 8 Acidosis-metabolic, respiratory, lactic Link abnormal lab value to clinical diagnosis

Acute Kidney Failure/Injury Document etiology, if known or suspected, such as: -Acute tubular, cortical, or medullary necrosis -Postprocedural -Posttraumatic -With transplant kidney Be clear on your intended diagnosis. Note that “acute renal insufficiency” results in an “unspecified” code. Do not use abbreviations AKI or ARF 9

Hypertensive Heart Disease Document link of cardiac and renal disease states Document type of CKD: –CKD Stage 1-5 –End Stage (ESRD) Document type of heart failure: –Systolic Heart Failure –Diastolic Heart Failure –Systolic & Diastolic Heart Failure 10

Nephritic Syndrome Document Severity: –Acute –Rapidly progressive –Chronic Document Manifestation: –Glomerular Disease –Glomerular Nephritis 11 Nephrotic Syndrome Document Manifestation: – Glomerular Lesions –Type Glomerular Nephritis

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