presented by · 9.1 (4.8-5.6%)h . lab mining hunting for labs that confirm or provide a diagnosis...

Presented by:

George W. Jackson, MD

Financial Disclosure

3 WellMed Medical Management Do not copy or distribute without written permission.

Dr. George W. Jackson has no relevant financial interests to disclose.

Objectives

By the end of this presentation, you (the data miner) will be able to:

Explain the impact of the ICD-10 on Data Mining.

Identify data mining tools and protocols.

Identify RAPs tools.


Vital Helpers


Med List and Vital

Signs

Problem

List

Imaging

Specialty Consults

and Reports

Labs and Screenings

Hospital Records

Getting Started


ePRG-> e-Tools ->DataRaps->Provider Member List

DATARAP 2015 Risk Adjustment Diagnosis Quick reference guide

HCC Helper (app)

DATARAPS Support Tool

Data mining sessions

Access to hospital portals

Access the DATARAPS Tool


Log into ePRG: https://eprg.wellmed.net/Home/Index

Click eTools

Click Provider Member list

Click RAPS Support Tool

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The RAPS Support Tool


Problem List

Review current medical problems to convert to possible DATARAP codes.

Example: J45.40 – Asthma NOS (not DATARAP)

J44.9 – Chronic Obstructive Asthma (DATARAP)


Problem List


Review “HCC helpers” to find possible “buddy codes”

Buddy codes: Two or more diagnosis we can combine to make one

Example: DM E11.9, BUDDY with Impotence of organic origin (Erectile Dysfunction) N52.1 (a complication of DM), and create an additional “RAPable” code = E11.69 Diabetes with Other Manifestations.

E11.69 DM w/Other Manifestations; ED

N52.9 Erectile Dysfunction; 2nd to DM

Problem List

While reviewing the Problem List look for codes that can convert from non-Risk to Risk / HCC codes

Depression

Look for codes that suggest more complex problems

Diabetes, 80% have complications

Cancer

Active / Remission

11 WellMed Medical Management

Do not copy or distribute without written permission.

Medication List

Review medications and link them to the diagnosis they treat.

Metformin -> Diabetes

SSRI’s -> Major Depression Disorder Anticoagulants -> A. Fib; Chronic DVT / PE


Medication List

Look for medications that suggest/confirm diagnosis (Dx).

Venlafaxine / Mirtazapine

Depression

Metformin

Diabetes

Diltiazem / Linsinopril

Hypertension (HTN) or Heart Disease


Labs

Review lab results for possible DATA RAP codes such as:

Abnormal renal function test- CKD, Microalbumins (code the appropriate stage)

Abnormal Liver function test –

Chronic Liver Disease (Hepatitis Unspec.) Cirrhosis- (Alcoholic), NOS-


Labs

Review lab results for possible DATARAP codes such as:

Abnormal blood counts –

Thrombocytopenia- (Low plt Count x 2)

Thrombocythemia- (High plt Count x 2)

Abnormal A1C’s –

>5.7- 6.4 – Pre diabetic or >6.5 x 2 Diabetes

Parathyroid Hormone (PTH)

Elevated PTH – Hyperparathyroidism -


Lab Mining

Hunting for labs that confirm or provide a diagnosis of Diabetes:

FBS

A1c


HEMOGLOBIN A1C

COLLECTION DATE 01/29/2015 10/29/2014 07/24/2014 05/06/2014

ORDER DATE 01/29/2015 10/29/2014 07/24/2014 05/06/2014

RESULT DATE 01/29/2015 11/17/2014 07/24/2014 05/07/2014

ORDERING PHYSICIAN

Hemoglobin A1c 5.8

(4.8-5.6%)H 8.1

(4.8-5.6%)H 12.0

(4.8-5.6%)H 9.1

(4.8-5.6%)H

Lab Mining

Hunting for labs that confirm or provide a diagnosis of Chronic Kidney Disease (CKD):

eGFR

Micro / Macro albumin

Associated labs

iPTH

Lytes

Remember “Buddy Codes”


93 (97-108 mmol/L)L

5.1 (3.5-5.2 mmol/L

134 (134-144 mmol/L

17 (11-26)

0.95 (0.57-1.00 mg/dL)

8.8 (8.6-10.2 mg/dL)

16 8-27 mg/dL)

7 (0-40 IU/L)

68 (>59 mL/min 1.73

59 (>59 mL/min/1.73)L

MICROALB/CREAT RATIO, RANDM UR

COLLECTION DATE 01/29/2015 07/24/2014

ORDER DATE 01/29/2015 07/24/2014

RESULT DATE 01/29/2015 07/24/2014

ORDERING PHYSICIAN

Creatinine, Urine 53.3 (15.0-278.0 mg/dL) 30.3 15.0-278.0 mg/dL)

Microalbumin, Urine 180.4 (0.0-17.0 ug/mL) H 59.9 (0.0-17.0 ug/mL) H

Microalbumin/Creat Ratio 338.5 (0.0-30.0 mg/g creat) H 197.7 (0.0-30.0 mg/g creat) H

Pathology and Other Reports

Labs may suggest other diagnoses; A. Fib

Pathology reports

Cancer


.D: 04/05/10 : 5:11pm

.T: INR

.PV: RJB 1.4 Range: SEE BELOW TESTING PERFORMED AT CLINICAL PATHOLOGY LABORATORIES, INC. 1501 N. MESA, SUITE 300 EL PASO, TEXAS 79902 CLA NO: 45D1064219

DIAGNOSIS (MACROSCOPIC AND MICROSCOPIC) RIGHT VOCAL CORD, BIOPSES: - INVASIVE SQUAMOUS CELL CARCINOMA, MODERATELY DIFFERENTIATED.

Vital Signs

Review BMI History for morbid obesity or malnutrition codes.

Example:

BMI > 40 morbid obesity

BMI > 35 w/co-morbidities

BMI < 18 Unspecified malnutrition

Review O2 Saturation levels for chronic respiratory diseases

Review blood pressure values for HTN


Vitals

BP for HTN

Wt. / Ht and BMI

Protein – Calorie Malnutrition

O2 Sat


Vitals: BP sitting: 138/72, RR 12/min, Pulse sitting: 100, Temp 97.7 F, Ht 5 ft 1 in, Wt 73 lbs, BMI 13.79 Index, Oxygen Sat Room Air: 91, Pain Scale 7 1-10, Nurse/MA

Imaging

Review X-ray, ultrasound, CT scans and MRI reports for possible DATA RAP codes such as:

COPD,

Aneurysms,

Aortic Atherosclerosis,

Emphysema,

Pulmonary Fibrosis,

Compression Fractures


Radiology Reports

Read the body of the report – not just the impressions! (443.81, 577.1, 440, ?)


There are degenerative changes in the spine. There is an apparent old healed posterior right tenth rib fracture. Prominent vascular calcification is noted. Water density material is seen in the dependent pleural spaces bilaterally, and there is subsegmental atelectasis at the dependent lung bases. Cannot exclude mild edema or infiltrate at the dependent lung bases. There is a thin crescentic area of low attenuation at the margin of the liver. No focal abnormality is seen within the parenchyma. There may be a small amount of calcific material in the dependent lumen of the gallbladder. There are apparent tiny calcifications scattered throughout the pancreas. No focal area of abnormal attenuation is identified. No abnormality is seen in the spleen or adrenal glands. There is diffuse thickening of the wall of the colon. No small bowel dilation is identified. A Foley catheter is seen in the urinary bladder, and a fairly prominent amount of air is seen within the lumen of the bladder. Uterus is not identified. There are apparent stents in the iliac and femoral arteries bilaterally. Surgical clips are seen in the subcutaneous tissues at the groin bilaterally. Impression: 1. Prominent atherosclerosis. 2. Bilateral pleural effusions with subsegmental atelectasis and infiltrate/edema at the dependent lung bases. 3. Prominent degenerative changes in the spine.

Special Studies

Review Echocardiograms and stress test reports for possible DATA RAP codes such as:

CHF-

Pulmonary HTM-

Aneurysms-

Ectasia-

Old MI-


Special Studies

Review EKG’s for old Myocardial infarction (Mis) or arrhythmias

Atrial Fibrillation-

Paroxysmal tachycardia-

Review endoscopies and Sonograms for abnormalities

Cancer (colon)-

Cirrhosis-

Portal Hypertension-

Esophageal varices-


Special Studies

Pulmonary function tests (PFTs)

Lung diagnoses

Diabetic peripheral neuropathy (DPN)

Neuropathy

FloChec /Ankle-brachial index (ABI)

Vascular Dz


MEASUREMENT BEST TRIAL %PRED PRED LLN

FVC (L) 2.20 1 < 69 3.19 2.19

FEV1 (L) 1.15 1 < 49 2.34 1.70

FEV1% 52 < 68 76 65

FEF25-75 (L/S) 0.71 1 35 2.00

PEF (L/S) 1.50 1 24 6.07

FET (S) 5.01 1

Report Summary:

Pre Med: Tests 1 Acceptable 0 Reproducible 0 FVC VAR: FEV1 VAR: ATS Interpretation: PREMED – Severe Obstruction

Left Leg Right Leg

Velocity: m/s m/s

Amplitude: m/s m/s

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Specialty Consults

Review progress notes, consults, and results for existing medical conditions.

Capture past and current medical history prior to first touch visit with providers for more efficient documentation and DATA RAP process.


Consult notes

Check the Impressions; but,

Don’t forget to read the body, as in the X-ray reports there is often more information there!


HEMATOLOGY & ONCOLOGY DIAGNOSIS:

1. Laryngeal cancer, stage III disease, as T3, N0, M0, diagnosed on 09/13/2013. She received concomitant chemo/radiation therapy but she missed the last doses. Actually, she is in complete remission after the evaluation of the PET/CT scan. We are going to do a restaging on her in 6 months. Only, a right thyroid nodule was found. She elected to ask the primary physician for an ultrasound. She has a pulmonary nodule and needs to be followed up.

2. Pulmonary nodule, stable at the moment. She needs to have a CT scan repeated in 6 months since the last visit. 3. Thyroid nodule, right. She elected to ask the primary for an ultrasound to be done. 4. Lower back pain, actually receiving hydrocodone. 5. Very mild anemia with microcytosis, already resolved. 6. PAC catheter, continue with flushing. 7. Chronic smoker. She refused to quit. She continues with that. 8. Performance status, ECOG 2 because she is in a wheelchair because of a left above-the-knee amputation. 9. History of breast cancer, involving the left side, diagnosed in 2006, never received chemotherapy or hormonal

therapy. It looks like it is in remission. 10.Vision problems because surgery was done for cataracts. 11.Hearing impairment, actually advised by Dr. Garcia to use hearing aids but she refused.

Hospitals

Log in to your local hospital portal for the following:

H&P, Discharge notes

Consultations

Progress notes

Labs & Radiology

Operative Reports

Any other hospital procedure


Frequently Overlooked Diagnoses


Description RAF

All Alcohol and Drug Dependency 0.420

Amputation Status 0.779

Tracheostomy Status 1.520

Artificial Opening Status 0.651

Insulin Dependent (long-term, current) 0.118

Parkinson’s Disease 0.691

Rheumatoid Arthritis 0.374

Systemic Lupus Erythematosus 0.374

Malignant Melanoma 0.154

Protein Calorie Malnutrition/Cachexia 0.713

Major Depression 0.330

Frequently Overlooked Diagnoses


Description 2014 RAF

Pulmonary Hypertension 0.368

Atherosclerosis of Aorta 0.299

Atherosclerosis of Renal Artery 0.299

Atherosclerosis of Native Arteries of Extremities 0.299

Simple Chronic Bronchitis, Smoker’s Cough 0.346

AIDS 0.470

HIV 0.470

DM with Complications

- Address Diabetes and Manifestation

- Link Manifestation to Diabetes (in progress note)

- Code Diabetic combo code & additional buddy code if indicated.

0.368

Coding Clarifications: Risk vs. Non-Risk Conditions


Code Non-Risk Condition HCC Code Risk Condition HCC

J45.909 Asthma, unspecified None VS. J44.9 Chronic Obstructive

Asthma 111

M12.9 Arthritis, unspecified None VS. M06.9 Rheumatoid Arthritis 40

F32.9 Depression, NOS

(MDD, single episode, unspecified)

None VS. F32.0 - F32.8

Major Depression, single episode, mild – severe or in

remission 58

F10.10 Alcohol Abuse None VS. F10.20 Alcohol Dependence/

Alcoholism 55

I70.91 Atherosclerosis,

generalized None VS. I70.20-

Atherosclerosis of the extremities

108

I51.9 Diastolic Dysfunction None VS. I50.30 Diastolic Heart Failure,

unspecified 85

K75.9 Hepatitis, unspecified None VS. K73.9 Chronic Hepatitis,

unspecified 29

R07.9 Chest Pain, unspecified None VS. I20.9 Angina, NOS 88

Patient Charts

There are patient charts on your table.

In the next 30 minutes, go through the chart and find all of the codes you can.


Summary

You are now able to:

Explain the impact of the ICD-10 on Data Mining.

Identify data mining tools and protocols.

Identify RAPs tools.


presented by · 9.1 (4.8-5.6%)h . lab mining hunting for labs that confirm or provide a diagnosis...

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