Updates from ACDIS Conference Worth Sharing

Today I’m going to continue my exploration of what I learned at the annual Association of Clinical Documentation Specialists (ACDIS) Conference last month in Chicago.

In one notable segment, Tim Brundage and Cheryl Ericson spoke about complications and patient safety indicators (PSIs). As they noted, it is unfortunate that the word “complication” has so many meanings. If a condition develops while a patient is in the hospital, it is a comorbid complication; it is complicating the patient stay. Some complications are associated with medical misadventure, and those are also referred to as “adverse events.” The Institute for Healthcare Improvement defines an adverse event as an unintended physical injury caused by or contributed to by medical care, and it requires monitoring, treatment, and prolonged stay; otherwise, it can result in death. “Preventable” means it could have been avoided, and “ameliorable” means the severity could have been minimized, even if the adverse event was unavoidable.

PSIs address potentially avoidable adverse events that often occur as a result of surgery or a procedure. They were created to identify systemic differences between providers or hospitals, as a mechanism to decrease preventable errors. Tim and Cheryl went on to explain how “postoperative” means a temporal period to clinicians, and indicates a complication of a procedure to a coder.

They also discussed different specific PSIs and pointed out opportunities. For instance, postoperative sepsis sometimes really reflects sepsis present prior to the procedure, making this an opportunity to clarify present-on-admission (POA) status. Another example of an opportunity is ensuring that only mechanical ventilation that exceeds what is routine for the procedure is captured. If the duration of ventilator support is typical for surgical recovery, postprocedural respiratory failure should not be diagnosed, and the intubation and ventilation should not be coded or billed separately.

I was tickled to see that they used a graphic I made, trying to sort out a normal postoperative course from acute postprocedural respiratory failure/acute postoperative pulmonary insufficiency.

If you can sort out what normal postoperative recovery and florid acute postprocedural respiratory failure are, what lives in the gray zone constitutes acute pulmonary insufficiency (a bit of a made-up CDI condition).

Speaking of respiratory failure, the next session I attended dealt with newborn respiratory failure. In fact, the Innovation & Expansion track was chock-full of pediatric topics.

Newborn respiratory conditions consist of respiratory distress, respiratory distress syndrome, transient tachypnea of the newborn, and respiratory failure. First, they talked about delayed transition of the newborn, which derives from changing over from the womb to breathing air. Neonates can have retractions and need some supplemental oxygen support, but within a short period of time, they make the transition, and it resolves. It is considered part of the birthing process and is not coded as pathological.

The other conditions are distinguished by onset, duration, severity, and treatment needed. They also discussed the difference between having meconium staining or passage and having meconium aspiration syndrome with respiratory symptoms. Since ACDIS and the American College of Physician Advisors are collaborating to create pediatric CDI materials, and respiratory conditions is our first topic, I was really happy to attend this talk.

The other pediatric CDI talks I attended dealt with sepsis, jaundice, and general CDI. I found it quite interesting that one of the facilities used Medicare Severity Diagnosis-Related Groups (MS-DRGs) in pediatrics; it is more common to use All Patient Refined (APR) DRGs. I learned that Herpes simplex viral (HSV) infections are increasing in incidence, and there are three distinct types: skin/eye/mucosa (SEM), central nervous system (CNS), and disseminated HSV infections.

There have been some changes to the sepsis/febrile infant practice since my clinical days. The oldest subgroup, 22-28-day-olds, are carved out and approached a little differently than the younger cohort, and inflammatory markers help determine whether a lumbar puncture is indicated. The antibiotic coverage has changed, and discharges are more rapid.

In the general peds talk, they identified the most commonly missed comorbidities as respiratory conditions, acute kidney injury (AKI), acidosis, malnutrition, and acute heart failure. They reviewed some diagnoses that increase severity of illness/risk of mortality, like hypocalcemia and hypovolemia/hemorrhagic shock. Finally, they went over the need for developing policies and procedures.

Next week, I am going to address one more session in depth. Stay tuned!

Programming note: Listen to Dr. Erica Remer as she cohosts Talk Ten Tuesdays today at 10 Eastern with Chuck Buck.