Saturday, July 31, 2010

Challenge Yourself... Coding Scenario

Consider this Hospital Note - What would you code???

Hospital Progress note for Patient Sam Smith

CC: Multi-system organ failure

INTERVAL HISTORY: Patient remains intubated and sedated. Overnight events reviewed. Tolerating tube feeds. Systolic pressures have been running in the low 90s on LEVOPHED. Cultures remain negative. Kidney function has worsened, but patient remains non-oliguric.


PHYSICAL EXAM: 96/60, 112, 100.8. Lungs have anterior rhonchi. Heart RRR with no MRGs. Abdomen is soft with positive bowel sounds. Extremities show moderate edema.


LABS: BUN 89, creatinine 2.6, HGB 10.2, WBC 22,000. ABG: 7.34/100/42 on 50% FiO2. CXR shows RLL infiltrate.


IMPRESSION

  1. Hypoxic respiratory failure
  2. Community acquired pneumonia
  3. Septic shock
  4. Non-oliguric acute renal failure

PLAN

  1. Continue NS at 75 cc/hr
  2. Decrease ZOSYN to 2.25 grams IV Q 6H
  3. Follow cultures
  4. Continue tube feeds
  5. Titrate LEVOPHED to maintain SBP > 90
  6. Usual labs ordered for tomorrow

Critical care time: 30 minutes and 1 second.

Signed: Dr. Batman


What would you code this as ?

99231 - Subsequent Hospital

99232 - Subsequent Hospital

99233 - Subsequent Hospital

99291 - Critical Care



If you chose Critical Care 99291 you are correct!!! Refer to your CPT book for explicit

use on Critical Care Services....


Correct Coding Chart for Critical Care Services

Less than 30 Minutes

Use appropriate E&M Code

30-74 Minutes

99291 once ( x1)

75-104 Minutes

99291 once (x1) and 99292 once (x1)

105-134 Minutes

99291 once ( x1) and 99292 twice (x2)

135-164 Minutes

99291 once ( x1) and 99292 three times (x3)

165-194 Minutes

99291 once (x1) and 99292 four times (x4)

194 Minutes or longer

99291 and 99292 as appropriate




Wednesday, July 28, 2010

How to Have a Perfect 10 Day

* I found this on advance.com and thought It was worth sharing! *

How to Have a Perfect 10 Day
Concentrate on T.E.N.S. (touch, eye contact, name, and smile).
By Dianne Durante, EdS and Kirsten Hagman, LMSW

When buying property, realtors tell us "it's all about location, location, location." Well, to have a perfect 10 day, relationship experts know that it is all about attitude, attitude, attitude! It seems easy to comprehend, but is it hard to accomplish? Maybe it's not as difficult as you might think. Let's break it down into some simple tasks that make for the perfect 10 attitude!

Touch
Start your day with touch. Before the day carries you away, give your spouse, children or pet a hug. That old slogan "reach out and touch someone" is a very healthy way to start the day. Don't go on autopilot with this; instead, use it as an opportunity to really connect. Allow yourself and the recipient to feel the warmth of the simple gesture. Saying "Have a great day" or "I love you" would be a great addition to this caring contact, but it's not necessary. You will benefit from this brief chance to share a moment with someone that you care about. Once you get to work, shake hands to greet your colleagues to continue this physical connection.
Touch in the workplace is a very delicate subject, and understandably so. While you want to be sure that you are not making anyone uncomfortable, the element of touch is an important part of the human experience; it increases connection between people when done in an appropriate way. Each business has its own culture, and it is important to be mindful of that culture and observe the norms for everyone's comfort. We all have been in offices that operate more like families, where a hug may be an acceptable and appropriate morning greeting. For other places, a handshake may be the extent of touch permitted. If it does not feel right to you or you fear that your colleagues would not be at ease with a handshake, it's best to skip it and go on to the next steps. Just make sure that you really take the time to connect with others through those actions.


Eye Contact
Next is eye contact, the second ingredient for a Perfect 10 day. Perhaps you stop for coffee or to pick up a morning paper. Look people in the eye and make the experience more personal by creating a link between the two of you. It has become so easy to rush about our day and not ever really notice that we are surrounded by other people. We sometimes get so caught up in our business that we forget that each person that we interact with is like us in many ways. Taking a moment to acknowledge the people around us is a way to increase positive emotions. It does not have to be lengthy or lingering, but a few seconds of eye contact helps to make a personal association.

Be aware that there are different cultural responses to eye contact. In some Asian and middle-Eastern cultures, it is not respectful to look in the eyes of someone who is your superior. Also, the length of unbroken eye contact may cause discomfort in your co-workers. You may want to consider the length of eye contact since this may lead some to feel as though it is sexual in nature. In most cases people regard constant, lingering eye contact to be intense, overbearing and intimidating. The best way to handle this is, as with touch, by considering the culture of your workplace.

Names
Names are very important. Now you have stopped for your coffee and looked the person in the eye. Have you noticed that many people are wearing nametags these days? From the cashier to bank tellers to baristas, there seems to be an outcry for identity. Try calling the person by his or her name as you are handed your morning Joe. You may even add a compliment with the name. Names are nice and make others feel as though you are appreciative of them. Studies have shown that even infants respond favorably to the sound of their name. It is the word that we recognize above most others, and hearing it in a warm tone is a pleasant, personal experience for most people.


In the workplace, we often strive to function as efficiently as possible, which is great except when it becomes a series of impersonal transactions. People may joke that their jobs could be done by a robot or a monkey--that's because they feel like they are being paid to do an impersonal job. As a supervisor, use the names of colleagues whenever possible. It will remind them that they are each individuals and that you are recognizing the person, not simply the job that is being done. When sending a business e-mail, make sure to address the person by name and include your name at the end. This has become an overlooked step now, since the sender and recipient are made clear by the e-mail addresses. However, take that extra couple of seconds to let the person know that you are talking specifically to them. The recipient will feel more like an individual than a nameless employee.

Smile
Then smile! The shortest distance between two people is a smile. A smile is contagious, and being smiled at has been found to build confidence. Also, people who smile are typically viewed as more attractive. A way to start your day is with contagious confidence. Even if your business is conducted primarily over the phone, smiling can be a great tool to use. While you are talking on the phone with someone, make the effort to smile. You will notice that your voice sounds more pleasant and your spirits lift. This will be felt by the person on the other end of the line. The face-to-face smile is irreplaceable but it is wonderful to know that, even in this technological world, we can still convey that positive emotion over the phone just by putting on a smile. Own it and pass it on.

Put It All Together
Although these steps form a terrific beginning to the day, we all know that sometimes the day starts off well and then gets derailed somewhere along the way. When this happens, take a minute to refocus and reframe things. One thing that you can control is your attitude. Go back to basics, to the way that you started your day. Think about T.E.N.S. and start fresh, even if it's the middle of the day. Who can you connect with? Whose mood can you improve? With these simple techniques, the moods of the people around us will lift. Since a positive mental attitude is infectious, this is a great way to get back on the right track for a great day.



Dianne Durante is author of "Everyday Symbols for Joyful Living", a book that inspires readers to use seven common items (penny, elastic band, pencil, crayon, candle, seashell, and chocolate heart) in order to have a richer, happier life. A licensed marriage and family therapist and business consultant, Dianne conducts motivational workshops nationwide with her daughter, Kirsten Hagman. A popular speaker, she combines symbols and stories, keeping audiences learning and laughing. For more information: www.DianneDurante.com