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Updates: E Codes, Coding Edits,
and Principal Language
SpokenOSHPD
Ginger Cox, RHIT, CCSMarch 2006
Agenda
Regulation Changes on E Codes
Coding Edits – New Warning Flags
Update on “Principal Language Spoken”
Proposed IP Regulations on E Codes
An E-code is to be reported on the record for the discharge first episode of care reportable to the Office during which the injury, poisoning, and/or adverse effect was first diagnosed and/or treated. If the E-code has been previously reported on a discharge or encounter record to the Office, the E-code should not be reported again on the discharge record.
Proposed ED and AS Regulations on E Codes
An E-code is to be reported on the record for the encounter first episode of care reportable to the Office during which the injury, poisoning, and/or adverse effect was first diagnosed and/or treated. If the E-code has been previously reported on a discharge or encounter record to the Office, the E-code should not be reported again on the encounter record.
Scenario # 1
Where is the E code reported for an injury that was first diagnosed or treated,?
a) First inpatient discharge
b) First ED encounter
c) First AS encounter
d) First physician office
e) Only a, b, or c, whichever occurs first
1st Reporting Facility
Scenario # 2
If the patient comes from the ED of acute hospital A and admitted to hospital B, who reports the E codes?
a) ED of acute hospital A
b) Hospital BHosp A
Scenario # 3
If a patient fell from a hospital bed in psych facility A and the attending physician first diagnosed and ordered the patient to be transferred to hospital B, who reports the E code?
a) Psych facility A
b) Hospital B Psych A
Scenario # 4
If a patient has a drug reaction that was first diagnosed or treated during the encounter or stay, who reports the E code?
a) Psych facilityb) Rehab facilityc) ED encounterd) AS encountere) Any of the above, whichever occurs first
1st Facility
Scenario # 5
If an injured patient was first diagnosed in a physician’s office and then sent to an Endoscopy Unit, who reports the E code?
a) Physician’s office
b) Endoscopy Unit
c) Not applicable
Endoscopy Unit
IPIP Standard “S025” Edit Change
Critical standard “S025” editRevised logic for missing E codeEffective for all discharges on or after July 2005
Revised LogicPrincipal Diagnosis: 800-995Type of Care: SNF, RehabAdmit Source: SNF, Rehab, Chem Dep, Psych, ASCheck for missing E code (external cause)
New Standard “SW25” Edit
Non-critical standard “SW25” editNew SW25 edit for missing E code
Effective for all encounters on or after January 2006
LogicPrincipal Diagnosis 800-995
Check for missing E code (external cause)
EDEDASAS
Non-Critical Standard Edit Example
Diagnoses PDx: 873.41 ODx: 969.5
Edits SW25
SW25 Missing Principal E code
The cause of injury is required for the reported principal diagnosis.
References:
California Code of Regulations, Title 22, Sections 97260 and 97261
E codes sufficient to describe the external causes shall be reported on records with a principal and/or other diagnoses (800-999) or where ICD-9-CM codebook indicate that E code is applicable for dx (001-799)
EDED ASAS
Accept or Reject??
Non-critical standard editsSW25 flags
Effective for all encounters on or after January 2006
Non-critical edits (aka: warning edits)Will not cause MIRCal to reject your data
Facilities should review records in question
EDEDASAS
Accept or Reject??
Critical standard editsS025 flags
Effective for all discharges on or after July 2005
Critical edits Will cause MIRCal to reject your data, if above ETL
Must correct to ETL (preferably all)
IPIP
New Standard “SW25” Edit
Review Quick Notes #10 – Sample Form
Have you been treated for your condition at
an emergency room, hospital, or surgery
center before today? (Your doctor’s office
does not count.) YES or NO
EDED
ASAS
IPIP
Counts and Displays
Counts of non-critical and critical flags will be separate
Only the critical flags have to meet the ETL
Non-critical flags should be checked
Displays will be separateNumber of records with SW25 flag
Number of records with S025 flag
EDED
ASAS
IPIP
Coding Edit Changes
50 inactive coding editsAll discharges on or after January 2000
Not identified as critical errors Exceptions in guidelines or coding scenarios
Improvements to MIRCal Edit ProgramChanged inactive coding edits to non-critical coding edits
IPIP
Coding Edit Manual
Coding Edit ManualNumerical order (V0001, V0002, VW003, VW004, …)
Available on the MIRCal web site for Jan-Jun 2006 report period
Handout ListList of 50 non-critical coding edits
IPIP
Non-Critical Coding Edits
Non-critical coding editsVW flags, instead of V flags
Effective for all discharges on or after January 2006
Non-critical edits (aka: warning edits)Will not cause MIRCal to reject your data
Encourage facilities to review records in question
IPIP
Non-Critical Coding Edit Example
Diagnoses 995.50 995.82
Edits VW713 VW713
VW713 Maltreatment E code needed
When the cause of injury is stated to be a maltreatment to a child or adult, an E967 code identifying the perpetrator is needed, if known.
References:
Coding Clinic for ICD-9-CM, AHA, 4th Quarter 1995, page 39.
ICD-9-CM Official Guidelines, General E Coding Guideline, 19.e.1., Dec 2005.
Counts and DisplaysIPIP
Counts of non-critical and critical flags will be separate
Only the critical flags have to meet the ETL
Non-critical flags should be checked for accuracy
DisplaysNumber of records with VW flags per type of care
Your VW flags and its descriptions
Uses of Language
Communication is important between health care community and the patient
Allow the patient to explain what is bothering themAllow the patient to understand the treatment that the doctor recommendsEliminate the confusion over medications
More attention to improve medical outcomesRely on what patient is saying (prior to tests and/or treatments)Provide interpretative servicesTrack the healthcare process and see where it breaks down
Principal Language Spoken
Health and Safety Code (law)Supporters of SB 680
California Pan-Ethnic Health NetworkConsumers Union (CU)AARPCongress of California SeniorsHealth Access CaliforniaLatino Issues ForumPacific Business Group on Health (PBGH)Hughes Electronic CorporationCalifornia Medical Association (CMA)VerizonService Employee International UnionCalifornia Public Employees Retirement System (Cal PERS)
ED & AS Required Data Elements
Date of Birth Sex
Race and Ethnicity ZIP Code
Social Security Number Service Date
Principal Diagnosis Other Diagnoses
Principal E code Other E codes
Principal and Other Procedures
Expected Source of Payment
Principal Language Spoken Disposition of Patient
IP Required Data Elements
Date of Birth Sex
Race (Ethnicity) ZIP Code
Social Security Number Admit Date
Admit Source Admit Type
Principal and Other Diagnosis and CPAA
Prehospital Care and Resuscitation (DNR)
Principal and Other E codes Discharge Date
Principal and Other Procedures and Dates
Expected Source of Payment
Principal Language Spoken Disposition
Language Resources
Other Resources:Office of Minority Health
Bilingual Act
Kopp Act
MediCal (counties and data)
Minimal data set for LTCs
State Personnel Board
JCAHO
Executive Orders for Limited English Proficiency (LEP)
U.S. Census Data
Bilingual
Title VI
Census
LEP SPB
MediCal
Kopp
JCAHOOMH
National Standard Data Element
National Standards
Language Indicator (X12 data element # 1303)
1 – language of instruction2 – language of examination3 – language in which examination is written4 – language spoken in the home5 – language reading6 – language writing7 – language speaking8 – native language
Language Lists
National StandardsMember Language
Selected from X12 data element # 1303
Language reading
Language speaking
Native language
Two standard lists (X12 data element # 66)
International Organization for Standardization (ISO) – list of names of languages
National Information Standards Organization (NISO) – list of written languages
ISO
International Organization for Standardization (ISO)
Worldwide federation of national standards bodies
Named entity to maintain the language code listISO 639
ISO’s Language Code List
ISO 639 = Language Code List400+ languages
Written in English
ISO 639.12 digit code list
Not all languages are captured
ISO 639.2 3 digit code list
All languages are captured
Terminology and Bibliography lists
ISO 639.1
ISO 639.2
Language Collection
Compare with other entities
who collect languagesMediCal
Crosswalk their codes to ISO 639.2 list (Terminology)
State Personnel BoardConsistent with ISO 639.2 list (Terminology)
Minimal Data Set for LTCs4 languages (English, French, Spanish, Other)
CA Office of Minority HealthConsistent with ISO 639.2 list (Bibliography)
Principal Language Spoken
Simplify the list of 400+ languagesUS Census (Spoken at home; 5 years & older)
English
Spanish or Spanish Creole
Other Indo-European Languages
Asian and Pacific Island Languages
Other Languages
Approach ANSI X12 Minimum necessary list for 837 HCSDRG
Principal Language Spoken
Do more homework
Keep you informed of our progress
Simplify the list for 837 HCSDRG
Write the regulationsAgency approval
Public comments
Office of Administrative Law
Add change to data collection programTest and implement
Wrap Up
Regulation Changes on E CodesE Code on the initial encounter or dischargeRevised S025 critical edit for IP data - 2005New SW25 non-critical edit for ED and AS data - 2006
Coding Edits – New Non-Critical FlagsVW non-critical coding edits for IP data - 2006
Update on “Principal Language Spoken”More research
Questions and
Answers