Tip: Brush up on sepsis audits, queries

November 21, 2013

CDI Strategies - Volume 7, Issue 24

"[Recovery Auditors] are doing a really good job at identifying the patients who don't have sepsis, and they're taking the money back," says ACDIS Advisory Board member Robert S. Gold, MD, CEO of DCBA, Inc., in Atlanta.

What are Recovery Auditors looking for? They're data mining for sepsis MS-DRGs and then focusing in on those with a short length of stay, particularly when the patient is discharged home, says Gold. Auditors are also looking for specific clinical indicators to support a diagnosis of sepsis, he adds.

"If there are no clinical indicators, auditors are denying payment," says Gold. "One of the things you have to realize is that a patient with sepsis may not have clinical indicators, especially if the patient is immune-compromised. Sometimes the patient will have all of the clinical indicators and not have sepsis, which means you have to look at the fact that perhaps these abnormalities were due to other causes."

To prevent denials:

Run a report of cases with a principal diagnosis of 599.0. Audit these cases to determine whether sepsis may have been present but not documented or coded.
Run a report of cases with a principal diagnosis of sepsis. Audit these cases to determine whether clinical indicators of sepsis are documented. Also look for secondary diagnoses of pneumonia, cellulitis, or other infectious processes.
Establish a physician advisor, liaison, or champion who can assist in explaining common documentation issues to physician peers.
Look at query trends. Run a report of all diagnoses to which your queries pertain. This will allow you to track and trend and find patterns. Excessive queries for sepsis could indicate poor physician documentation patterns that CDI specialists should help address.

Editor’s Note:This article is an excerpt from JustCoding.com.

Found in Categories:

Education, Clinical & Coding, Physician Queries