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