11/20/18 GHIMA Newsletter

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INSIDE THIS EDITION

West GHIMA ...........................2

North GHIMA ..........................3

Internal Hernia………………...4-5

2019 E/M Doc. ………………...6-7

2018-19 House ………………..8-9

Mentoring Café……………….10-11

East GHIMA updates………….12

Upcoming Events……………….13

New Credential Holders ……..13

Nominations 14

President’s Message

Happy Holidays in the United States mean

the celebration of Hanukkah, the season of

Advent, Christmas, Kwanzaa, and New

Year’s. The Christmas music that gets stuck

in our head and we continue to sing: Santa

Clause Is Coming To Town, All I Want for

Christmas Is You, or I’m Dreaming of a

White Christmas. The season brings shop-

ping, gift giving, gift exchanges, the get to-

gethers with family and friends along with

the delicious food and desserts — all of this while we conduct our

daily lives, watch our budget, drink water, exercise, eat in moder-

ation, work, and study for exams. This time of year forces us to

use year-end dental, vision, and medical benefits and meet

AHIMA’s continuing education requirements. As we reflect and

prepare for transformation, GHIMA is here to help you. Start by

visiting our newly designed website https://www.ghima.org/ for

continuing education needs with a replay of the December 8th,

2018 Coding Roundtable’s Hypertension session with Dr. Mann.

You will also find regional meeting dates, Mentoring cafe and ca-

reer opportunities. The GHIMA Merit Scholarship is always open

for donations. I encourage your to read the scholarship require-

ments and apply.

In addition, the call for board nominations are open until Febru-

ary 15th 2019, and registration is open for the 2019 Quad-State

meeting May 5th—8th, 2019 in Myrtle Beach, SC.

As you ponder what to do in the New Year consider obtaining a

new or another AHIMA credential.

http://www.ahima.org/certification.

Happy Holidays & Happy New Year 2019!

2

HAPPY HOLIDAYS FROM WEST GHIMA

All of us at West GHIMA would like to extend our greetings for the Happiest of Holidays to you and

yours. As we reflect on the year that has passed and look ahead to the year to come, let us all remember

that the path to success is paved with failures. Whether in our jobs or personal lives, we can appreciate

our successes, learn from those things attempted and not yet refined, and anticipate how to grow and

improve in the future to turn those failures into successes. We are all in this together!

QUARTERLY MEETING

West GHIMA will hold its next quarterly meeting Friday, January 18, 2019 at Navicent Health in Ma-

con, Georgia. We anticipate three great speakers, one of which will be a representative from the Georgia

Hospital Association (GHA). Please make plans to join us for this next meeting in Macon and get a

jumpstart on your 2019 CEUs!

WHAT: WGHIMA Quarterly Meeting

WHEN: Friday January 18, 2019 from 10:00 am – 3:00 pm EST

WHERE: Tentatively scheduled - Navicent Health (West Tower – Room 3)

777 Hemlock Street, Macon, GA 31201

MENTORING CAFÉ

West GHIMA will also be sponsoring the GHIMA Mentoring Café on Saturday December 15, 2018 in

Thomasville, Georgia. We are looking forward to a very successful meeting so please join us! Further

details about the Mentoring Café can be found on the GHIMA website.

WHAT: GHIMA Mentoring Cafe

WHEN: Saturday December 15, 2018 from 10:00 am – 12:00 pm EST

WHERE: John D. Archbold Memorial Hospital (East Tower Auditorium)

915 Gordon Avenue, Thomasville, GA 31792

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3

Volunteering, A Sense of Professional and

Personal Accomplishment

By

Neisa R. Jenkins, EdD, RHIA, FAHIMA

President, NGHIMA

As the North Georgia Health Information Management Association (NGHIMA) nears the end of 2018, my thoughts focus on the many volun-teers that help make NGHIMA the organization it is today. I believe that volunteers are the heart and soul of organizations like ours. There are people who volunteer over and over again because they see that there is a need and because this opportunity to give back provides a strong sense of accomplishment. Volunteering also builds awareness of community; we have each other’s back. We provide support and create lasting connec-tions. Our volunteers dedicate their time, expertise, and provide valuable input to help achieve organizational goals. They help make plans to serve our members at the highest level of customer service. As President of NGHIMA, I know that I can depend on volunteers to be at our meetings, ready to serve in any capacity, and for this I am grateful. Thank you to all of the volunteers who serve at the Regional, State and National levels, we can’t do the things we do as organizations without you. To those of you who are contemplating whether you should volunteer or not, take a mo-ment to have a conversation with people who give back selflessly. Ask them why they do it and what they get out of it. I am sure that you will find their responses encouraging and persuading. We need you, so vol-unteer today.

4

Internal Hernias following Roux-en-y

By: Coding Roundtable Committee

Patients who have had a Roux-en-y gastric bypass or a liver transplant are at a greater risk for an internal her-

nia.

An internal hernia is defined as the protrusion of a viscus, such as a small bowel, through a peritoneal or mes-

enteric orifice, resulting in its dislocation into another compartment.

Internal hernias can be acquired or congenital.

The most common is a paraduodenal hernia. There are also pericecal, transmesenteric, transmesocolic, retro-

anastomotic, foramen of Winslow, and intersigmoid hernias.

Of note, paravesical hernias are not true internal hernias.

HOW TO CODE

Coding Clinic First Quarter 2018 pages 11-12 addresses an internal

hernia at the Petersen space. Patient is status post Roux-en-y. The

jejunojejunostomy anastomosis had a significant portion of the bowel

in the Petersen space. The hernia was reduced, and the defect was

closed using an endo stitch device.

(See blue arrow for Petersen space -the opening between the mesen-

tery of the alimentary loop and the mesocolon of the colon transversum)

The repair was done laparoscopically. The defect is located in the mesentery. Use 0DQV4ZZ for repair mes-

entery, percutaneous endoscopic approach.

Per CPT assistant, a laparoscopically repaired internal hernia would use CPT code 44238 - Unlisted laparos-

copy procedure, intestine. (Note: When using unlisted CPT codes, payers may want the OP note or other doc-

umentation to clearly explain the procedure performed. Follow your facility guidelines.)

5

CASE STUDY

Patient presented with severe abdominal pain, nausea and vomiting. CT found internal hernia in

transverse mesocolon. The patient was taken to OR for laparoscopic repair of internal hernias due

to gastric bypass, 2 defects. OP NOTE: There was both a transmesocolic and Petersen’s defect.

Trocar and laparoscope inserted. There was a transmesocolic defect internal herniation of Roux

limb, reduced small bowel loops. Petersen’s defect was also open. Both defects were closed.

ICD 10 CM and PCS codes

K95.89 Other complication of bariatric procedure as PDx

K45.8 abdominal hernia specified site NEC (See hernia, internal in alpha index. Instructed to see

also hernia, abdomen)

0DQV4ZZ Repair mesentery, percutaneous approach

CPT code

44238 Unlisted laparoscopy procedure; intestine

Resources:

https://www.amboss.com/us/knowledge/Internal_hernia https://www.ajronline.org/doi/full/10.2214/AJR.05.0644 https://www.hindawi.com/journals/cris/2017/5948962/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515260/ ICD-10-CM/PCS Coding Clinic, First Quarter ICD-10 2018 Pages: 11-12 CPT Assistant, July 2017 Page: 10 ICD 10 CM 2019 AHIMA Press

CMS announced that they are committed to finding ways to reduce documentation burdens for pro-

viders and to streamline payment of E/M codes. Their initiative is called the ‘Patients Over Paper-

work’ initiative. Many of us asked how would this be done with such an antiquated system (the last

time E/M was revised for public use was decades ago)! Understanding this was a serious under-

taking; CMS put out some proposals earlier this year and then sought public comment from stake-

holders.

The proposals included the below:

• A single PFS payment rate for E/M visit levels 2-5 (new and established patients).

Create new G-codes to be reported with an E/M service to describe any additional

resource costs for specialty professionals.

Additional add-on payments to recognize additional resources to address inherent

complexity in E/M visits associated with primary care services and with cer-

tain non-procedural based care.

A multiple procedure payment adjustment that would reduce the E/M pay-

ment when the service is rendered on the same day of another procedure.

Additional add-on payment for 30 min of prolonged E/M service.

• A minimum documentation standard where, for Medicare PFS payment purposes for an of-

fice/outpatient based E/M visit, providers would only need to document the information to sup-

port a level 2 E/M, except when using time for documentation.

Providers would have the option to document using the current system based on

1995 or 1997 documentation guidelines, or based solely on medical decision-making

or based solely on time.

Current policy in regards to history and exam would be expanded to allow providers

to focus their documentation on only what has changed since the last visit (rather

than re-documenting information already in the record).

Providers would also be able to review and verify certain information in the med-

ical record entered by the beneficiary or ancillary staff, rather than having to re-

enter the information.

As expected, the above proposals caused a lot of angst amongst clinicians and health care administra-

tors alike. A single-payment system you say? A payment reduction when E/M is billed with modifi-

er-25 you say? I think not, said many providers! When it was all said and done, the dust settled

and effective January 1, 2019 we are left with these policies in the Final Rule:

• Elimination of the requirement to document the medical necessity of a home visit in lieu of an of-

fice visit;

• For established patient office/outpatient visits, when relevant information is already contained in

the medical record, practitioners may choose to focus their documentation on what has changed

since the last visit, or on pertinent items that have not changed, and need not re-

2019 E/M Documentation Changes

record the defined list of required elements if there is evidence that the practitioner reviewed the previ-

ous information and updated it as needed. Practitioners should still review prior data, update as

necessary, and indicate in the medical record that they have done so;

• Additionally, we are clarifying that for E/M office/outpatient visits, for new and established patients

for visits, practitioners need not re-enter in the medical record information on the patient’s chief com-

plaint and history that has already been entered by ancillary staff or the beneficiary. The practitioner

may simply indicate in the medical record that he or she reviewed and verified this information; and

• Removal of potentially duplicative requirements for notations in medical records that may have previ-

ously been included in the medical records by residents or other members of the medical team for E/M

visits furnished by teaching physicians. CY 2019 Physician Fee Schedule Final Rule

Due to serious concerns from clinicians and other stakeholders to the proposed rule, CMS did not finalize

aspects of the proposal that would have: (1) reduced payment when E/M office/outpatient visits are fur-

nished on the same day as procedures, (2) established separate coding and payment for podiatric E/M vis-

its, or (3) standardized the allocation of practice expense RVUs for the codes that describe these services.

Instead CMS has rolled back the proposed payment changes to calendar year 2021.

In addition to the documentation changes, beginning Jan.1 CMS will pay for a series of virtual and other

non-face-to-face visits in an attempt to allow greater flexibility to providers in how they care for beneficiar-

ies. Two new HCPCS codes were created to bill for virtual service(s) provided to the patient:

• G2010-Remote evaluation of recorded video and/or images submitted by an established patient;

• G2012-Brief communication technology-based service (e.g. virtual check-in)

Two new CPT codes were created to bill for inter-professional services between providers:

• 99451-Interprofessional internet consultation by consultant;

• 99452-Interprofessional internet consultation by treating /referring provider

Medicare will also reimburse for inter-professional services billed with existing CPT codes 99446-99449.

There are specific criteria that must be met in order to bill all of these services, so please be sure to read

the guidelines thoroughly. Medicare beneficiaries must also give written consent to billing Medicare

for these services.

Summary:

These are huge changes! Remember, the documentation changes are effective January 1, 2019 and only

applies to office or outpatient E/M services. The payment changes are scheduled to go into effect in 2021;

we will have to wait to see what exactly those changes will look like. In the meantime, clinics should ana-

lyze their current payment structure (e.g. RVUs, provider contracts, etc.) to see how the proposed pay-

ment changes will impact their financial bottom line.

Resources:

https://www.cms.gov/About-CMS/Story-Page/2019-Medicare-PFS-proposed-rule-slides.pdf

https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html

The 2018-2019 House Leadership Team met on November 30, 2018 for the first time in the 2018-19

House of Delegates (House) year. The House Leadership serves as a steering committee consisting of one

(1) delegate from each CSA. They ensure effective House operations through alignment with strategy.

House Leadership fosters the overall delegate experience and provides oversight of task force progres-

sion. During the call, the team discussed their role, the recommendations from the House Meeting

breakout sessions and newly created task forces. The team also discussed questions regarding AHIMA’s

Transformation, an action item on the revision of the Code of Ethics, and the 2019 Practice Councils

which reside under the House.

The team was educated on their role for the House of Delegates ensuring effective operations. A key re-

sponsibility is for maintaining the House Procedures. The procedures were updated and approved at the

House meeting in September, HOD Resource and Governance Documents. During December, the House

is reviewing the revisions to the AHIMA Code of Ethics proposed by the Professional Ethics Committee.

There is a comment period until January 4, 2019 and the House vote is January 7th-14th. Information is

available at:

House Vote: AHIMA Code of Ethics

House Discussion on the AHIMA Code of Ethics revision

The team participated in a review of the recommendations from the four SBARs from the House

breakout sessions:

• Envisioning Collaborative

• Apportionment

• Relevancy

Action Item – convene a task force to develop next steps once the strategy is determined

• HIM Reimagined

The recommendations are being reviewed and next steps determined. These SBARs and recommenda-

tions are posted in the State Leaders and House of Delegates (SLH) community resource: 2018 House

Meeting

2018-2019 House Leadership

Delegates discussed the AHIMA Transformation as well with questions and concerns on standards,

consumer engagement, and the CHDA exam. A FAQ document is forthcoming that will hopefully ad-

dress members’ questions and concerns. AHIMA is committed to transparency and, on a periodic basis,

will be updating the House, CSA leaders and staff, as well as members. Let your delegates know your

concerns so that AHIMA might track these.

A new opportunity is being shared with the delegates. It is a CCHIIM/House Task Force. The delivera-

bles include obtaining and reviewing member concerns regarding certification and developing resources

as needed to educate CSA members on the certification process or issues identified by a CSA. The

goal is to have bi-directional communication between CCHIIM and the membership through the House.

The 2019 Practice Councils were reviewed and the relationship to the House was discussed. There

are four councils for 2019:

• CDI: Documentation Requirements Practice Council

• Clinical Terminology & Classification Practice Council

• EHR Documentation Integrity Practice Council (New)

• Privacy & Security Practice Council

Currently there are four delegates serving on the practice councils. Once the 2019 ones have been

filled, it will be determined if there is a need to include a delegate representative since the Practice

Councils reside under the House. If you are interested in serving, complete the application on Engage,

Volunteer Opportunities. Applications are due December 21, 2018.

All the House activities are tracked on the Leadership Dashboard which is updated at least monthly. A member is welcome to review this document to view the House projects. Just go to the SLH, Leader-ship Dashboard for this information.

The GHIMA Mentoring Café Committee had its sec-ond meeting on December 15th in the West Region at the East Auditorium, John D. Archbold Memorial Hospital campus in Thomasville, GA. Our 2-hour in-teractive session was an open forum for the mentees to pose questions on any of the following topics: life skills, professional development, career guidance, networking, resume development, and industry best practices.

Our next meeting is Saturday, March 16th,

10:00a – 12:00p in the East Region. Loca-

tion TBA.

Are you interested in attending? Email us: GhimaMentoring@gmail.com

GHIMA Mentoring Café

(L-R): Erica Wilson (Committee Member), Ashton Thompson (Student Mentee), Ms. Andrew (Bldg. Admin), Stephanie Mercer (Incoming West Regional President), and Stephanie Causbey (West Regional President) Not Pictured: Karen Searcy (GHIMA President), Ginna Evans (AHIMA President-Elect), Earshler Taylor (GHIMA Mentoring Co-Chair), Jennifer McCollum (GHIMA Mentoring Co-Chair), and Dorothy “Dot” Steed,

We’re on the home-stretch for 2018 and half way through our year for EGHIMA. We are proud to announce that Lawrence Claybrook, RHIA | Statewide HIMS Ad-ministrator, GA Correctional Healthcare, is our 2018-2019 President-Elect! Con-gratulations, Lawrence! We look forward to your input and leadership over the next few years.

EGHIMA had an excellent meeting in Savannah @ Candler Hospital on 12/11 with speakers Lee Williams, RHIT, CCS, CCDS, CPC, CHONC, CEMC, CPCO, CRC, AAPC Fellow, Rebecca Marsh, CPC | nThrive, and Pamela Duncan, M.Ed. | Geor-gia Regional Hospital – Savannah. We had 14 attendees on-site and 8 who attend-ed via WebEx. In addition to reaching out to balance our meetings between Au-gusta and Savannah, we are also working with the AAPC-Savannah Chapter to provide collaboration meetings on Saturdays in the near future.

Thank you everyone for your support of EGHIMA and we look forward to seeing you for our HIP Week Celebration in March 2019! Stay tuned for more infor-mation to come.

Merry Christmas & Happy New Year!

Tyler Schumann, RHIA

President | East Georgia Health Information Management Association (EGHIMA)

New Credential Holders

Ghiya, Subhangi RHIT

Huffstutler, Nikki RHIT

Lott, Bonny CCS

Morris, Leanne CCA

Patel, Parvez CHPS, RHIA

Stephens, Hope CCS

Thomas, Michelle CCA

Vance, Hope RHIT

Upcoming Events

**2019 Quad-State Annual Meeting

(https://www.nchima.org/annualmeeting/)

NC-SC-GA-AL Health Information Management Associations

May 5-8, 2019

Hilton Myrtle Beach Resort

Myrtle Beach, SC

The Nominating Committee encourages members to support GHIMA. We will open nominations in a few days and close the nominations period on February 15, 2019. If you are interested in nominating yourself or a GHI-MA colleague to the 2019 ballot, please do so during this period. As an of-ficer of the Board of Directors, you will have opportunities to network with other leaders and apply your unique talents to the Association. Please consider nominating a member or members who have served this organization for one of the following GHIMA Board of Director positions: * President-Elect — 1 * At-Large Director — 2 * First Year Delegate — 1 * GHIMA Nominating Committee — 2 Please watch for eblasts with additional information and links to nomi-nate a colleague or yourself.

CALL FOR BOARD

NOMINATIONS,

DEADLINE:

FEBRUARY 15

GHIMA recognizes outstanding contributions made by its members every year via various awards. The process to nominate is very simple through GHIMA’s website (http://ghima.us1.list-manage.com/track/click?u=95c4af0da811aedf405eeb692&id=0d19f2e165&e=76e2686e89). The link will give a description of each individual award. GHIMA is soliciting nominations for the following categories: * Champion * Clinical Site * Distinguished Member * Distinguished Service * Established Professional * Mentor * Outstanding New Professional * Professional Achievement * Recent Graduate Award

CALL FOR

AWARD NOMINATIONS:

DEADLINE:

APRIL 1ST 2019