EM Coding Alert

You don’t need to build a ‘palace’ in your mind, just remember this acronym.

There are many moving parts in coding inpatient care claims, and forgetting or otherwise missing even one facet could tank your efforts.

Fortunately, there’s a simple trick you may find helpful.

Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania, has shared an acronym that can help you navigate claims for 99221 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity...) through 99239 (Hospital discharge day management; more than 30 minutes).

Pocket This: ADC VANDALISM

“There are several mnemonics to help you remember how to write admission orders,” reports Falbo. The one she is most familiar with is:

Admit & D/C VANDALISM (ADC VANDALISM)
“Here’s the general idea,” says Falbo, who provided the following bulleted list of examples:

• “Admit to Med/Surg; Tele; Intermediate (PCU); ICU. Select/write attending physician’s name. Also write service and co-residents if applicable.
• “Diagnosis: List in order of priority. Break them into two groups. First, new/acute problems. Second, chronic problems.
• “Condition: Stable, good, fair, guarded, critical, etc.
• “Vitals: Routine, q shift (aka every 8 hours), q4hours; parameters for notifying physician, e.g., SBP <90 or >150; HR < 60, RR <10, T > 38.3 degrees
• “Activity: Ad lib, bed rest/bathroom privileges (BRP), out of bed (OOB) ad lib/bedside commode/up in chair as tolerated, up to chair, ambulate TID, etc.
• “Nursing instructions:
  • Strict I/O’s, daily weights, Foley to gravity, O2 requirement; 1:1 observation, neurocheck q4h
  • Wound care: Dressing changes, DVT stockings, etc.
  • Respiratory care: Updrafts, endotracheal suctioning, spirometry, incentive spirometer, etc.
  • Precautions: Aspiration precautions, fall precaution, seizure precautions
  • Protocols: Hypoglycemia protocol, bedsore prevention, incentive spirometer.
• “Diet: Regular, ADA (diabetic), low sodium, NPO/NPO except ice chips/meds, clear liquid as tol, advance as tol, regular/4 g Na/diabetic (1800, 2000, 2400)
• “Allergies (to food and meds): No food allergies, NKDA, or name allergy AND reaction (e.g., hives, anaphylaxis)
• “Labs, studies, radiology, or imaging: CBC, chemistries, X-rays, MRI/CT, ECG, pulse ox, Ca, Mg, Phos, etc.
• “IV fluids: D5NS to run at 120cc/hr or NS at 100 cc/hr, etc.
• “Specialists or consults
• “Medications and monitoring:
  • Sedatives, analgesics, and prn meds
  • Antibiotics and meds that treat the new diagnoses
  • Reconcile home medications and choose those to d/c or cont.
  • Write med name, dose, route, and schedule.”