Neurosurgery Coding Alert

Mnemonic device leads to cleaner hospital claims.

Getting all the information just right on an inpatient care claim is difficult — there are a lot of moving parts, and missing just one piece of information could crash your claim.

Luckily, Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania, has shared an acronym that can help you with your 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) claims.

ADC VANDALISM: It’s a Good Thing

“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:

• “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 eg. 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 & 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 & Meds that treat the new diagnoses
  • Reconcile home medications and choose those to d/c or cont.
  • Write med name, dose, route, and schedule.”