Wiki failed Newborn hearing screening

[Sgile111]

I am being directed to code the failed test based on the test results and a statement that the physician has placed a referral for follow-up, although the Provider notes do not state that the Newborn failed the screening.
The difference in the DRG is a significant amount. I requested a query for clarification, but was overruled by CDI and the coding education manager with a note stating "sending a query is borderline questioning the MD judgment"
I have shared the official guideline language which is below
Per the official coding guidelines
Page 111 of 120
B. Abnormal findings Abnormal findings (laboratory, x-ray, pathologic, and other diagnostic results) are not coded and reported unless the provider indicates their clinical significance. If the findings are outside the normal range and the attending provider has ordered other tests to evaluate the condition or prescribed treatment, it is appropriate to ask the provider whether the abnormal finding should be added. Please note: This differs from the coding practices in the outpatient setting for coding encounters for diagnostic tests that have been interpreted by a provider.

Thoughts? am I right to stand my ground and insist on query?

 

[rthomas@impcna.com]

I am being directed to code the failed test based on the test results and a statement that the physician has placed a referral for follow-up, although the Provider notes do not state that the Newborn failed the screening.
The difference in the DRG is a significant amount. I requested a query for clarification, but was overruled by CDI and the coding education manager with a note stating "sending a query is borderline questioning the MD judgment"
I have shared the official guideline language which is below
Per the official coding guidelines
Page 111 of 120
B. Abnormal findings Abnormal findings (laboratory, x-ray, pathologic, and other diagnostic results) are not coded and reported unless the provider indicates their clinical significance. If the findings are outside the normal range and the attending provider has ordered other tests to evaluate the condition or prescribed treatment, it is appropriate to ask the provider whether the abnormal finding should be added. Please note: This differs from the coding practices in the outpatient setting for coding encounters for diagnostic tests that have been interpreted by a provider.

Thoughts? am I right to stand my ground and insist on query?

I agree with you 100%. As you already know, If It is not documented it didn't happen! Sounds like they need a reminder regarding compliance and malpractice. All of the provider I have worked with are thankful for the education when queried about documentation and coding.

 

[Sgile111]

I agree with you 100%. As you already know, If It is not documented it didn't happen! Sounds like they need a reminder regarding compliance and malpractice. All of the provider I have worked with are thankful for the education when queried about documentation and coding.

thank you. I refused to make the change and it is being done by another coder, but I'm contemplating going to compliance.

 

[mikhaila]

Hello,

I don't think the guideline you showed fully covers your reasoning without more info.

I included an attachment from the 2024 ICD-10-CM - see #5 with flowchart. General reference for readers.

Questions:

How many days old is the newborn less than or greater than 28 days?

Was this a Newborn Health Examination as stated in code Z00.11X - for child under 29 days where they check general hearing?
OR
A ROUTINE child health exam as in Z00.12X - for child over 28 days where they check general hearing?
OR
A separate encounter for SCREENING for ear disorders as stated in Z13.5?

If this was a general exam then I can see the logic of the provider and CDI specialists.

If it was a truly a screening of ear disorders than I would code Z13.5 and either 92558 or 92650 for the type of screening the provider performed or equivalent code for PCS there may be.

The provider who receives the referral can then code whatever procedure code he performs plus encounter for examination of ears and hearing:

Z01.10 without abnormal findings
OR
Z01.119 with abnormal findings following failed hearing screening
OR
Z01.118 with other abnormal findings

My apologies if this seems long-winded but looking up what occurs during a Newborn Health Examination seems to differ slightly and it is helpful to know what your facility routinely does in regards to hearing if anything, OR if they completely separate that out to a true hearing screen.

That's wonderful that you are a researcher and want to apply proper guidance. I would say to be cautious as to how management and providers are approached and error on the side of caution - that you could be mistaken so that your diligence in wanting to just code a chart properly isn't mistaken for something accusatory. We need diligent coders like yourself.

 

[Sgile111]

Hello,

I don't think the guideline you showed fully covers your reasoning without more info.

I included an attachment from the 2024 ICD-10-CM - see #5 with flowchart. General reference for readers.

Questions:

How many days old is the newborn less than or greater than 28 days?

Was this a Newborn Health Examination as stated in code Z00.11X - for child under 29 days where they check general hearing?
OR
A ROUTINE child health exam as in Z00.12X - for child over 28 days where they check general hearing?
OR
A separate encounter for SCREENING for ear disorders as stated in Z13.5?

If this was a general exam then I can see the logic of the provider and CDI specialists.

If it was a truly a screening of ear disorders than I would code Z13.5 and either 92558 or 92650 for the type of screening the provider performed or equivalent code for PCS there may be.

The provider who receives the referral can then code whatever procedure code he performs plus encounter for examination of ears and hearing:

Z01.10 without abnormal findings
OR
Z01.119 with abnormal findings following failed hearing screening
OR
Z01.118 with other abnormal findings

My apologies if this seems long-winded but looking up what occurs during a Newborn Health Examination seems to differ slightly and it is helpful to know what your facility routinely does in regards to hearing if anything, OR if they completely separate that out to a true hearing screen.

That's wonderful that you are a researcher and want to apply proper guidance. I would say to be cautious as to how management and providers are approached and error on the side of caution - that you could be mistaken so that your diligence in wanting to just code a chart properly isn't mistaken for something accusatory. We need diligent coders like yourself.

I understand the guidelines. The physician never stated abnormal findings, failed hearing test or anything close. The hearing test is pulled in (the same way a lab would be) but the physician didn't address it in the narrative. Take for example a patient has a low Hemoglobin and receives a transfusion, coders can't assume anemia and code it. It has to be stated.

 

[mikhaila]

I understand the guidelines. The physician never stated abnormal findings, failed hearing test or anything close. The hearing test is pulled in (the same way a lab would be) but the physician didn't address it in the narrative. Take for example a patient has a low Hemoglobin and receives a transfusion, coders can't assume anemia and code it. It has to be stated.

This is our thought process below.

Using the excerpt of the guideline provided for abnormal tests:

1) Abnormal findings Abnormal findings (laboratory, x-ray, pathologic, and other diagnostic results) are not coded and reported unless the provider indicates their clinical significance.

It was stated provider did not
indicate the clinical significance
of the abnormal finding; therefore,
initially don't code. Next....

2). If the findings are outside the normal range and the attending provider has ordered other tests to evaluate the condition or prescribed treatment, it is appropriate to ask the provider whether the abnormal finding should be added.

The provider did not order other tests
or prescribe treatment. He is requesting
a referral because he doesn't know or
because he needs another opinion from
a specialist. (I think this is where the
difference lies BUT we could be incorrect).
That was our (3) consensus.

Personally, we don't think it's an issue to ask the provider but each facility has it's own rules. Our place is very education-oriented.

Interesting to see other people's take on this.

Good luck.

 

[Sgile111]

This is our thought process below.

Using the excerpt of the guideline provided for abnormal tests:

1) Abnormal findings Abnormal findings (laboratory, x-ray, pathologic, and other diagnostic results) are not coded and reported unless the provider indicates their clinical significance.

It was stated provider did not
indicate the clinical significance
of the abnormal finding; therefore,
initially don't code. Next....

2). If the findings are outside the normal range and the attending provider has ordered other tests to evaluate the condition or prescribed treatment, it is appropriate to ask the provider whether the abnormal finding should be added.

The provider did not order other tests
or prescribe treatment. He is requesting
a referral because he doesn't know or
because he needs another opinion from
a specialist. (I think this is where the
difference lies BUT we could be incorrect).
That was our (3) consensus.

Personally, we don't think it's an issue to ask the provider but each facility has it's own rules. Our place is very education-oriented.

Interesting to see other people's take on this.

Good luck.

agree 100%