Conference conversations: Poster presenters discuss spinal surgery difficulties
session and see all the presentations.
Editor’s note: Jennifer Oetinger, RN, BSN, is a CDI specialist at Sisters of Providence Health System in Portland, Oregon. Oetinger has created a poster for the 2018 ACDIS Conference entitled “Spinal surgery: Interpretation, opportunities, and coding.” Janet Barber, MBA, BSN, RN, CCDS, and other members of the Providence Health System team will be presenting the poster in Oetinger’s stead. Make sure to stop by the poster session and see them all.
Q: What made you want to submit a poster this year? How did you decide on a topic?
A: My supervisor sent out a group email asking if anyone had any ideas for a poster for the national ACDIS conference. I had recently created an educational presentation on spinal surgeries which I presented to my coworkers, and at my local ACDIS (Oregon) chapter’s fall conference. Those who attended the presentations found the information valuable, and I felt it was worth sharing.
Q: What should a CDI specialist just beginning to review spinal surgery charts know about the process and opportunities?
A: Spinal surgery language is unique and it may be difficult to puzzle out what information in the operative reports is needed. Surgeons use varied language in their documentation, and coding these procedures in ICD-10 is very complicated. Fortunately, there are opportunities to be captured and accuracy is possible with a little knowledge.
Q: What's one thing you learned about spinal surgery documentation and coding that surprised you or helped you do your job better?
A: On reviewing surgery cases for the presentation, I found many errors by both CDI specialists and the coders. There were many mismatches, and too often neither person ended with the correct DRG assignment. These errors appeared to be due to misunderstanding the language, misinterpretation of the surgical intent, incorrect principal diagnosis sequencing, mixing up approach and column, and inaccurately coding hardware as a fusion. Coupled with complicated guidance in the Official Guidelines for Coding and Reporting and AHA Coding Clinic, these errors created DRG shifts with significant billing errors.
Q: Have you worked with any other departments on the issue of spinal surgery? If so, which ones and why?
A: A quality insurer coder/educator provided the Guidelines and Coding Clinics for the presentation, and vetted the information for accuracy.