Application (30 points):

The health information management team at Anywhere University Hospital (AUH) contracted with an
auditing firm to perform full assessment coding review. The results from this baseline assessment are
provided in four tables:
Variation Log by Type of Error
Variation Log by Coder
Variation Log by MS-DRG
MS-DRG Relationship Assessment

You are the inpatient coding manager at AUH. Your director has asked you to develop an ongoing review
and monitoring schedule for the next year based on the results from the outside review.

Include internal and external reviews, coding in-services, physician workshops, and external
seminars/educational sessions that will be performed and or provided for your staff. The schedule should
be specific (include volumes and/or percentages of charts to be reviewed). Keep in mind that on average
it takes 18 minutes to review one inpatient chart. Budget provides for $15,000 for external reviews. The
average cost for reviewing one inpatient record by an external review team is $55.00 (fully loaded).

There are 3 primary components I'm looking for in your response.

1. Review the results of the external audit (coder error rate, high volume/high error MS-DRGs, MS-DRG
sets with greatest deviations, areas of concern identified in the audit), identify the risk areas, and
determine an audit and training plan for the year. Include details on the frequency of charts to be
audited by the external auditor, Coding Manager and Data Quality Auditor taking the $15,000 budget
into consideration. Describe the frequency and type of education to be provided for the coders &
physicians (i.e., monthly, annually, etc.).
(20 points)
a. Considerations:
i. Will the entire budget be used for external audits, split between education and
audits, etc.?
ii. How is the work to be divided between the external & internal auditors?
iii. What MS-DRGs or focus areas are to be reviewed (refer to the external audit
findings)? Possibly those identified by the external audit with greater error
rates?
iv. Will specific attention be given to the coders with higher error rates and/or new
coders?
v. What is the plan for physician education?

2. What coding quality statistics (i.e., coder error rate, MS-DRG sets, etc.) should be monitored and
reported to the HIM Director and Compliance? (6 points)
a. The data quality auditor could maintain coding quality logs similar to the ones produced
by the external auditor. Monitor the same stats including coder error rate, error rate by
 DRG, reasons for DRG changes (Omission CC, etc.). This would make for easy
comparison from month to month, quarter to quarter, and such.
b. The statistics should be easy for the data quality manager to maintain, perhaps in a
database or spreadsheet format. The time it takes to maintain statistics should not be a
significant amount of time per day.

3. What reward & incentive plan should be used for the coders who improve and/or consistently meet
or exceed the standard of 95% compliance? (4 points)
a. There is not a right or wrong answer on this so be creative. Think of incentives you
appreciate at current or previous positions.
b. Example: A coding team worked very hard to lower the days from discharge to coding.
As a reward, the CEO/President of the hospital came to the department, shook each
coders hand, and thanked them all for their hard work. He also expressed how
important their position was to the hospital and to the patients.
c. Perhaps the coding manager could request that some of the budget be set aside for
incentives. If the entire $15,000 is not used for external reviews, then could some of that
be used for the employees?

Your Coding Team consists of:

Coding Manager (you)

Data Quality Auditor (1 FTE)

8 Inpatient Coders (8 FTE)

2-RHIA, CCS

3-CCS

3-RHIT

Results of the full assessment coding review for AUH

Two audits were performed:

1. Coding quality review by MS-DRG

2. MS-DRG Relationship Analysis

Variation Log by Type of Error % of errors

Inaccurate sequencing or specificity principal diagnosis, affect MS-DRG 17%

Inaccurate sequencing or specificity principal diagnosis, non affect MS-DRG 16%

Omission CC, non affect MS-DRG 2%

Inaccurate principal procedure, affect MS-DRG 3%

Omission procedure, affect MS-DRG 4%

More specific coding of diagnosis or procedure, non affect MS-DRG 12%

Inaccurate coding 5%

Missed diagnosis or procedure code 8%

Variation Log by Coder

Coder Error Rate Standard

Coder 1 3% 5%

Coder 2 9% 5%

Coder 3 8% 5%

Coder 4 2% 5%

Coder 5 4% 5%

Coder 6 16% 5%

Coder 7 12% 5%

Coder 8 3% 5%

Variation Log by MS-DRG*

MS-DRG Volume Error Rate

470 420 2%

313 233 14%

392 232 1%
291 232 17%

247 220 3%

292 216 5%

871 213 12%

641 209 0%

194 195 3%

293 193 1%

885 188 3%

312 177 0%

191 175 7%

287 173 2%

310 171 15%

689 157 11%

603 143 2%

379 137 3%

192 131 9%

683 116 11%

189 114 1%

069 110 2%

190 92 12%

193 87 10%

690 76 4%

065 76 5%

195 72 2%

066 52 2%

064 41 5%
 906 35 2%

*MS-DRG descriptions provided below

Variation Log by MS-DRG* Set

MS-DRG Set Hospital % Nation %

064 24.3% 21.4%

065 45.0% 43.8%

066 30.8% 34.8%

190 23.1% 15.2%

191 44.0% 33.5%

192 32.9% 51.3%

193 24.6% 17.5%

194 55.1% 54.2%

195 20.3% 28.3%

291 34.6% 29.2%

292 36.7% 38.8%

293 28.8% 31.9%

689 67.4% 21.7%

690 32.6% 78.3%

MS-DRG MS-DRG Title (FY 2008)

064 Intracranial hemorrhage or cerebral infarction w MCC

065 Intracranial hemorrhage or cerebral infarction w CC

066 Intracranial hemorrhage or cerebral infarction w/o CC/MCC

069 Transient ischemia

189 Pulmonary edema & respiratory failure

190 Chronic obstructive pulmonary disease w MCC

191 Chronic obstructive pulmonary disease w CC

192 Chronic obstructive pulmonary disease w/o CC/MCC

193 Simple pneumonia & pleurisy w MCC

194 Simple pneumonia & pleurisy w CC

195 Simple pneumonia & pleurisy w/o CC/MCC

247 Perc cardiovasc proc w drug-eluting stent w/o MCC

287 Circulatory disorders except AMI, w card cath w/o MCC

291 Heart failure & shock w MCC

292 Heart failure & shock w CC

293 Heart failure & shock w/o CC/MCC

310 Cardiac arrhythmia & conduction disorders w/o CC/MCC

312 Syncope & collapse

313 Chest pain

379 G.I. hemorrhage w/o CC/MCC

392 Esophagitis, gastroent & misc digest disorders w/o MCC

470 Major joint replacement or reattachment of lower extremity w/o MCC

603 Cellulitis w/o MCC

683 Renal failure w CC

689 Kidney & urinary tract infections w/ MCC

690 Kidney & urinary tract infections w/o MCC

871 Septicemia w/o MV 96+ hours w MCC

885 Psychoses

906 Hand procedures for injuries