the time of injury as well. ICD-10-CM Chapter 20: External
Causes of Morbidity codes play an important role in telling
this story. The code used could literally be the difference
between whether this employee receives workers’ compensation or not.
Quality Care Reporting
A 37-year-old female with Crohn’s disease presents to the facility with intense abdominal pain. After work-up it is determined that she is experiencing a flare-up of her Crohn’s disease and will require a partial large bowel resection due to the
extensive damage to the lining of her colon. During her recovery in the hospital she starts experiencing abdominal pain and
is taken to radiology. It is determined that she is experiencing
a post-procedural ileus.
How these types of encounters are coded and abstracted
can have an impact on the quality of care scores for a facility. If these types of cases are coded as complications of care
without confirmation from the provider, it can and will negatively impact the complication rates of the facility through the
Potentially Preventable Complications (PPCs) data reported.
There are many post-procedural occurrences that are all but
expected after certain surgical procedures due to the inherent
nature of the disease process.
In another example, a 59-year-old partially bedbound
functional quadriplegic is admitted to a facility due to lethargy and altered mental status. It is determined that this
patient has a severe urinary tract infection and will require
several days of hospitalization before they are stable enough
to go back to their nursing home. After 10 days the patient is
discharged and this encounter is sent down to coding and
is billed out to the payer. Upon auditor review it is discovered that this encounter went out with Present on Admission (POA) indicators of “N” on a stage 3 pressure ulcer that
was documented by the nursing staff and reported on the
history and physical by the attending provider. This type of
error in abstracting can again negatively impact the quality
scores of a facility. HIM professionals must pay close attention to the data they report and recognize the implications
their errors may have.
Disease Surveillance and Monitoring
According to the Centers for Medicare and Medicaid Services’ Official Guidelines for Coding and Reporting, there
are certain conditions that may not be abstracted and reported without confirmation by the provider. HIV/AIDS and
the Zika virus are the two exceptions to the Section II. H.
guideline for inpatient encounters for uncertain diagnoses.
These two conditions must be confirmed by the provider.
With this guideline in place, the Centers for Disease Control and Prevention (CDC) can track and monitor these outbreaks via the coded data.
Through the CDC’s National Vital Statistics System, states
collect and disseminate statistics on births and deaths. In this
manner, the public and healthcare professionals are able to
learn more about tuberculosis, HIV, influenza, and hospital
HIM professionals need to understand how erroneously
coded data can have far-reaching implications throughout the healthcare continuum. Facilities need to have
policies and protocols in place to ensure the accuracy of
coded data involved in data mining activities. The power
of coded data transcends far beyond the doors of the HIM
1. Rouse, Margaret. “data analytics (DA).” TechTarget. De-
2. wiseGEEK. “What is Data Analytics?” www.wisegeek.
3. Centers for Disease Control and Prevention. “Disease
Surveillance and Monitoring.” 2016. www.cdc.gov/
Centers for Disease Control and Prevention. International
Classification of Diseases, Tenth Revision, Clinical
Modification (ICD-10-CM). www.cdc.gov/nchs/icd/
Centers for Medicare and Medicaid Services. ICD- 10 web page.
Felicia A. Thomas ( email@example.com) is inpatient quality auditor and Wahiyda A. Harding ( firstname.lastname@example.org) is DRG team
coach at Accuity Delivery Systems, LLC.
Quiz ID: Q1838909 | EXPIRATION DATE: OC TOBER 1, 2019
HIM Domain Area: Clinical Data Management
Article—“Data Analytics: The Power of Coded Data”
Review Quiz Questions and Take the Quiz Based on
this Article Online at https://my.ahima.org/store
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The power of coded data transcends far beyond the doors of the health
information management department.