Coder Meeting

1. Coder Meeting January 2011

2. Agenda • Conference call: • Host code: • Participant code: • Coding decisions • Infant feeding changes • 1st trimester screening • Online documentation • “Infant Discharge Status” • Insurance coding • Coder Fax • August 2010 • September 2010 • November 2010

3. Coding: Infant Feeding INFANT FEEDINGDuring the period between birth and the fifth day of life (or discharge from the hospital if the infant is discharged before the fifth day of life), indicate whether the infant hasbeen fed breast milk exclusively, infant formula only, a combination of both breast milk and formula, or other. • Breast Milk Only: (Exclusive breast milk feeding) Infant has been fed ONLY breast milk and noother liquids or solids except for drops or syrups consisting of vitamins, minerals, or medicines.Breast milk feeding includes expressed mother’s milk as well as donor human milk, both of whichmay be fed to the infant by means other than suckling at the breast. • Formula Only: Infant has been fed formula (any amount). Has NOT been fed any breast milk. May or may not have been fed other liquids, such as water or glucose water. • Both Breast Milk and Formula: Infant has been fed BOTH breast milk (any amount) ANDformula, water, glucose water and/or other liquids (any amount). • Other: Infant has NOT been fed any breast milk or formula. This response is rare; it will includeinfants in the intensive care unit who require intravenous feeding.

4. Coding: 1st trimester screening • MSAFP: suggested changing the name to invasive (amnio, CVS) and noninvasive (MSAFP, triple screen, quad screen first trimester screening, sequential screening etc). • In the meantime, educating coders that most testing, aside from CVS and amnio, should be counted in the MSAFP triple screen field (CNY)

5. Coding: Online documentation • A question was raised regarding Internal Electronic Fetal Monitoring. The written Guidelines state "Use of an internal fetal monitoring device (synonym: scalp electrode) to track fetal heart rate during labor and/or delivery. This was agreed upon as the definition. • The expanded guidance definition that appears online for that variable states scalp electrode and IUPC can be included as IFM. • Online guidance was to be disabled because it is not being updated on a regular basis. There has not been sufficient resources to keep written and on-line help information in sync.

6. Coding: “Infant Discharge Status” • If a baby is sent to a Level 1 SCN (is not able to provide continuous ventilatory support) they code Infant transferred within 24 hrs as ‘Not Transferred’, abnormal conditions of the newborn, NICU admission as ‘No’ and infant discharge status as ‘’Infant transferred out’. This way they can keep track of babies that are sent to their SCN. I promised to check with you to see if this coding is consistent with the NYS guidelines. • E Shields: I've checked with our regionalization staff here, and the consensus is that a Level I facility is not recognized as having special care nursery capability under our regulations. Therefore you are correct in interpreting that the infant did not transfer out.

7. Coding: Insurance fieldsHMO or other managed care plan • The term managed care is used to describe a variety of techniques intended to reduce the cost of providing health benefits and improve the quality of care ("managed care techniques") … • A health maintenance organization (HMO) is a type of managed care organization (MCO) that provides a form of health care coverage that is fulfilled through hospitals, doctors, and other providers with which the HMO has a contract.

8. Coding: Insurance fields Self pay • Self Pay=person pays for their own insurance (not through employer)

9. Coding: Insurance fieldsHMO or other managed care plan • Most Americans who have health insurance through their employer (and many who are self-insured) are enrolled in some type of a managed care plan - either an HMO or PPO. The most common types of managed care plans are health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Less common are point-of-service (POS) plans that combine the features of an HMO and a PPO.

10. Coding: Insurance fields Blue Cross / Blue shield

11. Coding: Insurance fields MVP (all plans are managed care)

12. August Coder Fax 2010

13. August Coder Fax 2010 16 N = 18 2 7 11 3 1 10 10 1 17 16 2 15 3 18 10 1 17 18 17 1

14. August Coder Fax 2010 P3 N=16 P4 N=11

15. August Coder Fax 2010 P1 N=10 P3

16. August Coder Fax 2010 P4 N=17 N=16 P2 N=15

17. August Coder Fax 2010 P4 N=10 P3 N=17

18. September Coder Fax 2010

19. September Coder Fax 2010 VTX, vertex= cephalic 1 N = 17 1 17 16 17 17 2 2 17 17 15 10 6 1 Blank 1 Blank 17 1 Blank 37.4 (2) 16 1 14 16 3

20. September Coder Fax 2010 Fetal presentation P1 N=16

21. September Coder Fax 2010 Fetal Intolerance / Fetus at Risk P1 P1 N=15 P2 N=6 (incorrect) Ancef Dose 2 GM Route; IVGive during: Labor

22. September Coder Fax 2010 Assisted Ventilation P3 N=3

23. November Coder Fax 2010

24. November Coder Fax 2010 1 N = 19 19 18 1 1 16 1 2 2 18 6 17 14 12 2 19 17 1 1 Blank 16 19 19 1 Blank 18 2 3 Blank 16 1

25. November Coder Fax 2010 Fetal Presentation N=19 P1 P3 P4

26. November Coder Fax 2010 Route & Method P2 N=18 P3 P4

27. November Coder Fax 2010 Indication for Vacuum: FAR N=16 P1 P2

28. November Coder Fax 2010 Characteristics of labor and Delivery P1 N=14 N=18 P2 N=17 N=12 P4

29. November Coder Fax 2010 Anesthesia / Analgesia P1 N=19 P4 N=17

30. November Coder Fax 2010 Apgars P2 P3

31. November Coder Fax 2010 Gestational age / Newborn treatment / Assisted ventilation (N=16) P3