This got me thinking, since I recently read another article about ACOs, in which many experts agreed that the ACO model can’t be successful unless patients take responsibility for their own health. While it’s true that people need to take care of themselves, after reading the WSJ article, I all I could think was, “how are people supposed to make informed decisions about their care when all the information they get is contradictory?” Asking patients to choose between disagreeing doctors is, for some, a tall order.

Maybe the WSJ is to blame in this instance for its presentation of the issue. It’s one thing to give people a list of pros and cons–that would be useful, in fact–but to present people with one doctor saying “Yes! Take these to prevent heart disease!” and another who says “No! You might get diabetes!” is to confuse most people. These are two diametrically opposed positions–choose one, or the other. What do we want patients to do, flip a coin?

If we want patients to step up and take more responsibility for their own health, maybe we need to do a better job of communicating with them, and give them better information. Imagine your doctor prescribed statins for you. You pick up your prescription on your way home from work, and on the radio, a different doctor is talking about the dangerous side effects of statins, and how they shouldn’t be prescribed to healthy people. Are you feeling anxious yet? Somehow, I don’t think making patients anxious about the medicine they take will motivate people to be more accountable for their health.

Let’s find better ways to inform people so that they can feel better about the choices that they’re making, and in turn, feel better about being responsible for their own well being.

Dr. David Thorson, MD: “I think it is trying to get physicians to realize that the way we provide care needs to change. I don’t think there’s any question that we can’t continue to do what we’ve been doing and have a healthcare system that will stay afloat. the government is trying to do a technical change to force cultural change within clinics. And cultural change is hard. Technical change is a lot easier. The thing we talk about all the time is how we have to change the culture of how we deliver care. This is an awkward time because we’re trying to change culture before payment has been changed. It’s taking a very big leap of faith.”

I found the idea of a cultural change in the medical community to be a very intriguing idea. What do you think, dear readers? Is a cultural change what is needed? If so, what would that change be, and how would we make it happen? Type your answers into the comments!

Q:  How do I code residual effects from a traumatic brain injury where the initial trauma occurred long ago but we are still dealing with the sequelae such as gait abnormality, confusion, memory loss or seizures?

A:  What you describe would be called late effects of a traumatic brain injury.  These codes are in the 907 family.  The entire section 905 thru 909 deals with late effects of injuries.  One caution – unlike late effects of CVA (438 codes) where the late effect code comes first followed by additional codes to further describe the late effects – late effects of injury codes are done exactly opposite.  First list codes that describe the late effect (eg gait abnormality, memory loss) then list the 907.XX code.

1. Change the solution. Many people don’t remember to change the solution that their contacts soak in over night; instead, they simply add more solution. It is important to change the solution, as last night’s solution is already full of bacteria. Imagine it’s your kitchen sink. You wash your dishes in the sink and the water gets dirty. Would you let that water sit all day, and wash your dishes again in the same dirty water? No? Then don’t do the same thing with contact lenses.
2. Let the case air dry. The case needs to dry out so that bacteria don’t grow in it. Get a new lens case every month.
3. Use solution–not beer, not lemonade, not butter–to clean your lenses. Do I really need to explain this one? Make sure your home care patients know to only use solution to clean their contacts. Full stop.
4. Don’t sleep in your lenses. Sleeping in your lenses increases the likelihood of infection. Don’t do it.

When you’re in the patient’s home, you will have the opportunity to see how the patient takes care of his or her lenses, and you will be able to intervene if you see problems. The bright side is that these problems are relatively easy to correct. Make sure your patients know that proper lens care can save them a lot of pain and money.

Finally, are you taking good care of your lenses? As a home care worker, you work long hours. Sometimes you get home after a long day and you want to go straight to bed–you’re too tired to take your contacts out. Even though proper care can seem time consuming (particularly when you’re exhausted), but proper lens care will save you pain and money in future as well.

You don’t have to take my word for it, though:

This is especially important for those suffering from these terrible illnesses, because often times a change in surroundings can be very scary. Even moving from their own home to the home of a family member can be a rather unsettling experience for everyone involved. But with an in home caregiver, the dementia or Alzheimer’s care patient can receive the level of quality care they need and deserve while staying in the familiar surroundings they are most comfortable with.

Article Source: http://EzineArticles.com/6799653

Q:  I’ve had several clients lately with complications from gastric bypass surgery and gastric banding procedures.  I know that I should not use a surgical aftercare code when there is a complication, but none of the 998.XX codes seem quite right.  Should I use 998.89 – other specified complications?

A:  The most recent update to the ICD-9-CM Diagnosis Coding Manual contains a new section on complications of bariatric procedures.  These are found in the alpha index under:   Complications – Bariatric surgery.  In the numeric index, section 539 is new and contains codes for infection d/t gastric band procedure or other bariatric procedures, and other complications of bariatric procedures.  Be sure to follow the coding instructions to use additional codes to identify specific types of infection or specific complications.  The 539 codes all require 5 digits.

Q: Is a service dog considered an “assistive device”?

Our friends at Sansio – HomeSolutions.NET were kind enough to answer this question for us. (Thanks, guys!)

A: According to Question 27 of the CMS OCCB Q&As (October 2009): “If required for a patient’s safe function, service animals should be considered an assistive device for purposes of selecting responses to the OASIS items. Service animals should not be considered as assistance; in other words, should not be equated to human assistance (as in “someone must assist”…).”

Source: http://www.qtso.com/download/guides/hha/CAT4-01-11_Final.pdf

Your ICD-10 tip of the week is brought to you by Pathway Health Services.

Q:  Can a complication code be used with a surgical aftercare V code?

A:  No.  Complications always trump aftercare.  Remember that surgical aftercare V codes assume usual, expected course of recovery and treatment. Complications interfering with usual, expected healing/recovery must be coded and aftercare excluded.

Example:  Your client underwent a total knee replacement and developed a post- surgical infection at the incision site.

• M1020a   998.59 (other post op infection)

NOT V54.81 aftercare following a total joint replacement.

Still code the V43.65 status knee joint replacement code

Example:  Your client has undergone a hemicolectomy  for diverticulitis.  During the post-operative period, their abdominal incision dehisced and was determined to be infected

• M1020a  998.32 (disruption of external surgical wound)
• M1022b  998.59 (other postoperative infection)
• M1022c   causative organism if known
• NOT V58.75 aftercare following surgery of the teeth, oral cavity and digestive system

CMS Response: There is no requirement that every pressure ulcer be treated with moist wound healing in order to mark “Yes” for M2250 (g) or M2400 (f). If the agency has orders for and implements moist wound healing treatment for at least one pressure ulcer within the required time frames, then M2400 (f) should be “Yes”.

Q:  I understand that beginning 2012 we can no longer use 294.8 for dementia clients where there is no further information about the dementia.  How should we code this since we frequently don’t have a lot of information about the dementia?

A:  294.2x is now the correct family of codes for dementia NOS.  Unfortunately, these codes do not receive case mix points and they are the most likely codes to be used in dementia where little to no information is available about the cause of the dementia.

294.20 Dementia NOS – without behavioral disturbance

294.21 Dementia NOS – with behavioral disturbance

The cause of dementia must be stated in order to choose a code that comes with case mix points.  There is a V code available to indicate wandering as a behavior disturbance in dementia NOS (use V40.31 with 294.21 if pertinent)