DCBA

Relationships

Dr. Gold of DCBA has gotten involved with just about everything that affects clinical documentation and coding issues. He has been an advisor for some, a consultant for others and has affected change in policy.

Most recently, a web publication from the Medicare Learning Network, designed to help hospitals in RAC preparedness by emphasizing certain coding rules, contained some erroneous advice. Lynne Spryszak, RN, educator for HCPro, read it the day it came out and called Dr. Gold to discuss what she perceived to be a potential problem. Upon his review, it was apparent that the author of this piece based advice regarding the acceptability of assignment of "secondary" or "other" ICD codes on old guidelines. This had the potential to leave hospitals nationwide at risk of fines by the RACs for accepting diagnoses provided by other than the attending physician. Dr. Gold immediately contacted authorities at CMS, and particularly the Medicare Learning Network and explained the issue. Valerie A. Haugen, Director of Provider Information Planning and Development of CMS immediately pulled the piece and her team conferred with Sue Bowman, RHIA, CCS, Director of Coding Policy and Compliance of AHIMA and Nelly Leon Chisen, RHIA, Director of Coding and Classification of AHA and validated Dr. Gold's observations. Article #SE1028 was reissued October 29, 2010 with the correct advice regarding acceptable ICD codes for assignment as "secondary" or "other" diagnoses and hospitals are breathing a sigh of relief. This type of cooperation between CMS and the people in the field is exemplary and the responsiveness of the folks in Baltimore is appreciated.

The National Kidney Foundation has worked with Dr. Gold on convincing CMS and NCHS that hypertensive renal disease severity starts at stage 4 and not only stage 5 and ESRD. They are developing strategies to divide acute kidney injury into stages, following the lead of the Acute Kidney Injury Network, as CKD is currently divided into stages.

Dr. Gold noticed a discrepancy in the use of the code that the National Center for Health Statistics (NHCS) defined for a Percutaneous Endoscopic Gastrojejunostomy. The description and classification of the procedure was changed after several discussions with the group and they were convinced that no such procedure existed until four years after the code was assigned.

When NHCS initially released the code definitions for 403.90 and 403.91 as Hypertensive Kidney Disease without and with Chronic Kidney Disease, Dr. Gold spoke up, along with Sue Bowman, Director of Compliance for AHIMA, and the code definitions were eventually changed.

When the breakdown of aldosteronism first came out, Dr. Gold noticed that there was a code assigned for primary aldosteronism, 255.10 and another one for Conn's disease, 255.12. After notifying NCHS that Conn's disease was primary aldosteronism, the definitions were eventually revised the following April.

Dr. Gold has also consulted with The Delta Group regarding complication statistics for surgical procedures. Noting that the existing algorithms included several codes for chronic, stable conditions, he discussed with them that is was inappropriate to attribute a complication of procedure statistic to a diagnosis that had no indication that it was a complication. The Delta Group consulted with their coding experts and agreed that the 9xx series of codes was more reasonable to follow as complications. They worked together to change their algorithms to reflect that new outlook in 2003.
University HealthSystem Consortium (UHC) and other companies that use AHRQ algorithms converted to very similar code sets in 2008.

In addition, AHRQ implemented Present on Admission indicators for complications of surgery after Dr. Gold discussed the issue with them almost a year after POA indicators were implemented.

With a recent Coding Clinic advisory (1Q 2009) regarding the assignment of code 998.4, foreign body accidentally left during surgery, Dr. Gold worked with the Coding Clinic leadership and the National Quality Forum to identify a mistaken definition of "end of surgery" that led to the inappropriate advice. Gathering the aid of the American College of Surgeons, AHRQ and NQF itself as well as working with Dr. Gibb, a national leader in the drive to help hospitals avoid inadvertently leaving foreign bodies inside a patient, a movement is in progress to redefine "end of surgery" and reverse the advice of Coding Clinic so that objects actually removed prior to the patient leaving the operating room are not counted as having been left inside.

HCPro regularly publishes articles written by Dr. Gold - Clinically Speaking in Briefings on Coding Compliance Strategies and Minutes for the Medical Staff in Medical Records Briefing.

Dr. Gold is known nationally for his education regarding the clinical orientation of coding in AHIMA teleconferences and at the National Conferences on aspects of clinical coding. He has spoken at National and State level HFMA and HCCA meetings on the participation of medical staff in programs of documentation improvement.

Dr. Gold is on the advisory board for the Association of Clinical Documentation Improvement Specialists and is a frequent presenter at National and local CDI conferences as well as State HIMA meetings.

Another of DCBA's physician consultants, Dr. Cesar Limjoco has spoken to State HIMA meetings as well as having been called upon to present a talk on Heart Failure to the American College of Cardiology.