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COVID-19 UPDATES
The new codes related to COVID-19 for 2021 are listed in Table 2 . Only confirmed cases of COVID-19, defined as a positive test result or clinician documentation that the individual has COVID-19, are assigned code U07.1 and considered a confirmed case. A positive test result or documentation of the test result in the record is not required if a HOSPITAL LIFE AFTER COVID-19 VACCINATION Hospital life after COVID-19 vaccination. H ospitalist Robert Wachter, MD, MACP, said that only three of his behaviors have changed or will change since getting the COVID-19 vaccine. None of them are related to work. Robert Wachter, MD, MACP, received his first dose of COVID-19 vaccine on Dec. 18, 2020. “I did get a real haircut, I would go DISCHARGE LOUNGES DONE RIGHT Discharge lounges done right. D ischarge lounges have been used for decades at busy hospitals to alleviate overcrowding, offering a comfortable waiting area for patients who are ready for discharge but await transportation home and freeing up inpatient beds for those newly admitted or boarding in the ED. “If a patient is ready to gohome at
OPTIMAL HOSPITAL CARE FOR NATIVE AMERICANS Optimal hospital care for Native Americans. F acing an influx of seriously ill Native American patients with COVID-19, the physicians at Albuquerque's University of New Mexico (UNM) realized they needed to boost their cultural competency. To do that, they formed an educational collaboration with Gallup Indian Medical Center, an IndianHealth
BRINGING THE HOSPITAL HOME Bringing the hospital home. Pilot projects are providing inpatient-level care in patients' homes. By Charlotte Huff. O nce more concept than reality, treatment of patients sick enough to be admitted at home instead of in the hospital has gained some traction, fueled by improved technology, evidence of cost-effectiveness, and fullhospitals.
PHYSICIAN ADVISOR AS A CAREER PATH I n an era of declining reimbursement, expanding Medicare regulations, and ICD-10 implementation, a growing number of hospitals have enlisted the services of physician advisors. The physician advisor is a physician, typically with a broad base of clinical experiences, who assists certain hospital departments by ensuring compliance with regulatory issues, advises physicians on medical necessity HOSPITALIST TELEHEALTH SERVICES The services may be billed using CPT online codes 99421-99423 and HCPCS codes G2061-G2063, as applicable. Hospitalists would be unlikely to perform virtual check-ins or e-visits as part of their normal care, but these types of telehealth could be relevant if a hospitalist is called upon to follow up with a patient after discharge. U.S. STUDY FINDS GAPS IN ACCESS TO MECHANICAL THROMBECTOMY U.S. study finds gaps in access to mechanical thrombectomy for ischemic stroke. An analysis spanning 11 U.S. states found that 16% of patients with ischemic stroke from 2016 through 2018 were treated by EDs and hospitals that neither performed mechanical thrombectomy nor transferred patients to receive it. A TRANSFUSION THRESHOLD FOR EVERYONE A transfusion threshold for everyone. I t's been more than 20 years since the first evidence came out supporting restrictive blood transfusion strategies, Janice Zimmerman, MD, MACP, said during her ACP CME 30 session “Appropriate Transfusion of Blood Products in the Acutely Ill Patient.”. Yet, this less-is-more philosophy has only WHOSE DOCUMENTATION COUNTS? Medical students, nurses, nutritionists, physical therapists, respiratory therapists, social workers, and rehabilitation or occupational therapists are not included. Two exceptions allow documentation of a condition by someone other than the health care provider: BMI and the stage of pressure ulcers. However, the health care provider must stillCOVID-19 UPDATES
The new codes related to COVID-19 for 2021 are listed in Table 2 . Only confirmed cases of COVID-19, defined as a positive test result or clinician documentation that the individual has COVID-19, are assigned code U07.1 and considered a confirmed case. A positive test result or documentation of the test result in the record is not required if a HOSPITAL LIFE AFTER COVID-19 VACCINATION Hospital life after COVID-19 vaccination. H ospitalist Robert Wachter, MD, MACP, said that only three of his behaviors have changed or will change since getting the COVID-19 vaccine. None of them are related to work. Robert Wachter, MD, MACP, received his first dose of COVID-19 vaccine on Dec. 18, 2020. “I did get a real haircut, I would go DISCHARGE LOUNGES DONE RIGHT Discharge lounges done right. D ischarge lounges have been used for decades at busy hospitals to alleviate overcrowding, offering a comfortable waiting area for patients who are ready for discharge but await transportation home and freeing up inpatient beds for those newly admitted or boarding in the ED. “If a patient is ready to gohome at
OPTIMAL HOSPITAL CARE FOR NATIVE AMERICANS Optimal hospital care for Native Americans. F acing an influx of seriously ill Native American patients with COVID-19, the physicians at Albuquerque's University of New Mexico (UNM) realized they needed to boost their cultural competency. To do that, they formed an educational collaboration with Gallup Indian Medical Center, an IndianHealth
BRINGING THE HOSPITAL HOME Bringing the hospital home. Pilot projects are providing inpatient-level care in patients' homes. By Charlotte Huff. O nce more concept than reality, treatment of patients sick enough to be admitted at home instead of in the hospital has gained some traction, fueled by improved technology, evidence of cost-effectiveness, and fullhospitals.
PHYSICIAN ADVISOR AS A CAREER PATH I n an era of declining reimbursement, expanding Medicare regulations, and ICD-10 implementation, a growing number of hospitals have enlisted the services of physician advisors. The physician advisor is a physician, typically with a broad base of clinical experiences, who assists certain hospital departments by ensuring compliance with regulatory issues, advises physicians on medical necessity HOSPITALIST TELEHEALTH SERVICES The services may be billed using CPT online codes 99421-99423 and HCPCS codes G2061-G2063, as applicable. Hospitalists would be unlikely to perform virtual check-ins or e-visits as part of their normal care, but these types of telehealth could be relevant if a hospitalist is called upon to follow up with a patient after discharge. U.S. STUDY FINDS GAPS IN ACCESS TO MECHANICAL THROMBECTOMY U.S. study finds gaps in access to mechanical thrombectomy for ischemic stroke. An analysis spanning 11 U.S. states found that 16% of patients with ischemic stroke from 2016 through 2018 were treated by EDs and hospitals that neither performed mechanical thrombectomy nor transferred patients to receive it. A TRANSFUSION THRESHOLD FOR EVERYONE A transfusion threshold for everyone. I t's been more than 20 years since the first evidence came out supporting restrictive blood transfusion strategies, Janice Zimmerman, MD, MACP, said during her ACP CME 30 session “Appropriate Transfusion of Blood Products in the Acutely Ill Patient.”. Yet, this less-is-more philosophy has only WHOSE DOCUMENTATION COUNTS? Medical students, nurses, nutritionists, physical therapists, respiratory therapists, social workers, and rehabilitation or occupational therapists are not included. Two exceptions allow documentation of a condition by someone other than the health care provider: BMI and the stage of pressure ulcers. However, the health care provider must still HOSPITAL LIFE AFTER COVID-19 VACCINATION Hospital life after COVID-19 vaccination. H ospitalist Robert Wachter, MD, MACP, said that only three of his behaviors have changed or will change since getting the COVID-19 vaccine. None of them are related to work. Robert Wachter, MD, MACP, received his first dose of COVID-19 vaccine on Dec. 18, 2020. “I did get a real haircut, I would go NEW GUIDELINES, AUTHORIZATIONS ON REMDESIVIR, BAMLANIVIMAB The World Health Organization and Infectious Diseases Society of America (IDSA) changed their guidelines to be less favorable to remdesivir. Both the IDSA and NIH expressed reservations about bamlanivimab, while the FDA issued two new emergency useauthorizations.
STUDIES SHOW PANDEMIC'S EFFECTS ON EMERGENCY CARE, NIH Studies show pandemic's effects on emergency care, NIH recommends baricitinib for some Multiple studies found changed patterns in cardiac emergencies and care associated with the pandemic, and the NIH's COVID-19 guideline panel recommended baricitinib for patients on high-flow oxygen or noninvasive ventilation. PHYSICIAN ADVISOR AS A CAREER PATH I n an era of declining reimbursement, expanding Medicare regulations, and ICD-10 implementation, a growing number of hospitals have enlisted the services of physician advisors. The physician advisor is a physician, typically with a broad base of clinical experiences, who assists certain hospital departments by ensuring compliance with regulatory issues, advises physicians on medical necessity HOSPITALIST TELEHEALTH SERVICES The services may be billed using CPT online codes 99421-99423 and HCPCS codes G2061-G2063, as applicable. Hospitalists would be unlikely to perform virtual check-ins or e-visits as part of their normal care, but these types of telehealth could be relevant if a hospitalist is called upon to follow up with a patient after discharge. ELEVATED TROPONIN I LEVELS DURING SEPSIS MAY INDICATE RISK Elevated troponin I levels during sepsis may indicate risk for postsepsis CV complications. A U.S. retrospective study looked at rates of atherosclerotic disease, atrial fibrillation, and heart failure in the year after sepsis in patients with elevated troponin I levels and no previous diagnosis of cardiovascular (CV) disease.TO HOME OR SNF?
A n elderly patient admitted for pneumonia aspirates while on a feeding tube and subsequently develops delirium and problems with mobility and cognition. Although frail, the patient is judged medically ready to leave and the hospitalist—under pressure to expedite discharge—must make a quick decision about where to refer her: a skilled nursing facility (SNF) or supervised home care. ACUTE TUBULAR NECROSIS A cute tubular necrosis or injury (ATN) is a more common cause of acute kidney injury (AKI) among hospitalized patients than many hospitalists may realize. At least one study found that as much as half of AKI in seriously ill patients was caused by ATN (1 1.Liaño F, Pascual J. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. HEART FAILURE DOCUMENTATION AND CODING CHALLENGES As an example, for chronic diastolic heart failure and essential hypertension, the following codes are assigned in this order: I11.0 (hypertensive heart disease with heart failure), I50.32 (chronic diastolic heart failure), I10 (hypertension). In summary, heart failure is a clinical diagnosis based on signs, symptoms, and physicalfindings.
DOCUMENTING AND TREATING PRESSURE ULCERS In 2008, CMS announced it would stop reimbursing hospitals for various hospital-acquired conditions, including some pressure ulcers, depending on their timing. “You have to document it within 24 hours of admission, or you're going to be docked for a hospital-acquired pressure ulcer,” said Dr. Cavaliere. Typically, patients receive askin
HOSPITAL LIFE AFTER COVID-19 VACCINATION Hospital life after COVID-19 vaccination. H ospitalist Robert Wachter, MD, MACP, said that only three of his behaviors have changed or will change since getting the COVID-19 vaccine. None of them are related to work. Robert Wachter, MD, MACP, received his first dose of COVID-19 vaccine on Dec. 18, 2020. “I did get a real haircut, I would go NEW GUIDELINES, AUTHORIZATIONS ON REMDESIVIR, BAMLANIVIMAB The World Health Organization and Infectious Diseases Society of America (IDSA) changed their guidelines to be less favorable to remdesivir. Both the IDSA and NIH expressed reservations about bamlanivimab, while the FDA issued two new emergency useauthorizations.
DISCHARGE LOUNGES DONE RIGHT Discharge lounges done right. D ischarge lounges have been used for decades at busy hospitals to alleviate overcrowding, offering a comfortable waiting area for patients who are ready for discharge but await transportation home and freeing up inpatient beds for those newly admitted or boarding in the ED. “If a patient is ready to gohome at
U.S. STUDY FINDS GAPS IN ACCESS TO MECHANICAL THROMBECTOMY U.S. study finds gaps in access to mechanical thrombectomy for ischemic stroke. An analysis spanning 11 U.S. states found that 16% of patients with ischemic stroke from 2016 through 2018 were treated by EDs and hospitals that neither performed mechanical thrombectomy nor transferred patients to receive it. TAKING STEPS WITH MOBILITY TECHS WHAT IS CLINICAL VALIDATION? C linical validation is both a concept and a process. It has implications for diagnostic documentation, coding, claims submission, payer review, audits and denials, recovery audit programs, regulatory compliance, and sanctions, and it sometimes raises concerns aboutfalse
DOCUMENTING AND TREATING PRESSURE ULCERS In 2008, CMS announced it would stop reimbursing hospitals for various hospital-acquired conditions, including some pressure ulcers, depending on their timing. “You have to document it within 24 hours of admission, or you're going to be docked for a hospital-acquired pressure ulcer,” said Dr. Cavaliere. Typically, patients receive askin
ACUTE KIDNEY INJURY REVISITED Acute kidney injury revisited. A cute kidney injury (AKI) is defined as a reduction of renal function over a short period of time (typically within 7 days or less) as measured by a rising serum creatinine level or by diminished urine output. The term AKI is synonymous with “acute renal failure,” but the former has becomethe preferred
GETTING THE MOST FROM ADVANCED PRACTICE PROVIDERS Getting the most from advanced practice providers. P hysician assistants (PAs) and nurse practitioners (NPs) are regular faces on hospital teams, with roughly 40% of the former and nearly a third of the latter in the U.S. working in hospitals, according to recent estimates. Yet there is scant research about the impact of advancedpractice
CONNECTING THE CAUSES AND CODES FOR PNEUMONIA Connecting the causes and codes for pneumonia. D iagnosis and clinical management of pneumonia are difficult, but meeting documentation requirements and accurately conveying the severity and complexity of a pneumonia patient's condition are even more challenging. The rules that govern code assignment bear little relationship to long-accepted HOSPITAL LIFE AFTER COVID-19 VACCINATION Hospital life after COVID-19 vaccination. H ospitalist Robert Wachter, MD, MACP, said that only three of his behaviors have changed or will change since getting the COVID-19 vaccine. None of them are related to work. Robert Wachter, MD, MACP, received his first dose of COVID-19 vaccine on Dec. 18, 2020. “I did get a real haircut, I would go NEW GUIDELINES, AUTHORIZATIONS ON REMDESIVIR, BAMLANIVIMAB The World Health Organization and Infectious Diseases Society of America (IDSA) changed their guidelines to be less favorable to remdesivir. Both the IDSA and NIH expressed reservations about bamlanivimab, while the FDA issued two new emergency useauthorizations.
DISCHARGE LOUNGES DONE RIGHT Discharge lounges done right. D ischarge lounges have been used for decades at busy hospitals to alleviate overcrowding, offering a comfortable waiting area for patients who are ready for discharge but await transportation home and freeing up inpatient beds for those newly admitted or boarding in the ED. “If a patient is ready to gohome at
U.S. STUDY FINDS GAPS IN ACCESS TO MECHANICAL THROMBECTOMY U.S. study finds gaps in access to mechanical thrombectomy for ischemic stroke. An analysis spanning 11 U.S. states found that 16% of patients with ischemic stroke from 2016 through 2018 were treated by EDs and hospitals that neither performed mechanical thrombectomy nor transferred patients to receive it. TAKING STEPS WITH MOBILITY TECHS WHAT IS CLINICAL VALIDATION? C linical validation is both a concept and a process. It has implications for diagnostic documentation, coding, claims submission, payer review, audits and denials, recovery audit programs, regulatory compliance, and sanctions, and it sometimes raises concerns aboutfalse
DOCUMENTING AND TREATING PRESSURE ULCERS In 2008, CMS announced it would stop reimbursing hospitals for various hospital-acquired conditions, including some pressure ulcers, depending on their timing. “You have to document it within 24 hours of admission, or you're going to be docked for a hospital-acquired pressure ulcer,” said Dr. Cavaliere. Typically, patients receive askin
ACUTE KIDNEY INJURY REVISITED Acute kidney injury revisited. A cute kidney injury (AKI) is defined as a reduction of renal function over a short period of time (typically within 7 days or less) as measured by a rising serum creatinine level or by diminished urine output. The term AKI is synonymous with “acute renal failure,” but the former has becomethe preferred
GETTING THE MOST FROM ADVANCED PRACTICE PROVIDERS Getting the most from advanced practice providers. P hysician assistants (PAs) and nurse practitioners (NPs) are regular faces on hospital teams, with roughly 40% of the former and nearly a third of the latter in the U.S. working in hospitals, according to recent estimates. Yet there is scant research about the impact of advancedpractice
CONNECTING THE CAUSES AND CODES FOR PNEUMONIA Connecting the causes and codes for pneumonia. D iagnosis and clinical management of pneumonia are difficult, but meeting documentation requirements and accurately conveying the severity and complexity of a pneumonia patient's condition are even more challenging. The rules that govern code assignment bear little relationship to long-accepted STUDIES SHOW PANDEMIC'S EFFECTS ON EMERGENCY CARE, NIH Studies show pandemic's effects on emergency care, NIH recommends baricitinib for some Multiple studies found changed patterns in cardiac emergencies and care associated with the pandemic, and the NIH's COVID-19 guideline panel recommended baricitinib for patients on high-flow oxygen or noninvasive ventilation. NEW GUIDELINES, AUTHORIZATIONS ON REMDESIVIR, BAMLANIVIMAB The World Health Organization and Infectious Diseases Society of America (IDSA) changed their guidelines to be less favorable to remdesivir. Both the IDSA and NIH expressed reservations about bamlanivimab, while the FDA issued two new emergency useauthorizations.
DO YOU STILL NEED TO WORRY ABOUT CONTRAST AND AKI? F or some time, clinicians may have been reluctant to order imaging procedures with contrast because of a possible increased risk for acute kidney injury (AKI). But recent research has cast some doubt on the nature of this relationship. For example, no randomized controlled trial has compared rates of AKI in patients undergoing contrast-enhanced versus noncontrast CT scans, and other factors HOSPITALIST TELEHEALTH SERVICES The services may be billed using CPT online codes 99421-99423 and HCPCS codes G2061-G2063, as applicable. Hospitalists would be unlikely to perform virtual check-ins or e-visits as part of their normal care, but these types of telehealth could be relevant if a hospitalist is called upon to follow up with a patient after discharge. ELEVATED TROPONIN I LEVELS DURING SEPSIS MAY INDICATE RISK Elevated troponin I levels during sepsis may indicate risk for postsepsis CV complications. A U.S. retrospective study looked at rates of atherosclerotic disease, atrial fibrillation, and heart failure in the year after sepsis in patients with elevated troponin I levels and no previous diagnosis of cardiovascular (CV) disease. WHAT IS CLINICAL VALIDATION? C linical validation is both a concept and a process. It has implications for diagnostic documentation, coding, claims submission, payer review, audits and denials, recovery audit programs, regulatory compliance, and sanctions, and it sometimes raises concerns aboutfalse
ACUTE KIDNEY INJURY REVISITED Acute kidney injury revisited. A cute kidney injury (AKI) is defined as a reduction of renal function over a short period of time (typically within 7 days or less) as measured by a rising serum creatinine level or by diminished urine output. The term AKI is synonymous with “acute renal failure,” but the former has becomethe preferred
POSTPROCEDURAL RESPIRATORY FAILURE T he diagnosis of respiratory failure following surgery (post-op or postprocedural respiratory failure) has significant revenue, regulatory, and quality of care implications. It often results in a huge payment increase to the hospital. If improperly diagnosed without firm clinical grounds, it may become the basis for regulatory audits, sanctions, or penalties. DOCUMENTING AND TREATING PRESSURE ULCERS In 2008, CMS announced it would stop reimbursing hospitals for various hospital-acquired conditions, including some pressure ulcers, depending on their timing. “You have to document it within 24 hours of admission, or you're going to be docked for a hospital-acquired pressure ulcer,” said Dr. Cavaliere. Typically, patients receive askin
ALCOHOL DETOX: TO ADMIT OR NOT? The UNC protocol notes that if a patient has a documented history of DTs or seizures related to alcohol withdrawal and is having at least moderate withdrawal (CIWA score ≥8) the patient should be admitted, but could be discharged if having minimal symptoms (CIWA score >8). But hospitalists should also keep in mind the nature of alcoholism and HOSPITAL LIFE AFTER COVID-19 VACCINATION Hospital life after COVID-19 vaccination. H ospitalist Robert Wachter, MD, MACP, said that only three of his behaviors have changed or will change since getting the COVID-19 vaccine. None of them are related to work. Robert Wachter, MD, MACP, received his first dose of COVID-19 vaccine on Dec. 18, 2020. “I did get a real haircut, I would go NEW GUIDELINES, AUTHORIZATIONS ON REMDESIVIR, BAMLANIVIMAB The World Health Organization and Infectious Diseases Society of America (IDSA) changed their guidelines to be less favorable to remdesivir. Both the IDSA and NIH expressed reservations about bamlanivimab, while the FDA issued two new emergency useauthorizations.
DISCHARGE LOUNGES DONE RIGHT Discharge lounges done right. D ischarge lounges have been used for decades at busy hospitals to alleviate overcrowding, offering a comfortable waiting area for patients who are ready for discharge but await transportation home and freeing up inpatient beds for those newly admitted or boarding in the ED. “If a patient is ready to gohome at
U.S. STUDY FINDS GAPS IN ACCESS TO MECHANICAL THROMBECTOMY U.S. study finds gaps in access to mechanical thrombectomy for ischemic stroke. An analysis spanning 11 U.S. states found that 16% of patients with ischemic stroke from 2016 through 2018 were treated by EDs and hospitals that neither performed mechanical thrombectomy nor transferred patients to receive it. TAKING STEPS WITH MOBILITY TECHS WHAT IS CLINICAL VALIDATION? C linical validation is both a concept and a process. It has implications for diagnostic documentation, coding, claims submission, payer review, audits and denials, recovery audit programs, regulatory compliance, and sanctions, and it sometimes raises concerns aboutfalse
DOCUMENTING AND TREATING PRESSURE ULCERS In 2008, CMS announced it would stop reimbursing hospitals for various hospital-acquired conditions, including some pressure ulcers, depending on their timing. “You have to document it within 24 hours of admission, or you're going to be docked for a hospital-acquired pressure ulcer,” said Dr. Cavaliere. Typically, patients receive askin
ACUTE KIDNEY INJURY REVISITED Acute kidney injury revisited. A cute kidney injury (AKI) is defined as a reduction of renal function over a short period of time (typically within 7 days or less) as measured by a rising serum creatinine level or by diminished urine output. The term AKI is synonymous with “acute renal failure,” but the former has becomethe preferred
GETTING THE MOST FROM ADVANCED PRACTICE PROVIDERS Getting the most from advanced practice providers. P hysician assistants (PAs) and nurse practitioners (NPs) are regular faces on hospital teams, with roughly 40% of the former and nearly a third of the latter in the U.S. working in hospitals, according to recent estimates. Yet there is scant research about the impact of advancedpractice
CONNECTING THE CAUSES AND CODES FOR PNEUMONIA Connecting the causes and codes for pneumonia. D iagnosis and clinical management of pneumonia are difficult, but meeting documentation requirements and accurately conveying the severity and complexity of a pneumonia patient's condition are even more challenging. The rules that govern code assignment bear little relationship to long-accepted HOSPITAL LIFE AFTER COVID-19 VACCINATION Hospital life after COVID-19 vaccination. H ospitalist Robert Wachter, MD, MACP, said that only three of his behaviors have changed or will change since getting the COVID-19 vaccine. None of them are related to work. Robert Wachter, MD, MACP, received his first dose of COVID-19 vaccine on Dec. 18, 2020. “I did get a real haircut, I would go NEW GUIDELINES, AUTHORIZATIONS ON REMDESIVIR, BAMLANIVIMAB The World Health Organization and Infectious Diseases Society of America (IDSA) changed their guidelines to be less favorable to remdesivir. Both the IDSA and NIH expressed reservations about bamlanivimab, while the FDA issued two new emergency useauthorizations.
DISCHARGE LOUNGES DONE RIGHT Discharge lounges done right. D ischarge lounges have been used for decades at busy hospitals to alleviate overcrowding, offering a comfortable waiting area for patients who are ready for discharge but await transportation home and freeing up inpatient beds for those newly admitted or boarding in the ED. “If a patient is ready to gohome at
U.S. STUDY FINDS GAPS IN ACCESS TO MECHANICAL THROMBECTOMY U.S. study finds gaps in access to mechanical thrombectomy for ischemic stroke. An analysis spanning 11 U.S. states found that 16% of patients with ischemic stroke from 2016 through 2018 were treated by EDs and hospitals that neither performed mechanical thrombectomy nor transferred patients to receive it. TAKING STEPS WITH MOBILITY TECHS WHAT IS CLINICAL VALIDATION? C linical validation is both a concept and a process. It has implications for diagnostic documentation, coding, claims submission, payer review, audits and denials, recovery audit programs, regulatory compliance, and sanctions, and it sometimes raises concerns aboutfalse
DOCUMENTING AND TREATING PRESSURE ULCERS In 2008, CMS announced it would stop reimbursing hospitals for various hospital-acquired conditions, including some pressure ulcers, depending on their timing. “You have to document it within 24 hours of admission, or you're going to be docked for a hospital-acquired pressure ulcer,” said Dr. Cavaliere. Typically, patients receive askin
ACUTE KIDNEY INJURY REVISITED Acute kidney injury revisited. A cute kidney injury (AKI) is defined as a reduction of renal function over a short period of time (typically within 7 days or less) as measured by a rising serum creatinine level or by diminished urine output. The term AKI is synonymous with “acute renal failure,” but the former has becomethe preferred
GETTING THE MOST FROM ADVANCED PRACTICE PROVIDERS Getting the most from advanced practice providers. P hysician assistants (PAs) and nurse practitioners (NPs) are regular faces on hospital teams, with roughly 40% of the former and nearly a third of the latter in the U.S. working in hospitals, according to recent estimates. Yet there is scant research about the impact of advancedpractice
CONNECTING THE CAUSES AND CODES FOR PNEUMONIA Connecting the causes and codes for pneumonia. D iagnosis and clinical management of pneumonia are difficult, but meeting documentation requirements and accurately conveying the severity and complexity of a pneumonia patient's condition are even more challenging. The rules that govern code assignment bear little relationship to long-accepted STUDIES SHOW PANDEMIC'S EFFECTS ON EMERGENCY CARE, NIH Studies show pandemic's effects on emergency care, NIH recommends baricitinib for some Multiple studies found changed patterns in cardiac emergencies and care associated with the pandemic, and the NIH's COVID-19 guideline panel recommended baricitinib for patients on high-flow oxygen or noninvasive ventilation. NEW GUIDELINES, AUTHORIZATIONS ON REMDESIVIR, BAMLANIVIMAB The World Health Organization and Infectious Diseases Society of America (IDSA) changed their guidelines to be less favorable to remdesivir. Both the IDSA and NIH expressed reservations about bamlanivimab, while the FDA issued two new emergency useauthorizations.
DO YOU STILL NEED TO WORRY ABOUT CONTRAST AND AKI? F or some time, clinicians may have been reluctant to order imaging procedures with contrast because of a possible increased risk for acute kidney injury (AKI). But recent research has cast some doubt on the nature of this relationship. For example, no randomized controlled trial has compared rates of AKI in patients undergoing contrast-enhanced versus noncontrast CT scans, and other factors HOSPITALIST TELEHEALTH SERVICES The services may be billed using CPT online codes 99421-99423 and HCPCS codes G2061-G2063, as applicable. Hospitalists would be unlikely to perform virtual check-ins or e-visits as part of their normal care, but these types of telehealth could be relevant if a hospitalist is called upon to follow up with a patient after discharge. ELEVATED TROPONIN I LEVELS DURING SEPSIS MAY INDICATE RISK Elevated troponin I levels during sepsis may indicate risk for postsepsis CV complications. A U.S. retrospective study looked at rates of atherosclerotic disease, atrial fibrillation, and heart failure in the year after sepsis in patients with elevated troponin I levels and no previous diagnosis of cardiovascular (CV) disease. WHAT IS CLINICAL VALIDATION? C linical validation is both a concept and a process. It has implications for diagnostic documentation, coding, claims submission, payer review, audits and denials, recovery audit programs, regulatory compliance, and sanctions, and it sometimes raises concerns aboutfalse
ACUTE KIDNEY INJURY REVISITED Acute kidney injury revisited. A cute kidney injury (AKI) is defined as a reduction of renal function over a short period of time (typically within 7 days or less) as measured by a rising serum creatinine level or by diminished urine output. The term AKI is synonymous with “acute renal failure,” but the former has becomethe preferred
POSTPROCEDURAL RESPIRATORY FAILURE T he diagnosis of respiratory failure following surgery (post-op or postprocedural respiratory failure) has significant revenue, regulatory, and quality of care implications. It often results in a huge payment increase to the hospital. If improperly diagnosed without firm clinical grounds, it may become the basis for regulatory audits, sanctions, or penalties. DOCUMENTING AND TREATING PRESSURE ULCERS In 2008, CMS announced it would stop reimbursing hospitals for various hospital-acquired conditions, including some pressure ulcers, depending on their timing. “You have to document it within 24 hours of admission, or you're going to be docked for a hospital-acquired pressure ulcer,” said Dr. Cavaliere. Typically, patients receive askin
ALCOHOL DETOX: TO ADMIT OR NOT? The UNC protocol notes that if a patient has a documented history of DTs or seizures related to alcohol withdrawal and is having at least moderate withdrawal (CIWA score ≥8) the patient should be admitted, but could be discharged if having minimal symptoms (CIWA score >8). But hospitalists should also keep in mind the nature of alcoholism andACP HOSPITALIST
Write for ACP Hospitalist. Below are brief descriptions of ACP Hospitalist sections written by physician or medical student writers. Submissions are accepted on a rolling basis. Please note that articles are unpaid, that ACP Hospitalist is not a peer-reviewed publication, and that articles published in ACP Hospitalist are not indexed on PubMed.. Please e-mail your submissions or questions to DISCHARGE LOUNGES DONE RIGHT Discharge lounges done right. D ischarge lounges have been used for decades at busy hospitals to alleviate overcrowding, offering a comfortable waiting area for patients who are ready for discharge but await transportation home and freeing up inpatient beds for those newly admitted or boarding in the ED. “If a patient is ready to gohome at
SPLIT/SHARED SERVICES Split/shared services apply to specific E/M services. For the inpatient setting, these include: Initial hospital care (99221-99223) Subsequent hospital care (99231-99233) Observation care (99217-99220, 99224-99226, 99234-99236) Prolonged services (99356-99357) Split/shared services do not apply to critical care services (99291,99292) which
TAKING STEPS WITH MOBILITY TECHS ACUTE TUBULAR NECROSIS LITTLE'S LAW AND YOU Little's Law can also be applied to predict demand for ancillary services when standardized times are available and the arrival rate is known. This is particularly useful for imaging, which often becomes a bottleneck in patient flow, especially with capacity limitations or overutilization. But still, you are a hospitalist—do you really care CHRONIC KIDNEY DISEASE, INCLUDING TRANSPLANTS All transplant patients are considered to have CKD so any of the five stages will apply, based on the GFR. As an example, the code for a patient with a GFR of 50 mL/min/1.73 m 2 after transplant would be N18.3 (CKD-3) and Z94.0. The code for ESRD (N18.6) cannot be assigned because it requires chronic dialysis dependence If the transplant IMPROVING PATIENT SATISFACTION SCORES While 90.4% of the study's clinicians said that improving patient satisfaction during hospitalization was achievable, only 38% remembered targeted actions taken in their departments to improve satisfaction scores. All of the physicians worked at hospitals that used patient satisfaction surveys. “Only one-third of cliniciansstated that they
HEART FAILURE DOCUMENTATION AND CODING CHALLENGES As an example, for chronic diastolic heart failure and essential hypertension, the following codes are assigned in this order: I11.0 (hypertensive heart disease with heart failure), I50.32 (chronic diastolic heart failure), I10 (hypertension). In summary, heart failure is a clinical diagnosis based on signs, symptoms, and physicalfindings.
WELCOME TO ACP HOSPITALIST Welcome to. ACP Hospitalist. W elcome to ACP Hospitalist, a new monthly publication for physicians in hospital medicine. The number of hospitalists in the U.S. is projected to double from 15,000 to 30,000 by 2010, according to the Society of Hospital Medicine. That kind of rapid growth brings both new challenges and new opportunities.ACP HOSPITALIST
Write for ACP Hospitalist. Below are brief descriptions of ACP Hospitalist sections written by physician or medical student writers. Submissions are accepted on a rolling basis. Please note that articles are unpaid, that ACP Hospitalist is not a peer-reviewed publication, and that articles published in ACP Hospitalist are not indexed on PubMed.. Please e-mail your submissions or questions to DISCHARGE LOUNGES DONE RIGHT Discharge lounges done right. D ischarge lounges have been used for decades at busy hospitals to alleviate overcrowding, offering a comfortable waiting area for patients who are ready for discharge but await transportation home and freeing up inpatient beds for those newly admitted or boarding in the ED. “If a patient is ready to gohome at
SPLIT/SHARED SERVICES Split/shared services apply to specific E/M services. For the inpatient setting, these include: Initial hospital care (99221-99223) Subsequent hospital care (99231-99233) Observation care (99217-99220, 99224-99226, 99234-99236) Prolonged services (99356-99357) Split/shared services do not apply to critical care services (99291,99292) which
TAKING STEPS WITH MOBILITY TECHS ACUTE TUBULAR NECROSIS LITTLE'S LAW AND YOU Little's Law can also be applied to predict demand for ancillary services when standardized times are available and the arrival rate is known. This is particularly useful for imaging, which often becomes a bottleneck in patient flow, especially with capacity limitations or overutilization. But still, you are a hospitalist—do you really care CHRONIC KIDNEY DISEASE, INCLUDING TRANSPLANTS All transplant patients are considered to have CKD so any of the five stages will apply, based on the GFR. As an example, the code for a patient with a GFR of 50 mL/min/1.73 m 2 after transplant would be N18.3 (CKD-3) and Z94.0. The code for ESRD (N18.6) cannot be assigned because it requires chronic dialysis dependence If the transplant IMPROVING PATIENT SATISFACTION SCORES While 90.4% of the study's clinicians said that improving patient satisfaction during hospitalization was achievable, only 38% remembered targeted actions taken in their departments to improve satisfaction scores. All of the physicians worked at hospitals that used patient satisfaction surveys. “Only one-third of cliniciansstated that they
HEART FAILURE DOCUMENTATION AND CODING CHALLENGES As an example, for chronic diastolic heart failure and essential hypertension, the following codes are assigned in this order: I11.0 (hypertensive heart disease with heart failure), I50.32 (chronic diastolic heart failure), I10 (hypertension). In summary, heart failure is a clinical diagnosis based on signs, symptoms, and physicalfindings.
WELCOME TO ACP HOSPITALIST Welcome to. ACP Hospitalist. W elcome to ACP Hospitalist, a new monthly publication for physicians in hospital medicine. The number of hospitalists in the U.S. is projected to double from 15,000 to 30,000 by 2010, according to the Society of Hospital Medicine. That kind of rapid growth brings both new challenges and new opportunities. OPTIMAL HOSPITAL CARE FOR NATIVE AMERICANS Optimal hospital care for Native Americans. F acing an influx of seriously ill Native American patients with COVID-19, the physicians at Albuquerque's University of New Mexico (UNM) realized they needed to boost their cultural competency. To do that, they formed an educational collaboration with Gallup Indian Medical Center, an IndianHealth
CHRONIC KIDNEY DISEASE, INCLUDING TRANSPLANTS D ocumentation of chronic kidney disease (CKD) and its stage are crucial for correct coding, which affects hospital revenue and severity of illness classification. Precise diagnosis and reporting of CKD stage improve the accuracy of our national health care database used for research and for projections of national health care needs. PNEUMONIA | ACP HOSPITALIST Pneumonia. T he clinical distinction between community-acquired pneumonia (CAP), acquired without health care contact, and health care-associated pneumonia (HCAP), acquired outside the hospital but in connection with other health care contact, is crucial for correct management and antibiotic selection. CAP is usually caused byPneumococcus
WHEN PATIENTS WON'T LEAVE When patients won't leave. U sually when inpatients disagree with their recommended length of stay, it's a matter of leaving against medical advice. But some patients present the opposite challenge: They are reluctant to leave the hospital even though there is no medical reason for them to remain. “This sadly happens more than I'd like HOSPITAL-ACQUIRED PNEUMONIA IN THE ELDERLY Hospital-acquired pneumonia in the elderly. H ospital-acquired pneumonia (HAP), or nosocomial pneumonia, is a serious complication of hospitalized patients. HAP is associated with increased mortality, increased morbidity including prolongation of hospital stay, and increased economic costs. Many of the same risk factors thatpredispose elderly
AVOID COMMON MISTAKES WHEN TREATING HYPONATREMIA The worst symptoms of acute hyponatremia, such as seizure and obtundation, can usually be corrected by rapidly correcting serum sodium concentration by only 4 to 6 mEq/L, Dr. Johnson noted. “The risk of osmotic demyelination increases after the rate of correction exceeds 12 per L per day,” Dr. Nichani added. DIAGNOSTIC DOCUMENTATION FOR ONCOLOGY PATIENTS Diagnostic documentation needs to properly reflect, in the correct code assignments, the severity of illness of these patients, as well as associated risks, complexity of care, and use of resources. In this month's column we will investigate the clinical, coding and documentation nuances of 2 common and serious conditions associatedwith
THE RISE OF THE NEUROHOSPITALIST The rise of the neurohospitalist. A s a neurologist in private practice for more than 25 years in Ocala, Fla., Gregory Howell, MD, once spent his days shuttling between office and hospital. Emergency calls often forced him to cancel or reschedule outpatient appointments and miss out on potential revenue. WHAT NOT TO DO IN PALLIATIVE CARE Fresh air can also make patients feel better, but since it's often not available in the hospital, a fan is a good substitute. “There is something about cool air blowing across the face that actually physiologically relieves the dyspnea,” Dr. Pantilat said. Similarly, a cool cloth to the face has been proven to reduce shortness ofbreath.
TABLE 1. SPO TO PO CONVERSION TAL OXYGEN, WHAT THE PO ACPHOSPITALIST November 2013 7 REVISITING RESPIRATORY FAILURE Part two of a two-part series By Richard Pinson, MD, FACP L ast month’s column addressed some challenges in the diag-nosis of respiratory failure, including correct documentationACP HOSPITALIST
Write for ACP Hospitalist. Below are brief descriptions of ACP Hospitalist sections written by physician or medical student writers. Submissions are accepted on a rolling basis. Please note that articles are unpaid, that ACP Hospitalist is not a peer-reviewed publication, and that articles published in ACP Hospitalist are not indexed on PubMed.. Please e-mail your submissions or questions to DISCHARGE LOUNGES DONE RIGHT Discharge lounges done right. D ischarge lounges have been used for decades at busy hospitals to alleviate overcrowding, offering a comfortable waiting area for patients who are ready for discharge but await transportation home and freeing up inpatient beds for those newly admitted or boarding in the ED. “If a patient is ready to gohome at
SPLIT/SHARED SERVICES Split/shared services apply to specific E/M services. For the inpatient setting, these include: Initial hospital care (99221-99223) Subsequent hospital care (99231-99233) Observation care (99217-99220, 99224-99226, 99234-99236) Prolonged services (99356-99357) Split/shared services do not apply to critical care services (99291,99292) which
TAKING STEPS WITH MOBILITY TECHS ACUTE TUBULAR NECROSIS LITTLE'S LAW AND YOU Little's Law can also be applied to predict demand for ancillary services when standardized times are available and the arrival rate is known. This is particularly useful for imaging, which often becomes a bottleneck in patient flow, especially with capacity limitations or overutilization. But still, you are a hospitalist—do you really care CHRONIC KIDNEY DISEASE, INCLUDING TRANSPLANTS All transplant patients are considered to have CKD so any of the five stages will apply, based on the GFR. As an example, the code for a patient with a GFR of 50 mL/min/1.73 m 2 after transplant would be N18.3 (CKD-3) and Z94.0. The code for ESRD (N18.6) cannot be assigned because it requires chronic dialysis dependence If the transplant IMPROVING PATIENT SATISFACTION SCORES While 90.4% of the study's clinicians said that improving patient satisfaction during hospitalization was achievable, only 38% remembered targeted actions taken in their departments to improve satisfaction scores. All of the physicians worked at hospitals that used patient satisfaction surveys. “Only one-third of cliniciansstated that they
HEART FAILURE DOCUMENTATION AND CODING CHALLENGES As an example, for chronic diastolic heart failure and essential hypertension, the following codes are assigned in this order: I11.0 (hypertensive heart disease with heart failure), I50.32 (chronic diastolic heart failure), I10 (hypertension). In summary, heart failure is a clinical diagnosis based on signs, symptoms, and physicalfindings.
WELCOME TO ACP HOSPITALIST Welcome to. ACP Hospitalist. W elcome to ACP Hospitalist, a new monthly publication for physicians in hospital medicine. The number of hospitalists in the U.S. is projected to double from 15,000 to 30,000 by 2010, according to the Society of Hospital Medicine. That kind of rapid growth brings both new challenges and new opportunities.ACP HOSPITALIST
Write for ACP Hospitalist. Below are brief descriptions of ACP Hospitalist sections written by physician or medical student writers. Submissions are accepted on a rolling basis. Please note that articles are unpaid, that ACP Hospitalist is not a peer-reviewed publication, and that articles published in ACP Hospitalist are not indexed on PubMed.. Please e-mail your submissions or questions to DISCHARGE LOUNGES DONE RIGHT Discharge lounges done right. D ischarge lounges have been used for decades at busy hospitals to alleviate overcrowding, offering a comfortable waiting area for patients who are ready for discharge but await transportation home and freeing up inpatient beds for those newly admitted or boarding in the ED. “If a patient is ready to gohome at
SPLIT/SHARED SERVICES Split/shared services apply to specific E/M services. For the inpatient setting, these include: Initial hospital care (99221-99223) Subsequent hospital care (99231-99233) Observation care (99217-99220, 99224-99226, 99234-99236) Prolonged services (99356-99357) Split/shared services do not apply to critical care services (99291,99292) which
TAKING STEPS WITH MOBILITY TECHS ACUTE TUBULAR NECROSIS LITTLE'S LAW AND YOU Little's Law can also be applied to predict demand for ancillary services when standardized times are available and the arrival rate is known. This is particularly useful for imaging, which often becomes a bottleneck in patient flow, especially with capacity limitations or overutilization. But still, you are a hospitalist—do you really care CHRONIC KIDNEY DISEASE, INCLUDING TRANSPLANTS All transplant patients are considered to have CKD so any of the five stages will apply, based on the GFR. As an example, the code for a patient with a GFR of 50 mL/min/1.73 m 2 after transplant would be N18.3 (CKD-3) and Z94.0. The code for ESRD (N18.6) cannot be assigned because it requires chronic dialysis dependence If the transplant IMPROVING PATIENT SATISFACTION SCORES While 90.4% of the study's clinicians said that improving patient satisfaction during hospitalization was achievable, only 38% remembered targeted actions taken in their departments to improve satisfaction scores. All of the physicians worked at hospitals that used patient satisfaction surveys. “Only one-third of cliniciansstated that they
HEART FAILURE DOCUMENTATION AND CODING CHALLENGES As an example, for chronic diastolic heart failure and essential hypertension, the following codes are assigned in this order: I11.0 (hypertensive heart disease with heart failure), I50.32 (chronic diastolic heart failure), I10 (hypertension). In summary, heart failure is a clinical diagnosis based on signs, symptoms, and physicalfindings.
WELCOME TO ACP HOSPITALIST Welcome to. ACP Hospitalist. W elcome to ACP Hospitalist, a new monthly publication for physicians in hospital medicine. The number of hospitalists in the U.S. is projected to double from 15,000 to 30,000 by 2010, according to the Society of Hospital Medicine. That kind of rapid growth brings both new challenges and new opportunities. OPTIMAL HOSPITAL CARE FOR NATIVE AMERICANS Optimal hospital care for Native Americans. F acing an influx of seriously ill Native American patients with COVID-19, the physicians at Albuquerque's University of New Mexico (UNM) realized they needed to boost their cultural competency. To do that, they formed an educational collaboration with Gallup Indian Medical Center, an IndianHealth
CHRONIC KIDNEY DISEASE, INCLUDING TRANSPLANTS D ocumentation of chronic kidney disease (CKD) and its stage are crucial for correct coding, which affects hospital revenue and severity of illness classification. Precise diagnosis and reporting of CKD stage improve the accuracy of our national health care database used for research and for projections of national health care needs. PNEUMONIA | ACP HOSPITALIST Pneumonia. T he clinical distinction between community-acquired pneumonia (CAP), acquired without health care contact, and health care-associated pneumonia (HCAP), acquired outside the hospital but in connection with other health care contact, is crucial for correct management and antibiotic selection. CAP is usually caused byPneumococcus
WHEN PATIENTS WON'T LEAVE When patients won't leave. U sually when inpatients disagree with their recommended length of stay, it's a matter of leaving against medical advice. But some patients present the opposite challenge: They are reluctant to leave the hospital even though there is no medical reason for them to remain. “This sadly happens more than I'd like HOSPITAL-ACQUIRED PNEUMONIA IN THE ELDERLY Hospital-acquired pneumonia in the elderly. H ospital-acquired pneumonia (HAP), or nosocomial pneumonia, is a serious complication of hospitalized patients. HAP is associated with increased mortality, increased morbidity including prolongation of hospital stay, and increased economic costs. Many of the same risk factors thatpredispose elderly
AVOID COMMON MISTAKES WHEN TREATING HYPONATREMIA The worst symptoms of acute hyponatremia, such as seizure and obtundation, can usually be corrected by rapidly correcting serum sodium concentration by only 4 to 6 mEq/L, Dr. Johnson noted. “The risk of osmotic demyelination increases after the rate of correction exceeds 12 per L per day,” Dr. Nichani added. DIAGNOSTIC DOCUMENTATION FOR ONCOLOGY PATIENTS Diagnostic documentation needs to properly reflect, in the correct code assignments, the severity of illness of these patients, as well as associated risks, complexity of care, and use of resources. In this month's column we will investigate the clinical, coding and documentation nuances of 2 common and serious conditions associatedwith
THE RISE OF THE NEUROHOSPITALIST The rise of the neurohospitalist. A s a neurologist in private practice for more than 25 years in Ocala, Fla., Gregory Howell, MD, once spent his days shuttling between office and hospital. Emergency calls often forced him to cancel or reschedule outpatient appointments and miss out on potential revenue. WHAT NOT TO DO IN PALLIATIVE CARE Fresh air can also make patients feel better, but since it's often not available in the hospital, a fan is a good substitute. “There is something about cool air blowing across the face that actually physiologically relieves the dyspnea,” Dr. Pantilat said. Similarly, a cool cloth to the face has been proven to reduce shortness ofbreath.
TABLE 1. SPO TO PO CONVERSION TAL OXYGEN, WHAT THE PO ACPHOSPITALIST November 2013 7 REVISITING RESPIRATORY FAILURE Part two of a two-part series By Richard Pinson, MD, FACP L ast month’s column addressed some challenges in the diag-nosis of respiratory failure, including correct documentation This website uses cookies to ensure you get the best experience on ourwebsite. Learn more
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AN AGENDA FOR HOSPITALISTS' RESEARCH The pandemic added opportunities and barriers to an already challengedfield.
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FIGHTING HAIS WHILE FIGHTING A PANDEMIC Central line-associated bloodstream infections made a comeback lastyear.
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THE INTERGALACTIC HOSPITAL FOR MALFUNCTIONING MECHANICALS Since the hospital's inception, no mechanical beings have passed the rigorous entrance examination to practice there. By Jamie Newman, MD, MHA, MACPCoding Corner
CAUTI, A TALE OF TWO CONTEXTS Confusion abounds over the diagnosis and documentation of catheter-associated urinary tract infections. By Richard Pinson, MD, FACPExpert Analysis
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