Garbage In, Garbage Out

gigoYears ago, computer programmers would refer to GIGO as a reason their programs performed or didn’t perform as expected.  The rule of thumb is that if the correct data was not put into the computer in the correct format, the computer would not produce anything meaningful.  The programming community’s language has evolved much since then, turning to words like ‘elegant’ and ‘robust’ to describe their programs.  A program no longer puts out garbage when it is not used appropriately.  It merely becomes unstable.

I have no independent knowledge of why the old ‘garbage in; garbage out’ catchphrase went out of style.  Perhaps it was overused or maybe, it is because the programmers put into place checks and balances to ensure that bad data wasn’t entered into the computer.

Compared to programmers, the coding industry is far, far behind.  Agencies hire certified coders or outsource coding to outstanding organizations such as ours and are very disappointed when the coding doesn’t appreciably approve.  That’s because the only codes that a certified coder can use are those that are supported in the medical record.  If the coder has only garbage to work with, the coder will not produce quality work.

Here are some of the most common scenarios we see that are hurting for additional information.  If your field staff are aware of them at the time of admission, recertification and resumption of care, the quality of information will be improved and the time that it takes to develop information will be appreciably decreased.

Low Vision

Just because a patient has grossly impaired vision does not mean that a low vision code is supported in the documentation.  Often we will see low vision or Diabetes with vision related complications and the corresponding code is offered as low vision.  In order to count for scoring in PPS, an actual diagnosis that is not corrected with lenses is required. Think diabetic retinopathy or glaucoma.

Cataracts are another example of documentation used to justify a low vision diagnosis.  Because they are easily removed they do not support low vision unless  a patient is not a candidate for cataract surgery and the reason why is documented.

Heart Failure

When a patient has a history of a heart attack, is on lasix, bumex and potassium, has a weight that bounces around and often finds it difficult to breathe, there’s a real good chance they have a touch or more of congestive heart failure.  CHF is the only diagnosis that has been isolated and is known to increase hospitalizations.  However, if the physician has not verified congestive heart failure in the documentation, it may not be coded.

In addition to costing you dollars, the failure to code failure affects outcomes when the agency is asked how symptoms of heart failure were addressed.  Too often the response is NA because the patient did not have a diagnosis of failure.

Clinically, it should not make a difference but it does.  Many agencies, because of intense scrutiny on surveys have a policy that weights will be obtained only on patients with failure, renal disease, etc.  If the diagnosis of failure is not documented, weights may not be ordered placing the patient at risk.

Attention Nurses:  If your patient has a history of cardiac disease, takes meds suggestive of heart failure and there is no evidence to the contrary, treat the patient as if they do have failure.  Even if there is no diagnosis, you can save a life or at least a hospitalization by weighing your patients and predicting early decompensation which can be treated without life support.

Diabetes

It is getting much less frequent but there are still nurses who chart that patients with insulin are type I diabetics.  After all, Type I diabetes used to be called Insulin Dependent Diabetes so it sort of makes sense.

Type I diabetics do, indeed, take insulin.  Their body, for whatever reason stopped, – usually abruptly – producing it.  Type II diabetics also take insulin when oral medications and lifestyle changes are not effective.  If you do not have solid information from a referral source, you can determine with a high degree of accuracy that a patient on insulin has Type II diabetes if they originally took oral medications and were recommended to change their lifestyle.  Although not impossible, most type I diabetics develop the condition early in life.  Statistically speaking, it wasn’t until the past 20 years that type I’s lived long enough to receive Medicare.  You can thank Mary Tyler Moore, insulin pumps, pancreatic transplants for the opportunity to meet Type I’s in home health.

Are there any common coding errors that you wish were addressed more thoroughly?  Let us know in the comments box below or email us.

The great garbage can featured in the picture is a Simple Human design.  You gotta hand it to folks who know how to make garbage look goodl

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