I remember a time when assigning ICD-9 procedure codes when we always picked up blood transfusions. With the implementation of ICD-10-PCS, this was one of the procedures that most hospitals phased out. The rationale for this decision in most organizations stemmed from a lack of documentation regarding the route of administration, an element necessary for code assignment. It was also decided that this information could be obtained from the blood bank or through hospital charges.
The best, but not necessarily most efficient, way to determine if anyone is using coded data is to stop coding it. At times it seems no one is paying attention to what we code as long as they get what they need, but if you stop coding what they need, things start emerging that you didn’t anticipate. Case in point: the impact blood transfusion procedure coding has on quality measures.
The U.S. maternal mortality and morbidity rates have doubled in the last 15 years. As such, the Severe Maternal Morbidity (SMM) rate is a key indicator of outcomes among pregnant women. Quality indicators set forth by the Joint Commission and Agency for Healthcare Research and Quality (AHRQ) as well as other organizations are addressing SMM. One of the key components of this quality tracking requires obtaining blood transfusion data.
The California Maternal Quality Care Collaborative (CMQCC) has taken a lead in recommending their organizations report blood transfusion ICD-10-PCS codes on obstetrical cases. In their Alert on Blood Transfusion Procedure Coding, they give steps toward capturing these codes. In turn, Haugen Consulting Group has adopted this alert as a best practice for coding for the purpose of supplying data for quality measures, which cannot be obtained from the blood bank or through charges.
But what of the missing documentation for the route of administration? In discussions with CMQCC’s Elliott Main, MD, I confirmed that the critical component of these blood transfusion codes is the root operation (Transfusion) and blood product that was given (e.g., packed red blood cells, fresh frozen plasma), not the route of administration. In most instances, blood transfusions will be given by peripheral IV rather than through a central venous access. Coding Clinic for ICD-10-CM/PCS established a precedent for developing an internal policy regarding the use of a default body part based on common practice in its Third Quarter 2014 article titled “Excision of Saphenous Vein for Coronary Artery Bypass Graft.”
The need for this data stresses the impact ICD-10-CM/PCS codes have not just for reimbursement, but for their original intended purpose of data collection. At Haugen Consulting Group, we recommend in our audits and education, that organizations report ICD-10-PCS codes for blood transfusions on all maternal cases. In establishing this internal coding policy, organizations should consult with clinical staff to establish a default coding policy regarding the body part for these codes.
We stopped coding blood transfusions, and someone noticed. It will take time to correct this course, but I think all coders can agree that it feels good to be asked to code something because it may have a true impact on the quality of patient care.
Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer
Kristi also performs DRG and APC audits and is known for her vast knowledge on coding vascular interventional radiology procedures. Kristi has an extensive background in coding education and consulting and is a national speakers on topics related to ICD-10 and CPT coding as well as code-based reimbursement.