Real results: An organization boosted by Custom Edits

Business need:
The medical center uses over 20 different Custom Edit messages related to their Vizient needs. The edit topics include cardiac arrhythmia, chronic liver disease, sepsis, malnutrition, respiratory failure, acute renal failure, chronic kidney disease, etc.

The medical center pays close attention to these Vizient-related codes because they are tracked for quality performance in Vizient’s member-driven performance improvement system.

How the Custom Edit was implemented:
When the “Vizient Sepsis code” triggers, the Custom Edit in the 3M coding system instructs the coder to query the physician for symptom confirmation before continuing the coding session.

The medical center ranks this Custom Edit as “high severity,” which prevents the coder from completing the record until the issue is resolved.

Real Results:
 

• Vizient score performance improvement
• Coders are capturing more diagnoses they might have otherwise missed (especially when working in a different or unfamiliar specialty)
• Coders are querying the physician when alerted to confirm the symptoms for Vizient reporting
• Increased accuracy, decreased rework and a faster ramp-up when cross-training coders

Business need:
The medical center saw a large increase in births from 2,500 to over 3,800 in just three years. With this dramatic increase in births, a recurring quality issue began to appear: An invalid maternity admit diagnosis code was commonly being entered by the nursing staff.

The “invalid newborn diagnosis” CustomEdit was put in place so the coders could catch the incorrect diagnosis code and enter the correct one.

How the Custom Edit was implemented:
When the “Invalid newborn diagnosis” Custom Edit triggers, it instructs the coder to correct the newborn admit diagnosis before continuing the coding session.

The medical center ranks this Custom Edit as “normal severity,” which does not prevent the coder from completing the record before resolving the issue.

Real Results:
 

• This Custom Edit allowed them to catch the incorrect newborn diagnosis at the time of coding
• Coders have become more aware of this problem area and are querying more often
• This Custom Edit had a significant impact on the efficiency and accuracy of the maternity coding process

Custom Edits helped this medical center achieve its organizational goal of improving the accuracy of diagnosing Acute Kidney Injury (AKI) versus Acute Tubular Necrosis. The results below demonstrate the AKI specificity improvement the organization saw over a period of eight months.

Real Results:
 

• Medical center target AKI specificity rate: 15%
• Actual AKI specificity rate eight months after implementing Custom Edits: 18.7%
• Total AKI specificity rate increase: 10.1%

• Coders spend less time transferring back and forth between the EHR and 3M systems to make corrections
• Claims are generated and out-the-door more quickly
• Cleaner claims are going out