Hot Topics in Coding: ECMO, Sepsis, Heart Device Reporting and More

The webinar begins with Cherie Myron, the Marketing Manager for True Code, expressing gratitude to attendees and introducing Megan DeVoe, the产品经理 for Tru code, who has over 25 years of experience in the field. Cherie outlines housekeeping rules for the webinar, including instructions for asking questions, accessing handouts, and obtaining AHIMA CEU certificates post-webinar.

Megan DeVoe explains what ECMO (Extracorporeal Membrane Oxygenation) is, detailing its function as a heart and lung machine similar to cardiopulmonary bypass. She discusses the differences between ECMO and traditional CP bypass, including initiation methods and patient conditions. Megan also provides a historical overview of ECMO, mentioning its development in the 1960s and notable cases, emphasizing its evolution and current worldwide use.

The presentation continues with an explanation of the ECMO circuit components, including the mechanical pump, gas exchange device, and heat exchanger. Megan describes the process of how blood is treated in the ECMO circuit, emphasizing the importance of warming the blood before it's returned to the patient. She also touches on the different reasons ECMO might be used, such as recovery from severe illness or as a bridge to transplant.

Megan discusses the documentation of ECMO in medical records, highlighting the importance of recording flow rates, blood gas analysis, and cannulation processes. She differentiates between VV and VA ECMO, explaining the implications of peripheral and central cannulation. Megan also addresses the coding changes as of October 1st, 2018, which introduced three separate ECMO codes based on the type of procedure performed.

The discussion shifts to the impact of ECMO on MS-DRG assignments and hospital reimbursement. Megan explains how central ECMO is classified as an hour procedure and groups to MS-DRG 003, while peripheral VA and VV ECMOs are classified as non-hour procedures and group to different MS-DRGs based on the patient's principal diagnosis. She also mentions the feedback received by CMS regarding the new procedure codes and the potential changes proposed for 2020.

Megan delves into the evolution of sepsis definitions, noting the shift from the systemic inflammatory response to infection (SIRS) to a focus on organ dysfunction caused by a dysregulated host response. She outlines the new criteria for identifying sepsis using the SOFA (Sequential Organ Failure Assessment) score and the quicker, bedside CUE (Clinically Undetermined Event) SOFA method. Megan also discusses the proposed changes to the coding of sepsis, including the potential deletion of the R65 category and the need for updated guidelines.

The webinar concludes with an overview of heart assist devices, including LVADs and total artificial hearts (TAH). Megan explains the purpose of these devices and their use as a bridge to transplant or destination therapy for end-stage heart failure patients. She provides examples of different types of ventricular assist devices and touches on the coding for these procedures, emphasizing the non-coding of intra-aortic balloon pumps (IABP) and the use of specific codes for Impella insertion and removal.

Megan provides a preview of the proposed code changes for 2020, notably the removal of the 'biventricular' qualifier in the heart and great vessel system. She also highlights the importance of staying updated with coding clinics and the National Center for Health Statistics' recommendations. The webinar ends with Cherie Myron reminding attendees about the process for obtaining their AHIMA CEU certificate and thanking everyone for their participation.