1. Updates: E Codes, Coding Edits, and Principal Language Spoken OSHPD Ginger Cox, RHIT, CCS March 2006

2. Agenda Regulation Changes on E Codes Coding Edits – New Warning Flags Update on “Principal Language Spoken”

3. Proposed IP Regulations on E Codes An E-code is to be reported on the record for the discharge first episode of care reportable to the Office during which the injury, poisoning, and/or adverse effect was first diagnosed and/or treated. If the E-code has been previously reported on a discharge or encounter record to the Office, the E-code should not be reported again on the discharge record.

4. Proposed ED and AS Regulations on E Codes An E-code is to be reported on the record for the encounter first episode of care reportable to the Office during which the injury, poisoning, and/or adverse effect was first diagnosed and/or treated. If the E-code has been previously reported on a discharge or encounter record to the Office, the E-code should not be reported again on the encounter record.

5. Scenario # 1 Where is the E code reported for an injury that was first diagnosed or treated,? a) First inpatient discharge b) First ED encounter c) First AS encounter d) First physician office e) Only a, b, or c, whichever occurs first 1 st Reporting Facility

6. Scenario # 2 If the patient comes from the ED of acute hospital A and admitted to hospital B, who reports the E codes? a) ED of acute hospital A b) Hospital B Hosp A

7. Scenario # 3 If a patient fell from a hospital bed in psych facility A and the attending physician first diagnosed and ordered the patient to be transferred to hospital B, who reports the E code? a) Psych facility A b) Hospital B Psych A

8. Scenario # 4 If a patient has a drug reaction that was first diagnosed or treated during the encounter or stay, who reports the E code? a) Psych facility b) Rehab facility c) ED encounter d) AS encounter e) Any of the above, whichever occurs first 1 st Facility

9. Scenario # 5 If an injured patient was first diagnosed in a physician’s office and then sent to an Endoscopy Unit, who reports the E code? a) Physician’s office b) Endoscopy Unit c) Not applicable Endoscopy Unit

10. IP Standard “S025” Edit Change Critical standard “S025” edit Revised logic for missing E code Effective for all discharges on or after July 2005 Revised Logic Principal Diagnosis: 800-995 Type of Care: SNF, Rehab Admit Source: SNF, Rehab, Chem Dep, Psych, AS Check for missing E code (external cause)

11. New Standard “SW25” Edit Non-critical standard “SW25” edit New SW25 edit for missing E code Effective for all encounters on or after January 2006 Logic Principal Diagnosis 800-995 Check for missing E code (external cause) ED AS

12. Non-Critical Standard Edit Example DiagnosesPDx: 873.41ODx: 969.5 EditsSW25 SW25 Missing Principal E code The cause of injury is required for the reported principal diagnosis. References: California Code of Regulations, Title 22, Sections 97260 and 97261 E codes sufficient to describe the external causes shall be reported on records with a principal and/or other diagnoses (800-999) or where ICD-9-CM codebook indicate that E code is applicable for dx (001-799) ED AS

13. Accept or Reject?? Non-critical standard edits SW25 flags Effective for all encounters on or after January 2006 Non-critical edits (aka: warning edits) Will not cause MIRCal to reject your data Facilities should review records in question ED AS

14. Accept or Reject?? Critical standard edits S025 flags Effective for all discharges on or after July 2005 Critical edits Will cause MIRCal to reject your data, if above ETL Must correct to ETL (preferably all) IP

15. New Standard “SW25” Edit Review Quick Notes #10 – Sample Form Have you been treated for your condition at an emergency room, hospital, or surgery center before today? (Your doctor’s office does not count.) YES or NO ED AS IP

16. Counts and Displays Counts of non-critical and critical flags will be separate Only the critical flags have to meet the ETL Non-critical flags should be checked Displays will be separate Number of records with SW25 flag Number of records with S025 flag ED AS IP

17. Coding Edit Changes 50 inactive coding edits All discharges on or after January 2000 Not identified as critical errors Exceptions in guidelines or coding scenarios Improvements to MIRCal Edit Program Changed inactive coding edits to non-critical coding edits IP

18. Coding Edit Manual Numerical order (V0001, V0002, VW003, VW004, …) Available on the MIRCal web site for Jan-Jun 2006 report period Handout List List of 50 non-critical coding edits IP

19. Non-Critical Coding Edits Non-critical coding edits VW flags, instead of V flags Effective for all discharges on or after January 2006 Non-critical edits (aka: warning edits) Will not cause MIRCal to reject your data Encourage facilities to review records in question IP

20. Non-Critical Coding Edit Example Diagnoses995.50995.82 EditsVW713 VW713 Maltreatment E code needed When the cause of injury is stated to be a maltreatment to a child or adult, an E967 code identifying the perpetrator is needed, if known. References: Coding Clinic for ICD-9-CM, AHA, 4th Quarter 1995, page 39. ICD-9-CM Official Guidelines, General E Coding Guideline, 19.e.1., Dec 2005.

21. Counts and Displays IP Counts of non-critical and critical flags will be separate Only the critical flags have to meet the ETL Non-critical flags should be checked for accuracy Displays Number of records with VW flags per type of care Your VW flags and its descriptions

22. Uses of Language Communication is important between health care community and the patient Allow the patient to explain what is bothering them Allow the patient to understand the treatment that the doctor recommends Eliminate the confusion over medications More attention to improve medical outcomes Rely on what patient is saying (prior to tests and/or treatments) Provide interpretative services Track the healthcare process and see where it breaks down

23. Principal Language Spoken Health and Safety Code (law) Supporters of SB 680 California Pan-Ethnic Health Network Consumers Union (CU) AARP Congress of California Seniors Health Access California Latino Issues Forum Pacific Business Group on Health (PBGH) Hughes Electronic Corporation California Medical Association (CMA) Verizon Service Employee International Union California Public Employees Retirement System (Cal PERS)

24. ED & AS Required Data Elements Date of BirthSex Race and EthnicityZIP Code Social Security NumberService Date Principal DiagnosisOther Diagnoses Principal E codeOther E codes Principal and Other Procedures Expected Source of Payment Principal Language SpokenDisposition of Patient

25. IP Required Data Elements Date of BirthSex Race (Ethnicity)ZIP Code Social Security NumberAdmit Date Admit SourceAdmit Type Principal and Other Diagnosis and CPAA Prehospital Care and Resuscitation (DNR) Principal and Other E codesDischarge Date Principal and Other Procedures and Dates Expected Source of Payment Principal Language SpokenDisposition

26. Language Resources Other Resources: Office of Minority Health Bilingual Act Kopp Act MediCal (counties and data) Minimal data set for LTCs State Personnel Board JCAHO Executive Orders for Limited English Proficiency (LEP) U.S. Census Data Bilingua l Title VI Censu s LEP SPB MediCal Kop p JCAHO OMH

27. National Standard Data Element National Standards Language Indicator (X12 data element # 1303) 1 – language of instruction 2 – language of examination 3 – language in which examination is written 4 – language spoken in the home 5 – language reading 6 – language writing 7 – language speaking 8 – native language

28. Language Lists National Standards Member Language Selected from X12 data element # 1303 Language reading Language speaking Native language Two standard lists (X12 data element # 66) International Organization for Standardization (ISO) – list of names of languages National Information Standards Organization (NISO) – list of written languages

29. ISO International Organization for Standardization (ISO) Worldwide federation of national standards bodies Named entity to maintain the language code list ISO 639

30. ISO’s Language Code List ISO 639 = Language Code List 400+ languages Written in English ISO 639.1 2 digit code list Not all languages are captured ISO 639.2 3 digit code list All languages are captured Terminology and Bibliography lists ISO 639.1 ISO 639.2

31. Language Collection Compare with other entities who collect languages MediCal Crosswalk their codes to ISO 639.2 list (Terminology) State Personnel Board Consistent with ISO 639.2 list (Terminology) Minimal Data Set for LTCs 4 languages (English, French, Spanish, Other) CA Office of Minority Health Consistent with ISO 639.2 list (Bibliography)

32. Principal Language Spoken Simplify the list of 400+ languages US Census (Spoken at home; 5 years & older) English Spanish or Spanish Creole Other Indo-European Languages Asian and Pacific Island Languages Other Languages Approach ANSI X12 Minimum necessary list for 837 HCSDRG

33. Principal Language Spoken Do more homework Keep you informed of our progress Simplify the list for 837 HCSDRG Write the regulations Agency approval Public comments Office of Administrative Law Add change to data collection program Test and implement

34. Wrap Up Regulation Changes on E Codes E Code on the initial encounter or discharge Revised S025 critical edit for IP data - 2005 New SW25 non-critical edit for ED and AS data - 2006 Coding Edits – New Non-Critical Flags VW non-critical coding edits for IP data - 2006 Update on “Principal Language Spoken” More research

35. Questions and Answers