Terminologies
CDI
What is Clinical Documentation Improvement?
The diagnosis chosen as the condition established after study to be chiefly responsible for occasioning the admission to the hospital for care
What is the Principal Diagnosis?
A diagnosis that was acquired during the hospitalization?
What is a Hospital Acquired Condition (HAC)?
Lab results: WBC 22.0, Temp 102, pulse 118 and diagnosis of urinary tract infection, this is a definition of what?
What is Sepsis?
A set of measures to provide a perspective on the quality of pediatric healthcare by screening for problems that pediatric patients experience as a result of exposure to the healthcare system and that may be amenable to prevention by changes at the system or provider level
What is Pediatric Quality Indicators (PDI)?
The sum of all of the DRG Relative Weights divided by the census and tracked each month by the hospitals for budget?
What is Case Mix Index?
Query is not answered within 48 hours of submission and moved to this next step
What is the Query Escalation Process?
A score used to showcase how sick a patient is and can also be used in reimbursement calculations
What is Severity of Illness (SOI)?
Congenital heart defect in which the left side of the heart is severely underdeveloped and unable to pump blood throughout the body forcing the right side of the heart to do all pumping
What is Hypoplastic Left Heart Syndrome (HLHS)?
June 24th, 1858
What is the date and year BGH opened?
Comprehensive guidebook to the DRG classification system and divided into body system chapters and can be used during system downtimes
What is the DRG Expert Book?
Ensuring all portions on the query form reflect the correct clinical indicators and supporting diagnosis options to avoid leading a provider to the answer
What is a compliant query?
A score used to showcase the risk a patient may expire
What is Risk of Morality? (ROM)
A cyanotic heart defect and is one of the most common types of congenital heart disease. If left untreated has a mortality of 50% by the age of six
What is Tetralogy of Fallot (TOF)?
Notification Chain
What group we send email notification to on HACs and PSIs?
Enforces federal sentencing guidelines and investigates allegations of False Claims
What is the Office of Inspector General (OIG)?
A process used to determine if a query is complete, non-leading and has the right diagnosis options supported by the clinical indicators listed and feedback provided
What is a Query audit?
Used to gain clarification of ambiguous terminology, missing diagnoses, abnormal labs, diagnoses in the chest x-ray, etc.
What is a Query?
pH 7.20, PaCO2 72, sustained ABG's with similar results, vent, and not within a 48 hour window after surgery
What is Acute Hypercapnic Respiratory Failure?
A type of query that is shared on the floor, over the phone or other mediums that is verbalized and must adhere to the same standards and expectations as if written
What is a Verbal Query?
This part of government manages payment for federal funded services at the state and federal level, and sets the standard for documentation requirements
What is Centers for Medicare & Medicaid Services (CMS)?
The Agency of Healthcare Research and Quality(AHRQ) monitors this PSI to ensure respiratory complications from surgery are tracked so a hospital can improve patient care
What is PSI 11?
When used, this criteria can support the diagnosis of Malnutrition
What is the American Society for Parental and Enteral Nutrition (ASPEN)?
A congenital defect where the right side of the heart is severely underdeveloped and unable to pump blood throughout the body, forcing the left side to do all the pumping.
What is Hypoplastic Right Heart Syndrome (HRHS)?
Reviews 20-25 per day, query rate 30-35%, Agree rate 85% or higher, Response rate 95%-100% and overall review percentage for all patients qualifying for a CDI review is 85% or higher
What is CDI Productivity?