An innovative stop-bill process could help ensure appropriate myocardial infarction (MI)-related coding, particularly among patients experiencing in-hospital death, according to research presented Feb. 14 at ACC's Cardiovascular Summit in Orlando, FL.

According to the poster authors Renee Swanson, RN, MSN, et al., accurately differentiating between type 1 MI, type 2 MI, and myocardial injury without MI is increasingly important at a time of increased accountability for high-quality MI care, greater use of high-sensitivity cardiac troponin assays, and a rising prevalence of non-MI conditions associated with an elevated troponin level. In some cases, incorrect documentation can result in DRG mis-assignment, while in other cases lack of specificity could result in artificially inflated MI-mortality rates and may contribute to unwarranted Value-Based Purchasing penalties by the Centers for Medicare and Medicaid Services.

Starting in 2018, Providence Heart and Vascular Institute-Oregon implemented an automated stop-bill process in its electronic health record that allowed review of all in-hospital deaths assigned to a MI DRG at eight of its hospitals. Identified cases underwent an immediate, but separate review by members of Providence's coding quality improvement (CQI) and clinical documentation improvement (CDI) teams to determine if the documentation supported an MI DRG or if further information was needed. If either of the two groups felt that further clarification was required, a request for adjudication was sent to a lead physician reviewer and the discharging provider. Turnaround time for this process was two business days for the CQI/CDI review and seven business days for the provider review.

Over a span of five months, 29 cases were flagged by the stop-bill process. Of these, 90 percent underwent review without changes, while 10 percent were reviewed and had an alternate DRG assigned. Researchers noted that reviews were more common when a cardiologist was not involved in the case.

According to the researchers, while the impact of this process on the MI-related mortality rate remains to be determined, the process itself proved successful in ensuring appropriate MI-related coding. It also underscored the importance of increased education around specificity of documentation for patients with type 2 MI or myocardial injury without MI.

Keywords: CV Summit, Troponin, Hospital Mortality, Quality Improvement, Centers for Medicare and Medicaid Services, U.S., Medicaid, Medicare, Myocardial Infarction, Electronic Health Records, Diabetes Mellitus, Type 2, Acute Coronary Syndrome

< Back to Listings