January 11Th, 2017 Coder Meeting Minutes

Finger Lakes Region Perinatal Program

January 11th, 2017 Coder Meeting Minutes I. Attndance: Stacey Peers (NW), Catherine Vandermeid (Noyes, Jeanne Brightly (Unity), Maureen Herbstsommer (HH), Amy Burchell (HH), Rosemary Varga

II. Entry Quality reviews: This year I will be doing Quality reviews of your entry process. As some of you know this has been done in the past the with possible exception of the past two years. I’m not sure about 2015 and I was too new in 2016 to evaluate anything! My knowledge has increased to the point that it is time to restart the reviews I will be scheduling meetings with each hospital for a time to review one chart, preferably one that may have been a bit more difficult to complete. The chart selection will be your choice. It would be good if all Coders could attend but 2 would be necessary, one to work your computer as I coded and the other to have your copy of the submitted data for comparison. I will, also, be inviting your supervisor to join us. Included in my follow up report to your supervisors will be the results of the review, your attendance record at the bi- monthly Coder Meetings and your participation in the monthly scenarios. You will receive a copy of the report. I will try to schedule these on the date of your hospital’s Outreach Meeting. Newark-Wayne was my guinea pig. Together we began honing the review process. You, all, will help in its continued development. This is a change from the previous formats as computers have entered our world changing how we retrieve our needed information. SMH does not have an Outreach Meeting. The review will be scheduled at a time convenient to the Coders

A quick note on Outreach Meetings – It is to yours and your supervisors benefit to attend the 1st ½ of the meetings during which Dr. Glantz shares Regional data derived from your entries. In the past changes in how the data is provided to you have changed because of your input in these sessions.

Several of the hospitals have programs built into their computer system that follow the workbook. When a detail is charted by the nurses or doctors, it automatically flows to the Registrars page, decreasing the amount of time spent searching. It was noted that there can still be errors and you need to be aware of your entries in that they make sense.

III. Data Quality: . Following up on last month’s missing data missives: Fully realizing that 100% is impossible, is there a way to improve statistics so that all of our area hospitals are fewer than 10% missing? Has anyone tried something different? Eileen Shields said that as the areas in question are “QI” they are not mandatory. We all know that there are no mandatory questions, all can be refused. We need to look at the questions as mandatory. Highland has started spending an extra minute or two in the room with the patient if they noted that the interview questions are not complete. With a little added explanation the women seem more willing to complete the survey.

. Natality reports continue to be issue about quarterly. I do not get them. Please, continue to send me summaries as they are a means of my being able to support in having information put into prenatals and labor and delivery records. It is still on my agenda to contact the office support for your providers to ask if they can have input into the problem areas.

 I still have all of the packets you gave me with your breakdown of the Birth Certificate Workbooks. I will be scanning these in a creating a folder on the web page so you can view how others in our region get their work done. IV. AOP Continuation. December scenario results

Number of # correct # correct # correct # correct # correct # correct # correct # correct coders who answers Q1 answers Q2 answers Q3 answers Q4 answers Q5 answers Q6 answers Q7 answers Q8 participated proof of who is the divorced and Changes Oral/written FOB’s POA FOB sign Still legally Identity? legal father remarried allowed sign? w/out married mother 22 16 21 8 21 19 20 13 18

. How are you handling the requirement to have the AOP presented both orally and in writing? . The DOH answer to #3, FOB is husband divorced after conception or husband she married immediately after divorce but before the baby was born was a surprise. . Michelle T. had asked about payment for paternal DNA testing. Ann-Marie answered: There is not a standard way that every single court handles payment for DNA testing, but here is the general formula… o If the father is on DSS, then DSS pays for the test. o If the father is not on DSS and is found to be the father, then he can be charged for the test for himself, the mother and the child. o If he is NOT found to be the father, then DSS pays for the test. The bottom line is, you may be best just referring them to the judiciary system as you cannot know all of the financial aspects of their lives. . Many of you have this address for the Putative Father Registry but here is again: o NYS Putative Father Registry PO Box 15364 Albany, NY 12212-5364 . This would be used if an FOB wants to complete the AOP father’s portion without the mother’s agreement.

. AOP’s can be destroyed if not signed by the father even if the mother has filled in the entire form except for the signature.

. Parents can have a copy of the AOP if requested

. Are there any other AOP questions?

V. What’s in a name? Coders vs registrars? The folks attending the meeting said they are known by a variety of names. We discussed if ‘Coder’ actually fits what is done. The general response was ‘No’. I would others to weigh in on this. My thought are that you are ‘Registrars’ and should be called as such. N-W incorporates the job under the Unit Secretary position, Noyes is under Nursing, Unity calls them Representatives. Do you have a preference? Drop me a note with your thoughts.

VI. Scenarios: November: The woman is 41 weeks pregnant. On vaginal exam her cervix is 1 cm. dilated. She is not contracting. On arrival at the hospital she is placed on EFM and induction is started with the placement of a cervical foley. Number of # correct # correct coders who answers Q1 answers Q2 participated medicinal external 22/30 12/22 20/22

January: Patient at 38 weeks, who is a previous C-section x1, presents in active labor. We are a non-VBAC hospital, so, we code elective / other. But given the push for no elective deliveries prior to 39 weeks do I also select ‘Maternal Condition - Pregnancy Related’? Discussed at the meeting but as not many have responded I’m not gonna put the answers in. Just know that you may need to refer to the HELPER Guidelines.

There are still generally 2/3’s of the Registrars responding to the scenarios. I’d love to see it closer to 100% as they do raise questions which can positively affect your data entry. VII. Coder questions answered: When you feel the need to call the state for an answer, would you please drop me an email with the concern and the state’s response? If you have a question, so does someone else have the question or will in the future. I will continue to share via these minutes.  Immunoglobulin administration documentation is only for the infant  If mom is induced and delivers in 2.5 hours it is documented as ‘precipitous’.  An IUPC is not entered as internal monitoring. The info required is fetal heart rate monitoring. Contraction intensity is not requested  If a C-sect is performed at 41 weeks for fetal distress and presumed CPD, code ‘Fetus at Risk’ ONLY  Latent labor is labor, just the early stages.  If an Order of Filiation’ is presented in the hospital, the Father’s name on the Birth Certificate is the name on the order. This means that they have already gone before a judge and proven to the judge’s satisfaction that the father requesting inclusion is indeed the biological father.  Entry to the SPDS system can be started before the baby is born.

VIII. Web Page: https://www.urmc.rochester.edu/finger-lakes-regional-perinatal-program.aspx That is the address of our web page. I have been updating it over the past several months and have rebuilt the Coder page. Check it out. Tell me is you find it helpful and / or if I could make it more helpful.

IX. We will be holding our next Coder Meeting May 10 th , 2017 at the Saunders Research Bldg., 265 Crittenden Blvd. on the Strong Hospital Campus, room 2420 A&B, (top of the stairs). Parking passes and a Conference Line will be available.