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Dr. David Chand is a pediatric hospitalist and Lean Six Sigma deployment leader at Akron Children's Hospital. He has a special interest in eliminating waste in healthcare and uses Lean Six Sigma principles to improve patient care and efficiency.

About David Chand, MD

Dr. David Chand is a pediatric hospitalist and Lean Six Sigma deployment leader at Akron Children’s Hospital. He has a special interest in eliminating waste in healthcare and uses Lean Six Sigma principles to improve patient care and efficiency.

ICD-10 transition has been a smooth one

Dr. David Chand reports on the recent implementation of ICD-10 and previews a coming change for ordering radiology studies to improve care as well as coding and reimbursement.

ICD-10 Tips: Initial vs subsequent encounter

In preparing for the ICD-10 implementation on Oct. 1, I’d like to provide a few educational points as we identify opportunities for improvement. For several diagnoses, the Diagnosis Calculator in Epic will prompt providers to choose between “initial encounter” and “subsequent encounter.” For coding and billing purposes, this should be viewed from the patient’s perspective and […]

Next steps for ICD-10 coding implementation

The Ambulatory coders recently participated in a 2-day ICD-10 training program and are now required to complete testing for certification. Starting in April, coders began identifying the top 10 ICD-9 diagnosis codes for their areas of responsibility and then mapped them to the corresponding ICD-10 diagnoses. From there, we hope to establish opportunities to improve documentation.

Complete documentation leads to increased hospital reimbursement

Last year, there were more than 300 coding queries and as a result of providing complete and accurate documentation in response to these queries, hospital reimbursement increased by $606,786.

CDI Team: Excisional versus non-excisional debridement

The CDI team has noticed an increase in the number of queries being sent to physicians regarding excisional and non-excisional debridement. Coders cannot assume that the debridement of bone, fascia or muscle is always excisional.

Clarifying criteria for respiratory failure codes

When querying for Acute Respiratory Failure, the Clinical Documentation Improvement (CDI) team has noticed that there is a lack of clarity about what constitutes the diagnosis of “Acute Respiratory Failure” from a coding standpoint.

Is it functional or spastic quadriplegia?

After reviewing several charts, the Clinical Documentation Improvement (CDI) team has noticed some confusion with regards to the difference between “Functional Quadriplegia” and “Spastic Quadriplegia.”

How to ensure the discharge summary is complete

This month, I would like to focus on the Discharge Summary. Perhaps one of the most important elements of documentation, the Discharge Summary serves as a communication tool for primary care providers, summarizes the hospital course for future reference and is a primary source of information for coding and billing. Despite its multiple uses, discharge summaries often lack the core elements that allow them to serve such functions.

Clinical documentation tips for SIRS

As expected, the Centers for Medicare & Medicaid Services (CMS) set the new conversion date for ICD-10 to Oct.  1, 2015.  As an organization, Akron Children’s Hospital is still finalizing a revised, comprehensive implementation plan.

Improving clinical documentation: ICD-10 tips on influenza

From the time we began planning for the implementation of ICD-10, we maintained the position that our mission is to help providers become better documenters, not coders.