Ingenix InSite User GroupAugust 10, 2010

Approval Code: IN187

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Ingenix InSite User Group: Welcome

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Email ingenix.insite@ingenix.com. Ingenix InSite Website Questions? Call or email the Ingenix Helpdesk 1-866-

818-7503 or client.support@ingenix.com.

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Ingenix InSite User Group: Agenda

10:00 AM – 10:05 AM Welcome & InSite Operations Announcements 10:05 AM – 10:25 AM Focus on: Aneurysms 10:25 AM – 10:50 AM Using InSite to Identify

and “Work” Highest Suspected RAF Patients 10:50 AM – 11:00 AM Q & A

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InSite Operations Announcements

Data Refresh Update– InSite data was refreshed August 9th – Next data refresh targeting September 7th

July 30th 2010 – New InSite Release– Prevalence Report modification for filtering by health plan– Freeze column headers on reports, searches & custom lists– New Superbills for Nephrology & Pediatrics– July & August Ingenix Insider– Updated ICD-10 Link– InSite Compatibility with:

• Internet Explorer 7.0• Internet Explorer 8.0

Focus On: Aortic Aneurysm and Dissection and Other Aneurysm

Mary Jo Groome, CCS-P, CPC-HIngenix, Clinical Assessment Solutions

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Aortic Aneurysm and Dissection

An aneurysm is a localized abnormal dilation of blood vessels. A dissecting aneurysm is one in which blood enters the wall of the artery and separates the layers of the vessel wall. As theaneurysm progresses, tension increases and the aneurysm islikely to rupture, which usually results in death.

In general, an aneurysm is considered clinically significantif its diameter is twice that of a normal artery.

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Aortic Aneurysm and Dissection

Risk factors for AAA include:3

Male gender65 years and olderSmoking historyFamily historyHigh cholesterolHigh blood pressureOther vascular disease Obesity

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Aneurysms are diagnosed…

primarily by their location, such as:1

– Aneurysm of coronary vessels 414.11– Dissecting aneurysm of abdominal aorta 441.02– Aneurysm of abdominal aorta with rupture 441.3– Aneurysm of thoracic artery 441.2– Ruptured aneurysm of thoracic artery 441.1– Thoracoabdominal aneurysm wo mention of rupture 441.7

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Thoracic vs Abdominal

The aorta is first called the thoracic aorta as it leaves the heart, ascends, arches and descends through the chest until it reaches the diaphragm (the partition between the thorax and abdomen).

The aorta is then called the abdominal aorta after it has passed the diaphragm and continues down the abdomen. The abdominal aorta ends where it splits to form the two iliac arteries that go to the legs.

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Area of Study

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Aortic Aneurysm and Dissection

441 Aortic aneurysm and dissection1

441.0 Dissection of aorta (HCC104)

DEF: Dissection or splitting of wall of the aorta; due to blood entering through intimal tear or interstitial hemorrhage

441.00 Unspecified site441.01 Thoracic 441.02 Abdominal441.03 Thoracoabdominal

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Documentation Note

If documentation identifies the abdominal aortic aneurysm as a Type I, Type II or Type III, the condition still classifies to 441.0x, Dissection of aorta. The fifth digit for this category identifies the site.

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Aortic Aneurysm and Dissection

441 Aortic aneurysm and dissection1(cont)

441.1 Thoracic aneurysm, ruptured (HCC 104)

441.2 Thoracic aneurysm w/o mention of rupture (HCC 105)

441.3 Abdominal aneurysm, ruptured (HCC 104)

441.4 Abdominal aneurysm w/o mention of rupture (HCC105)

441.5 Aortic aneurysm of unspecified site, ruptured (HCC104)

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Aortic Aneurysm and Dissection

441 Aortic aneurysm and dissection1 (cont)

441.6 Thoracoabdominal aneurysm, ruptured (HCC 104)

441.7 Thoracoabdominal aneurysm, w/o mention of rupture (HCC105)

441.9 Aortic aneurysm of unspecified site w/o mention of rupture(HCC 105)

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Other Aneurysm

Includes aneurysm (ruptured) (false) (varicose)1

aneurysmal varix Excludes arteriovenous aneurysm or fistula

acquired (447.0)congenital (747.60-747.69)traumatic (900.0-904.9)

442.0 of artery of upper extremity442.1 of renal artery442.2 of iliac artery442.3 of artery of lower extremity

femoral or popliteal

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Other Aneurysm cont

442.8 Of other specified artery1

442.81 Artery of neck442.82 Subclavian artery442.83 Splenic artery442.84 Other visceral artery442.89 Other

442.9 Of unspecified site

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Quick Facts

Between 5% and 10% of males ages 65-79 have an AAA.2

A ruptured AAA is a medical emergency that carries an 85% to 90% mortality.3

When an AAA reaches a diameter of 5cm, the risk of rupture is high enough that surgical repair (or possibly endovascular repair) should be initiated for individuals who are fit for surgery.,2,3,4

Smoking is the strongest independent risk factor-a lifetime history as few as 100 cigarettes is considered a smoking history.5

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References

1. World Health Organization. “2010 CCD-9-CM for Physicians-Volume 1 & 2, Expert.” St Paul MN: Ingenix Inc, 2009. Print

2. Cosford, PA, Leng. GC. Screening for abdominal aortic aneurysm. Cochrane Database of Systematic Reviews 2007, Issue 2, ART. No.: CD002945. DOI: 10.1002/14651858.2945.pub2.

3. Powell, JT Clinical Practice, “Small Abdominal Aortic Aneurysms.” New England Journal of Medicine 2003;348: 1895-1901.

4. Screening for Abdominal Aortic Aneurysms: Recommendation Statement.” US Preventive Services Task Force. Ann Intern Med 2005; 142: 198-202

5. Fillinger, M. “Screening for Abdominal Aortic Aneurysm: Recommendation Statement.” Perspect Vasc Surg Endovasc Ther 2006; 18: 71-83.

Using InSite to Identify and “Work” Highest Suspected RAF Patients

Presented by:Pam HoltRegional Manager Market ConsultationSouthern California

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Progress Report

Report shared during strategy meetings with groups Outstanding patients with highest suspected RAF

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Recommended Actions

Two separate projects based on DOS year

1. Outreach to patients2. Chart Review

How to use InSite to identify these patients

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Opportunity / Project # 1

Target high risk patients for outreach (2010)– Schedule extended visit to evaluate chronic conditions– Include PAF showing suspected conditions

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CSI Report Identifies the Patients

Export the CSI report – Use “2010” filter for Outreach – Project # 1

Select the cells from Cell A4 – AD4 & down to bottom– All except the header rows (rows 1 – 3)

“Data” Sort by: 1. First: Column AD (“Combined Suspected HCC Factor”) - descending2. Then by: Column F (“Member ID”) - ascending3. Then by: Column C (“PCP”) – if applicable – ascending

Report will have highest suspected RAF at top

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A little more work for Project # 1 …..

Export MWOV– Sort by Likelihood

• Very High• High

– Disregard any duplicates– Add Patients with Very High and High Likelihood from

MWOV to the CSI list of patients to contact

Print Patient Assessment Forms (PAF)– For physician to use at time of visit

• Lists the suspected conditions for evaluation

Outreach to patients to schedule an extended appointment prior to end-of-year

Evaluate all chronic conditions, document & code

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Opportunity / Project # 2

Focused chart review based on highest suspects– Coders review charts for documented conditions not coded

(2009 DOS)– Complete an ASM Spreadsheet

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Again…CSI Report Identifies the Patients

Export the CSI report – Use “2009” filter for Outreach – Project # 2

Select the cells from Cell A4 – AD4 & down to bottom– All except the header rows (rows 1 – 3)

“Data” Sort by: 1. First: Column AD (“Combined Suspected HCC Factor”) - descending2. Then by: Column F (“Member ID”) - ascending3. Then by: Column C (“PCP”) – if applicable – ascending

Report will have highest suspected RAF at top

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Final Steps - Project # 2

Work from 2009 list to pull charts for review

Coders review charts for documentation not previously coded

Submit additional codes found via ASM Spreadsheet prior to January Sweep

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Summary

Suspects from Progress Reports can be identified by using an exported CSI Report

Two separate projects – worked simultaneously– vary based on resources– impact both current and retrospective payment periods– prioritize based on potential RAF

It’s the perfect time of year to start these projects!

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User Group Feedback Survey

We want your feedback!

Survey is to be sent immediately after this call

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Question and Answer

Approved: IN071