Review a Case - HIM Reviewer
Once you elect to review a case, a new screen with a summary of the case and spaces for you to enter your case review findings will be presented.
The screen consists of five sections which are separated by headings that appear as horizontal blue bars. Two of the sections are hidden – View Case Details and View Case History. Click on a blue bar to reveal the information within the section. Click again to hide the section.
After you finish entering your case findings and review decision you must click on the “Submit” button at the bottom of the screen. If you are not ready to submit your decision, click on the “Save” button at the bottom of the screen so that you do not lose the information you entered.
Patient information is displayed in its entirety and consists of patient identification and demographic data, admission and discharge dates, discharge disposition and attending physician.
This section also includes an indicator (PSRS Match) of whether a patient safety event was previously reported in the voluntary Patient Safety Reporting System (PSRS) for this patient. A value of “Y” for this indicator means that an event was previously reported in PSRS, but may not be the same event as the one summarized on this screen.
This section identifies the event that is the subject of this case review (e.g., Pulmonary Embolism or Deep Vein Thrombosis) and displays the patient’s admit and discharge services and all the services and nursing units on which the patient resided during his/her hospitalization.
This section displays the patient’s principal and secondary diagnoses and principal and secondary procedures. Each diagnosis has a “Present on Admission” (PoA) indicator of whether the diagnosis was present on admission (pre-existing) (PoA = Y) or acquired during the patient’s hospitalization (PoA = N). For some diagnoses, like “Normal Delivery”, it is not meaningful to assign a PoA value; under these circumstances, the diagnosis is exempt (PoA = E).
The diagnosis that caused the event to be flagged for review is highlighted. These are diagnoses that were acquired (PoA = N).
This section displays the review decision about the coding of the ICD-9-CM diagnosis and / or PoA codes that requires your attention.
This section provides space for you to enter the findings from your review. It also asks you to enter a review decision.
After you review the previous reviewer’s decision and the patient’s CareWeb and other records:
1. Enter the findings from your investigation in the text box.
2. Enter your review decision.
Coding Correction Needed: If you agree with the Primary Review that the ICD-9-CM diagnosis or Present on Admission (PoA) coding was incorrect, select Review Decision 1 or 2, provide an explanation in the Findings section, and press the Submit button at the bottom of the page to close the case.
Disagreement with Primary Reviewer Decision: If the ICD-9-CM diagnosis or Present on Admission (PoA) coding was correct, provide explanation in the Findings section, select Review Decision 3 or 4 and press the Submit button to forward the case to an Arbitrator
3. Finally, submit your case findings and review decision by clicking the “Submit” button at the bottom of the screen. (If you are not ready to submit your decision, click on the “Save” button at the bottom of the screen so that you do not lose the information you entered).