Providers Adjusting on the Fly as Hurricane Irma Sets Sights on South Florida

EDITOR’S NOTE: At this hour Laurie Johnson is at the Fort Lauderdale Airport awaiting a Southwest Airline flight that is expected to return her tonight to Pittsburgh, Pa.

BOCA RATON—Have you ever experienced preparations for a hurricane in a health information management (HIM) department? I just recently added this experience to my resume by working in south Florida as Hurricane Irma approached.    

The hurricane is currently 700 miles from south Florida and has recorded sustained winds of 170 mph – it was a Category 5 on Thursday afternoon and now a Category 4 today. Gasoline is in precious supply, the traffic on I-95 is very heavy, the shelters in Miami-Dade County are getting full, there are mandatory evacuations, and bottled water was getting scarce even on Labor Day. Publix is closing its stores on Friday evening and airports are closing in Miami and Fort Lauderdale then as well. This is a scary storm.

In ICD-10-CM, exposure to a hurricane is identified with code X37.0-. This is an external cause code that is listed as a secondary code that will identify all the injuries associated with the hurricane. According to the Official Coding Guidelines for the Coding and Reporting of ICD-10-CM, external cause codes have no national requirement for reporting. The seventh characters of “A,” “D,” and “S” are available as seventh characters. The “A” indicates active management. The “D” indicates that the patient is completing follow-up or aftercare of any injury that occurred due to the hurricane, while “S” indicates that the injury is due to sequela of the injury. If you remember from my past articles, all injury codes will be found in Chapter 19 and begin with letters “S” and “T,” which I memorize by the terms “simply traumatic.” The current injuries will be reported before the external cause code (or the X code).

Here are my recommendations for hurricane preparedness:

1. Communicate clearly your organization’s expectations to the staff. Everyone is trying to prepare for the hurricane, take care of friends and family, and work their job. This situation brings with it the potential to over-communicate. There should be communication from administration as well as from departmental management. It should include a phone, list including cell phone numbers, the organization’s emergency line, and any other important phone numbers. Encourage staff to check the emergency line frequently or the method that has been identified so that staff will know when to report.
2. Prepare early. Time goes by very quickly and there is much to do. It takes quite a while to prepare equipment and departments for potential damage. For preparations, tape and plastic are needed. Acquire these materials early.
3. Technology takes much time to prepare for transport. All the computers, printers, and fax machines must be covered with plastic and moved from the floor, if appropriate.
4. Consider wind and water damage. It’s the reason all important documents and equipment must be moved from the floor. Each staff member should remove any personal items that are valuable/sentimental to them. Turn bookshelves away from any windows and remove pictures from the walls. References should be packed and taken to a safe location. Remember that good back mechanics must be used during this packing process to avoid injury.
5. Identify medical records/documentation that have not been converted to electronic files. These must be moved into a secure file covered with plastic. These files are important, as they are the only version of the clinical documentation.
6. Plan a debriefing session after the hurricane. Identify what preparations worked and what procedures need updated. You may find as the hurricane approaches that your policies and procedures have not been updated since the last time, and the organization’s (and/or department’s) situation may have changed since the last hurricane.

HIM is the custodian of all patients’ protected health information (PHI). That duty cannot be forgotten, even in these times. That requirement is another reason the HIM department must be prepared well.  

Please keep all people impacted by Irma in your thoughts in the coming days. Be safe and limit your X37.0.