Recent Articles
Determining the benefit of flesh-and-blood CDI vs. computer-assisted coding
Don't fear advent of computer assisted coding.
I received an interesting question following the February ACDIS Quarterly Conference Call about the impact of new technology on the CDI profession. It read: “Do you think computer-assisted coding (CAC) will reduce or eliminate CDI jobs?”
Several members of the ACDIS advisory board formulated answers worth sharing (read a few of their comments in the April edition of the CDI Journal.)
Here’s how I feel about CAC. It can be a valuable tool in the box of a CDI specialist, like a hammer or saw, but it does not replace the CDI specialist. At times I too react to new technologies with skepticism and defensiveness, wondering if this or that new gadget will sound the death knell for my own job. But machines will never replace the human element.
In short, summarizing the sentiments of the ACDIS Advisory Board:
- As long as physicians require education as to why accurate, complete, and legible documentation is important, CDI will be here to stay.
- As long as doctors respond to a face instead of an electronic prompt, CDI will be here to stay.
- As long as medicine remains part art and part science, CDI will be here to stay.
In short, CDI is not going anywhere anytime soon. View these new technologies as a new and exciting challenge to master, not as an enemy to fear. What do you think about CAC and the impact it will have on CDI? Send me an e-mail with your thoughts.
Conference Q&A: ‘CDI Career Ladder’
Want to climb the CDI career ladder? Two ACDIS speakers will tell explain how during today's presentations.
Editor’s Note: This post is part of an ongoing series of Q&As with presenters and participants from the 2012 ACDIS Conference in San Diego. The following features Jennifer Love, RN, BA, CCDS, and her co-presenter Janet Gentle, RN, BSN, MSN, CCDS on the presentation “CDI Career Ladder: Two Perspectives,” which takes place today, Thursday, May 10, 3:15-4:15 p.m.
Q: How long have you been a CDI professional?
JL: In 2008 I was hired as the manager of CDI for Novant Health. In 2011, I became the area director of Clinical Documentation Improvement for Kindred Healthcare.
JG: Seven years.
Q: What inspired you to follow this career path?
JL: When I was a Surgical Care Improvement Project analyst at Novant, my senior director informed me that the hospital system was considering implementing a CDI program. In discussions that followed, I was allowed to purchase The Clinical Documentation Improvement Specialist’s Handbook. I read that book cover-to-cover! I was hooked! CDI was something fresh; a new challenge which definitely sparked my interest. I was hired as the manager of Clinical Documentation Improvement and the CDI program was implemented shortly thereafter.
JG: We had consultants who were brought in to redesign our case management (CM) department and establish a CDI program. They encouraged me to interview for the dual CM supervisor/CDI position which, within three years, turned into a full-time CDI position.
Q: What should someone who is interested in becoming a CDI specialist do to begin their career?
JL: I’d recommend they read The Clinical Documentation Improvement Specialist’s Handbook, too, or check out the ACDIS website before making the leap. I would also encourage them to get approval to shadow current CDI specialists.
To take the CDI career path, the individual should be very attentive to detail, e computer savvy, and possess clinical expertise. To take on this career, the individual will be required to communicate effectively to everyone from coders to physicians. I’d also tell them to be honest with themselves regarding their weakness and strengths. If the CDI role plays up your strengths—go for it! I wish you the best of luck! Give yourself time to master this role, however. It will take months before you will feel truly competent. One more thing, you will make mistakes. No one in this field is perfect.
JG: Definitely research the CDI role first. And take part in ACDIS/AHIMA educational opportunities. In fact, join ACDIS/AHIMA on either the national or local level for educational and networking opportunities. Attend conferences/educational programs such as Boot Camps and look for an entry level position with a facility that will help train you.
Of course someone looking to advance their CDI career should be able to research best practices to improve current processes, know how to monitor effectiveness via internal audit/productivity measures, understand the importance of developing policies and procedures. There are other ways to advance your career, too. Those on the cutting edge of this profession know how to develop ICD-10 compliant queries or have become involved in their local ACDIS chapter.
Additional opportunities exist down some unexpected avenues such as CDI travel assignments and remote CDI at home, etc.
Q: If a CDI professional has been working in the field for a few years what steps should they take to advance their role, program, and/or career?
JL: Don’t let yourself stagnate. Always be reading something or pursuing something for your professional growth. Don’t rely solely on your employer to sign you up for conferences, classes, etc. Take the initiative yourself and your employer will take notice. Also, if you are interested in an opportunity for advancement—speak up! Your boss can’t read your mind. Once you’ve shared your interest, your boss then starts ‘grooming you’ for the next big thing. You never know!
JG: Develop a CDI team leader/coordinator position and consider yearly salary market adjustments in addition to raises. Look for reimbursement for conference attendance and tie that attendance to team education and CDI program process improvements. There are increasingly opportunities in collaborative environment and autonomous practice
Q: What steps can a CDI manager take to help staff members feel there are opportunities for advancement at their own facility?
JL: One thought is to implement a CDI career ladder program. Another thought is to encourage the employees to build relationships with quality, HIM, case management, and other related departments within the facility as opportunities for advancement may exist and/or open up in one of them. The specialized experience of a CDI professional along with the other skills one possesses would make for an appropriate transition during a needed time of new projects, etc.
JG: As mentioned earlier managers need to provide different educational opportunities and tie those opportunities to overall process improvements within the program. Empowering staff to take ownership of their own career is also important.
Q: What are you looking forward to most at this year’s ACDIS conference?
JL: I look forward to seeing the beautiful city of San Diego, those familiar smiling faces, and taking away at least one pearl of wisdom that will take me to the next level of CDI expertise.
JG: Presenting about career ladders! I am also looking forward to all the networking opportunities the great educational opportunities. Our local chapter the Michigan ACDIS is having dinner together on Wednesday night and then Friday I’m looking forward to the great Local Chapter Networking Lunch and Event. Of course, I’m looking forward to the sunshine and visiting the Pacific Ocean.
Q: What inspired you to become an ACDIS conference speaker?
JL: I felt compelled to share valuable insight from my recent CDI career change with my ACDIS colleagues. I wanted others who may be considering a CDI job change to be even more equipped and informed than I was during my job search.
JG: I am very passionate about creating a career ladder for nurses in alternative practices, such as CDI. Historically, clinical ladders have been developed for bedside nurses. The development of the specialty ladder at Northern Michigan Regional Hospital was innovative and based on original literature search, and it has afforded all NMRH nurses equity and opportunity for professional advancement.
Visit the poster presentation at ACDIS in San Diego
ACDIS attendees take in the information at the 2011 conference poster presentation. This year nearly 24 presentations are being offered.
If asked, could you describe your CDI challenges and successes on a 36 X 48-inch poster? Some of your peers have done just that and will boast their programs at the 5th Annual ACDIS Conference 2012 ACDIS Poster Presentation in San Diego.
The posters are a visual snapshot of program successes and offer you the opportunity to take tried-and-tested ideas back to your facility. Along with their posters, each presenter will provide a one-page description of the poster and the program it showcases.
Posters will be on display in the Elizabeth Foyer, outside the main conference and exhibit halls. We will be setting up later today, Wednesday, May 9, at 4 p.m., and a few will be installed early Thursday morning.
If you are attending this year’s conference, please make time to stop and view the posters, talk to the presenters, and ask questions. Your peers walk the same path you do and they can be an invaluable source of guidance.
If you cannot attend, don’t worry, we will be taking photos of the presentations and compiling a special report after the program so you can see all their hard work.
This year there are nearly 24 different presentations! Here is a list of what you can expect to see:
CDI program history and growth
- Analyn Dolopo, University of California San Diego Health, CDI Program Success
- Lisa Romanello, CJW Medical Center, The GPS of CDI
- AnnMarie Wells, CMC Main, CDI Growth in Evolving Health Care Industry
- Lynette Whitley, CMC Northeast, Program History
- Margaret Scott, Baylor Health, Inpatient Documentation Improvement Program
- Valerie Bica, Nemours-Alfred Dupont Hospital for Children, Pedi CDI, not a Medicare Program
Educational/promotional lessons
- Joi Freeman, Kindred Healthcare, Monthly Newsletter to Clinical Staff
- Cynthia Ziblis, St. Alphonsus RMC, CDI Newsletters and Educational Flyers
- Tim Weister, Mayo Clinic Rochester, CDI Education for Providers and Medical Students
- Diane Clement, Maine Medical Center, Advertise Your CDI Program
Multi-disciplinary enterprises
- Donna McIvor, KP Northern California, Remote RNs in CDI
- Wendy Platt, Baxter Regional Med Center, Using your Physician Champion to Captain Rough Seas
- Ellen Mitchell, Lutheran Medical Center, Multi-disciplinary Effort to Improve Documentation
- Kara Masucci, Morristown Memorial/Atlantic Health, It Takes a Village to Reinvigorate the Program
Quality and mortality measures
- Michelle Johnson, Quality Metrics
- Alicia Gordon, Fletcher Allen, Mortality Scores and CDI Nurses
- Pam Florence, U Kentucky HealthCare and UHC, What Drives Mortality?
- Dawn LaRoque, Riverside Health, CDI Impact on Morality Scores
- Mary Shaughnessy, Northwestern Memorial, Mortality Metrics Improvement
Additional efforts
- Sylvia Hoffman, Hoffman Consulting, Avoid Leading Queries
- Tara Kreiling, St. Mary Medical Center, Solve the Documentation Puzzle
- Susan Tiffany, Robert Packer Hospital/Gurthie, Regional Network in Rural Community
And don’t forget to vote for your favorite poster on Thursday! You’ll get a ballot in your conference bag. The winner will receive a fabulous blue ribbon to hang on their poster and then take home as a forever reminder of the 2012 Poster Presentations.
Pre-Conference Q&A: ‘The Physician Advisor’s Role in CDI’
ACDIS Advisory Board member Trey La Charite, MD, co-presents a two-day preconference event regarding the role of the physician advisor in CDI efforts
Editor’s Note: This post is part of an ongoing series of Q&As with presenters and participants from the 2012 ACDIS Conference in San Diego. Today’s post features Trey La Charite, MD, ACDIS Advisory Board member and physician advisor for the University of Tennessee Medical Center who is co-presenting the ACDIS pre-conference session titled “The Physician Advisor’s Role in CDI: A collaborative approach for success.” The two-day session began today.
Q: How much time should a physician advisor dedicate to CDI efforts every week?
A: I hate to sound like I am deflecting but it truly depends on the size of the facility and the depth of the problem. If you have a big hospital and nobody ever writes anything in the chart, you have a lifetime’s worth of work ahead. If your facility only has 100 beds and most people already write reasonable notes, then you may only need just two to three hours a week.
In general, however, I would think that around 25 to 30 hours a month is a reasonable starting estimate with the understanding that this will likely grow as the wide-reaching effects of a CDI advisor are realized in the utilization review, quality improvement, compliance, and denial/appeal worlds.
Q: What are the top three reasons to employ a physician advisor who is specifically dedicated to documentation improvement?
- Although this paints physicians in a negative light, most physicians simply take education, direction, and suggestion better from other physicians. Unfortunately, many physicians will just not listen to a nurse, HIM personnel, or an administrator.
- CDI programs need a constant, positive, and visible example of someone “walking the walk” as opposed to just “talking the talk.”
- The need for tying a program to a face. The medical staff may take a new endeavor more seriously if they know this is “Dr. So-And-So’s program.”
Q: What are three of the CDI physician advisor’s primary tasks?
- Medical staff education
- Being a visible example of following all CDI principles (definition usage, creating excellent notes, etc.)
- Establishing program direction and providing guidance
Q: What is the greatest obstacle to hiring/employing a physician advisor?
A: The fear of being seen as someone who has been seduced by the dark side of the force (i.e. – administration in the C-suite).
Q: What are you looking forward to most about this year’s ACDIS Conference?
A: Learning from other CDI professionals how they achieve CDI success in their facilities.
Conference excitement: All that’s missing is ‘Jingle Bells’
ACDIS jingle bells. Anyone have suggestions for some CDI related lyrics?
It feels like the days leading up to Christmas to me. I just can’t wait to get to the ACDIS conference in San Diego.
I admit that part of the attraction is the chance to get out of the office for a few days, take a plane trip to a great city, and let someone else cook my meals and make the bed. I know my husband will miss me, but I’m confident he won’t starve in my absence.
But the real reason I can’t wait to get to the conference is to meet the people who are driven by such passion for the work they do as CDI professionals.
I joined the ACDIS team last fall, but have worked for the parent company for 12 years, mostly in the marketing department. I wrote promotional copy for ACDIS for years, including the launch pieces back in 2007. I assumed—probably like a lot of your non-CDI peers—that writing thorough, detailed documentation was a given and probably easily done. I couldn’t have been more wrong.
In my short tenure with ACDIS I’ve developed a new respect for the work CDI professionals do. I have a pretty good handle on the mechanics of my job as the member services specialist. I can help you get certified; stay certified; award CEUs for your chapter meetings; fine tune the language in applications, web posts, and handbooks; and chase down the glitches and hitches that complicate moments in a busy day.
Now it’s time for me to learn about CDI from your point of view. I want to build my understanding of how you do your job and understand the foundational knowledge you all have obtained through your experiences that make you vital to your facility’s success. I want to learn the rules and the guidelines, and how to apply them.
You’re with ACDIS so you can be the best CDI professional you can be. I’ve got a similar goal: to be your best support partner. Let’s give it our best shot.
May 6-12 is National Nurses Week! Let’s celebrate
The American Nurses Association (ANA) and nurses across the country are celebrating National Nurses Week, May 6
Florence Nightingale says Happy National Nurses Week!
-12. According to the ANA web site, National Nurses Week is celebrated annually from May 6, also known as National Nurses Day, through May 12, the birthday of Florence Nightingale, the founder of modern nursing.
ACDIS would like to pause for a moment and join the many voices that cheer in the nursing profession and the role such professionals fill. We support your tireless efforts, thank you for your skill and insight, and are blessed by your compassion and kindness.
Our ACDIS membership is approximately 75-80% RNs that have since moved into CDI, but it’s certainly true that once a nurse, always a nurse.
May the next year bring you personal and professional success and satisfaction!
Crossing CDI program boundaries
What will it take to push your program beyond its artificial boundaries?
What new boundaries are CDI professionals exploring? CDI specialists discussed several areas of expansion during the 2011 CDI Week celebrations last September. You can read about them in the special CDI Week Q&As and in the CDI Week Industry Survey, which are still available on the ACDIS website. CDI professionals also frequently explore the boundaries of the CDI profession on the ACDIS Blog and on CDI Talk discussion strings.
And I know that those fortunate enough to attend the ACDIS conference in San Diego next week will certainly learn about new documentation improvement opportunities. Come to think of it, the conference has such good ideas every year—and a good idea doesn’t truly get stale—you should take a look back at conference materials from previous events to see what tips you may find and consider implementing.
Conversations regarding CDI expansion really should be considered aspects of program and organizational strategic planning. CDI managers need to consider where CDI specialists will focus their primary efforts over the next year, two years, even five years.
Yes, the regulatory environment governing healthcare is always changing and most CDI program directors can guess about how those regulatory changes will affect CDI, patient care, and the healthcare revenue cycle. But well-informed professionals can make some practical suggestions to position their CDI team appropriately for the future.
Warning, what follows is somewhat like throwing pasta against a wall—some ideas may simply fall and other ideas, like a good al dente macaroni will stick. Regardless, here are my thoughts about possible avenues for CDI program expansion.
CDI specialists should consider conducting record reviews for:
- Mortality/quality/length of stay/severity of illness profiling
- Surgical complications
- Hospital acquired and present on admission conditions
- Medical necessity support (both initial and ongoing stay)
- Evaluation and management documentation
Additionally, CDI programs may gain ground by exploring:
- Medicaid, third-party, private payer initiatives
- Outpatient CDI (e.g., emergency department, ambulatory, denials management)
- Documentation improvement opportunities in alternative settings such as long-term care, rehabilitation, psych, pediatric, and obstetrics units (ACDIS recently launched a new networking group dubbed APDIS-the Association for Pediatric Documentation Improvement Specialists)
- New government initiatives such as Value-Based Purchasing, Accountable Care Organizations, and payment bundling
- Proactive Recovery Auditor and external auditor defense
- Collaboration in development of clinical best practice, documentation, protocols, etc.
- Data mining and reporting (internal drivers and external reports)
- ‘Hardwire’ documentation improvement elements in EMR and IT systems
- Quality data versus coded data
- Why and where does a difference exist?
- What can be done to ensure both data sets are parallel and completely accurate?
- How can CDI contribute to clinical care and quality data measurements?
Of course, a number of previous posts directly or indirectly address exploring new CDI areas. As you investigate new ideas, try new things out, consider sharing with your professional colleagues—comment on CDI Talk, write a blog post, contribute a CDI Strategies quick note, or partner with other staff to write a CDI Journal article.
Pre-Conference Q&A: ‘The Physician Advisor’s Role in CDI’
James S. Kennedy, MD, will present a two-day pre-conference regarding the role and responsibilities of physician advisors for CDI.
Editor’s Note: Over the coming days and weeks, we will post a series of Q&As with presenters and participants from the 2012 ACDIS Conference in San Diego. Today’s post features James S. Kennedy, MD, CCS, ACDIS Advisory Board member and a director at FTI Healthcare in Brentwood, Tenn. Kennedy will co-present the ACDIS pre-conference event titled “The Physician Advisor’s Role in CDI: A collaborative approach for success.” The two-day session takes place Tuesday and Wednesday, May 8-9, 8 a.m. to 4 p.m.
Q: What role should CDI physician advisors play in audit review and data analysis?
A: Clinical Documentation Improvement (CDI) physician advisors are critical to the entire process of ensuring the integrity of coded administrative data (ICD-9-CM and CPT) and its application to physician and hospital quality and cost efficiency measurement.
CDI is the process of preventing and reconciling inconsistent, incomplete, imprecise, conflicting, or illegible documentation to bridge the gap between treating physicians and coders. Physician advisors must be able to analyze data derived from these codes to target their efforts and should review the results from documentation audits as to hone their message.
Examples of these activities include:
- Data Analysis: ICD-9-CM coded administrative data is primarily used to determine, measure, and report severity and risk adjusted outcomes and cost data for various metrics. These include cost, length of stay, complications, mortality, readmissions, and the like.
Risk and severity adjustment means that the actual metric being measured (observed) is compared to the likelihood of that metric occurring (expected). CDI ensures the integrity of the expected metric, usually increasing it since many clinical descriptions are incomplete or imprecise, thus reducing the risk-adjusted metric.
Take for example the Colorado Hospital Report Card. Note that Colorado reports an actual mortality rate and a “risk-adjusted” mortality rate. There are instances when the risk-adjusted mortality is less than the actual mortality since the death rate is less than expected. There are others, however, where the risk-adjusted mortality rate is higher than the actual.
Another aspect is measuring complications of care. Some facilities code incidental serosal tears as “accidental lacerations.” Physician advisors would want to analyze Patient Safety Indicator data at their hospitals (e.g. from Thomson-Reuters, the Delta Group, and the like) to determine if the data driving these metrics is accurate.
For example, look at the website “CareChex,” a division of the Delta Group, to see how it ranks overall surgical care in Chattanooga, Tenn.
Physician advisors should partner with their chief quality officer to learn how these risk-adjustment methodologies work and how the definition, diagnosis, documentation, and coding of these conditions factor into them.
Armed with this information, the physician advisor can help develop systems that work with providers to accurately capture these metrics.
- Chart Audit: Physician advisors are integral to the chart review, given that they recognize the clinical scenarios that are often not documented completely and precisely. Imagine a patient admitted with a pH of 7.02, pCO2 of 100 and a pO2 of 40 and stupor requiring mechanical ventilation but only described as respiratory insufficiency with CO2 narcosis. This patient has acute hypercapnic respiratory failure and could potentially be labeled as having a metabolic encephalopathy. The physician advisor recognizes these scenarios and can help concurrent reviewer and coders recognize the circumstances whereby query would be prudent.
AHIMA published a nice summary of the role of the physician advisor, and you read more about the role in the January edition of the CDI Journal.
Q: How can a physician advisor help achieve buy-in from the medical staff for CDI efforts?
A: The best ways I know to achieve buy-in from the medical staff are to:
- Make CDI an academic exercise, emphasizing the definitions of clinical conditions. These can include:
- Transient ischemic attack versus stroke. Note that the 24-hour time frame is completely eliminated.
- Acute myocardial infarction vs. accelerated angina. Note the critical role of properly calibrating troponins and equating elevated levels with “symptoms of ischemia.”
- Acute kidney injury. Note that it is only a rise of the serum creatinine of only 0.3 mg/dl
- Ask the quality officers of your hospitals to generate individual physician reports regarding their own cost efficiency and outcomes, outlining the actual and the expected outcomes. Should a physician see that their expected mortality rates is higher than expected and that CDI is a strong solution addressing the “expected” component, his or her participation and interest is likely to increase!
Q: How involved should the physician advisor be in the day-to-day operations of the CDI program?
A: Given that most physician advisors have their own private practices, they do not need to be involved with the direct day-to-day operations of initiating queries. They should, however, be available at designated times to support concurrent reviewers and coders regarding the clinical circumstances assessments of clinical situations requiring query and to aid in their construction.
If at times a physician does not respond, the physician advisor may potentially have a collegial conversation about a query. One must be cautious, however, to frame this conversation about defining a patient’s condition without putting the physician on the defensive.
One of the fun things a physician advisor can do is support the development of the electronic medical record as to make the capture of complete and precise documentation less onerous to the practicing physician.
Q: What are you looking forward to most about this year’s ACDIS Conference?
A: Wow….what’s not to look forward to? ACDIS is everything a CDI professional, coder, or physician advisor would want—clinical conversations, problem solving, medical informatics, and collegial interaction with like-minded individuals working to solve the challenges we all share.
It’ll be great to be with old friends and make new ones! Not to mention that all this occurs in downtown San Diego, in a phenomenal setting (this is a beautiful hotel), right next to Balboa Park (let’s rent a bicycle and ride!) and close to Sea World, the ocean, and all that makes southern California great!
I must say, however, that the most anticipated event for me is the Physician Advisor pre-conference where Dr. Trey LaCharité and I spend two days training physicians from all over the nation to understand and embrace CDI principles.
I feel that this contributes to the professional practice of medicine and empowers physicians to successfully negotiate healthcare reform. Needless to say, I’m very excited about the conference!
May meetings and June plans for local events
Maryland: The MDHIMA hosts its meeting 1-5 p.m., Thursday, May 3, at the Convention Center in Baltimore. The
Attendees of the April Dallas, TX, ACDIS meeting.
agenda features ACDIS Advisory Board member Robert S. Gold, MD, and discussion of CDI-related efforts including:
- Getting Medical Staff Interested in ICD-10
- Metrics of CDI
- Writing Effective Queries
For information, visit http://www.mdhima.org/ContactUs.html.
Alabama: The first ACDIS Alabama Chapter meeting takes place Friday, May 11, 10 a.m., at Capstone Village Retirement Community in Tuscaloosa. Breakfast and lunch will be served for $15 for those who RSVP. For information, contact Kim S. Murphy at 205/759-7371 or email kmurphy@dchsystem.com.
West Virginia: The newly formed West Virginia ACDIS Chapter holds its first meeting Monday, May 14, at 1 p.m., at CAMC Hospital in Charleston. For information, contact Sheila Harrison at 304/389-0689 or email Sheila.Harrison@camc.org.
Washington: The Evergreen (WA) ACDIS Chapter hosts a teleconference meeting Tuesday, May 15, 8-9 a.m. For information, contact Jennifer Woodworth at 206/215-2073 or email Jennifer.Woodworth@swedish.org.
Massachusetts: The Boston, MA AAPC Chapter hosts a CDI-related event Wednesday, May 16. Click on this link to learn more or to register.
Virginia: The VA ACDIS Chapter holds its spring meeting Saturday, May 19, 10:30 a.m. to 2:30 p.m., at Sibley Memorial Hospital in Washington, DC. Agenda includes:
- Networking, open items, discussion
- Presentation by 3M regarding Potentially Preventable Complications
- Lunch and networking
- ACDIS 2012 Conference recap
- Credentials for the CDI specialist: CCDS vs. CDIP
- CDI specialists in the IT department: Interaction with EHR design and implementation
- Business wrap-up
RSVP by Friday, May 11, for lunch. For information, contact meeting host Mark N. Dominesey at 202/660-6782 or email mdominesey@sibley.org. Those interested in additional chapter information can sign up for the Virginia ACDIS Yahoo group! http://finance.groups.yahoo.com/group/VA_ACDIS/
Connecticut: The CT ACDIS Chapter holds its meeting Thursday, May 24, 9-10:30 a.m., at the Hospital of Central Connecticut Bradley Memorial Campus. There will be a discussion of lessons learned during the 2012 ACDIS National Conference. For information, call MaryAnn Shanley at 860/714-1261 or email mshanley@stfranciscare.org.
Kentucky/Illinois: The next session of the Kentucky/Illinois ACDIS Chapter will be Thursday, May 24, 1-4 p.m., at St. Mary’s and Elizabeth Hospital in Louisville, KY. For information, contact Rita Fields at or email rita.fields@BHSI.COM.
June meetings
Florida: The Florida ACDIS meeting will be held on Friday, June 1, 9 a.m. to 3 p.m., at Jupiter (FL) Medical Center. Reservations requested by May 23 to Iris at 561/263-5783. For additional information, visit the Florida ACDIS Chapter website at http://flacdis.org/ or its Facebook page at http://www.facebook.com/acdisflorida.
Texas: The Austin/San Antonio ACDIS Chapter holds its first meeting Tuesday, June 5, at the University Medical Center Brackenridge in Austin. For information, contact Barbara Presley at 512/324-7679 or email bapresley@seton.org.
Georgia: The next meeting of the Southeast Chapter of the Association of Clinical Documentation Specialists will be Friday, June 15, 10 a.m. to 2 p.m., at Wellstar Kennestone Hospital in Marietta, GA. For information, contact Bonnie I. Epps at 404/712-4550 or email Bonnie.Epps@emoryhealthcare.org. Visit the Southeast Regional ACDIS Chapter Facebook page for announcements and other information.
Heartland: The new Heartland ACDIS Chapter (encompassing the region where MO, IL, KY, TN, and AR meet) will host its first annual meeting HealthPoint Plaza in Cape Girardeau, MO, on Friday, June 22, 5-7 p.m. Light refreshments will be served. For information, contact Sara Baine at 573/331-6932 or email sbaine@SEhealth.org.
Save the date
Kentucky/Southern IN: The KY and IN ACDIS Chapters will host a combined Regional Chapter Meeting on Thursday, August 23, 9 a.m. to 4 p.m., at Columbus Regional Hospital. For information, contact Susan Bradford at 317/776-7285 or email sbradford@riverview.org.
The clock strikes twelve…
Now that you have the extra time...
…and the documentation coach will turn into a pumpkin if you’re not on time. As a CDI specialist, what has been your approach to ICD-10? Are you hoping it will go away? Are you waiting for 2014? Are you preparing now?
Although the official start date for ICD-10 CM and ICD-10 PCS is expected to move out to October 1, 2014, the start of fiscal year 2015, most hospitals should be, and are, preparing now.
AHIMA has produced an ICD-10 checklist, with a detailed timeline and suggestions as to who should be involved at what stage of the process. CDI specialists aren’t specifically mentioned until the very end, as one group of the many users who will need ICD-10 education, but their role will be critical.
According to the timeline, you should have already looked at your physicians’ documentation to see if it will stand up to ICD-10 coding requirements, and should be developing and implementing strategies to address any weaknesses in that documentation. You can’t do that if you don’t know ICD-10. If you are not expert in anatomy and physiology (A&P), get refresher training now. While you are likely not coding the chart, you are ensuring that the documentation is sufficiently detailed to meet ICD-10 (especially PCS) coding requirements, and that means having expert understanding of A&P.
If your hospital hasn’t decided what changes to it needs to make in its electronic documentation processes, get involved. (See related articles CDI input helps EHR implementation succeed and E-nvolved: The case for planning EHR implementation available in the CDI Journal archives.) You are the experts on documentation requirements. It will be much easier to work the documentation requirements into your electronic system before implementation than to try to retrofit a process into an existing system later.
You may think it is too early to learn about ICD-10, or that if you learn it now, you will forget it by the implementation date because you are still using ICD-9. Think back to when you first learned the MS-DRG system and ICD-9-CM codes. How long did that take? Aren’t you still learning? Don’t you have to give yourself time to become competent so that you could educate your doctors?
Consider this: Everything you teach physicians about documentation for ICD-10 will improve their documentation under ICD-9. Your coders are not going to complain that you enabled the physician to be too accurate. When you send a query, physicians generally doesn’t know or care about the coding rule or the classification system that triggered the query. They just know they have to answer to the level of detail you’re asking, so start sending questions that generate ICD-10 compliant answers. When you learn ICD-10, you can start guiding your physicians in the right direction, and the official transition in 2014 will be much less painful.
I liken the preparation for ICD-10 to that, a little more than a decade ago, for Y2K. Some people feared disasters including nuclear holocaust, and when nothing happened on 1/1/2000, they were almost disappointed. In reality, the preparation had been impressively thorough and left nothing to chance. Although the world might not end if we aren’t ready for ICD-10, getting all the details covered before the official implementation date can make the actual conversion more like distant thunder clap than an Armageddon explosion.
Training seminars, boot camps, and books abound. Take advantage of everything that’s offered, and ask for training if you haven’t received any. If you’re just starting to train, review CMS’s overview of ICD-10. The World Health Organization offers an ICD-10-CM online training tool that’s free and easy to use.
As a CDI consultant, I knew that at some point I would be required to provide ICD-10 documentation education to new CDI specialists. So I decided to pull out the ICD-10-CM official guidelines and actually compare them side by side with the ICD-9 CM guidelines. Not only did I learn about ICD-10-CM, but I refreshed my knowledge of ICD-9-CM.
Then I began putting together a presentation on ICD-10-PCS, and by working my way through the definitions and the rules, I educated myself. By the time I finished creating my PowerPoint, not only did I have a greater understanding of the complexity of the documentation requirements, but I was able to code a simple procedure. I was very proud of myself, too! Now, I didn’t become an ICD-10 expert that day, but by challenging myself to work with it, I found it much less frightening and much less mystifying.
Please don’t wait for education to come to you. Please don’t wait for someone else to tell you what your CDI process should be. Put the “special” in CDI specialist.
