RSSRecent Articles

TBT: Training new staff? Consider the following tips

Become a CDI mentor and help new CDI specialist understand the value of the role they play.

Help new CDI specialists understand the value of the role they play.

Editor’s Note: In social media memes Throw-back Thursday generally means sharing an old high school photo, something you wish had been left unpublished–like your 80s bouffant or 70s bell bottoms. We thought we’d pick up on the theme and occasionally go back into our CDI archives to highlight some salient CDI tid-bit. This week’s installment comes from the January 2011 edition of the CDI Journal.

By some estimates, there are upwards of 4,000 CDI specialists working at hospitals across the nation. As pay-for-performance initiatives increase and ICD-10 implementation becomes a reality, even more facilities will recognize the important role CDI plays in today’s healthcare system. But as the value of CDI staff increases, so does the demand for their services. As a result, few managers will have the luxury of hiring staff with concurrent record review experience.
Thus, once you hire new staff, you need to determine how to train them. First, hire the right person for the job, says Melanie Halpern, RN-BC, MBA, CCDS, CCRA, CDI manager at University of Medicine and Dentistry of New Jersey. For Halpern, that means someone with a strong clinical background. “I don’t want to have to stop and go back over basic clinical information when training,” she says.
The best scenario, of course, is finding someone who already has experience in CDI. Barring that, look for someone with experience in abstracting information from the medical record, such case managers or utilization review nurses, says Deborah Dallen, RN, clinical documentation coordinator at Albert Einstein Medical Center in Philadelphia. Dallen trained a new CDI staff member who previously performed utilization review for Blue Cross. Although Dallen has been a CDI specialist at Albert Einstein since the program’s inception eight years ago, she came to CDI from a career in case management.
“I tell [new hires] that their previous experience will really help them in this role,” she says. “Of course, once they’re here, they think none of that experience applies. They think we’re crazy for hiring them. Eventually, the [understanding] clicks and they make the connection between their previous role and their new responsibilities in clinical documentation improvement.”
Begin by analyzing your new hire’s strengths, weaknesses, individual personality traits, and learning preferences. “You have to know where they are coming from,” says Halpern.
Even if the new hire is an experienced nurse who understands core measures, “you can’t just throw him or her a problem list and set them to the task,” she says. To get new staff excited, encourage them to use their experience to enhance the program, says Halpern. “Start with the individual’s strengths and illustrate how their specific strengths can help the program,” she says. In that way you “get them interested, excited about how they can help.”
Sandy Beatty, RN, BSN, CCDS, clinical documentation specialist at Columbus (IN) Regional Hospital, asked coworkers how they wanted to learn; not surprisingly, she received different responses from each new team member. One wanted to shadow Beatty as she worked through her day and then be shadowed in turn. Another wanted to take on the task by herself and have Beatty examine her efforts, like a student turning in a paper to a professor.
“If you are a manager, you need to understand basic adult learning principles,” Halpern says. “You cannot hammer people with information for eight hours a day.”
Dallen devotes at least two half-days per week to one-on-one training with new staff. She also employs a variety of other strategies, including hands-on learning, job shadowing with both CDI and coding staff, independent learning via reading materials, and reinforcement through repetition. To keep track of her efforts, Dallen developed a staff orientation checklist, which sets satisfactory comprehension of basic CDI functions at 90 days.
It may take up to a year for a new CDI specialist to become fully comfortable with their new role, but for competency, a six-month expectation is fair, says
Colleen Stukenberg, MSN, RN, CMSRN, CCDS, clinical documentation management professional at FHN Memorial Hospital in Freeport, IL. By the end of six months, you should be well beyond teaching the specialist about coding and query basics. By then, “you should be able to introduce new concepts and have them really working as a member of the CDI team,” Stukenberg says.
Editor’s Note:Don’t spend time creating training materials from scratch. ACDIS’ acclaimed CDI Boot Camp instructors have created The Clinical Documentation Improvement Specialist’s Complete Training Guide to serve as a bridge between your new CDI specialists’ first day on the job and their first effective steps reviewing records.

Q&A: Atelectasis query for secondary diagnosis

Have a question that is troubling you and your team? Ask us!

Have a question that is troubling you and your team? Ask us!

Q: When atelectasis is noted on an ancillary test such as a CT-scan of the abdomen or chest x-ray can nursing documentation of turning, coughing, and deep breathing considered an intervention that qualifies as one of the criteria to meet a secondary diagnosis?

A: In order to answer your question more information surrounding the circumstances of the encounter would be required. Atelectasis is usually considered an integral condition when it occurs following surgery because the turning, coughing, and deep breathing is typically routine protocol for this type of patient.

There are specific guidelines for coding conditions that may be an integral part of a disease process. If the condition is routinely associated with the disease process or procedure and no additional monitoring or treatment is ordered to evaluate the condition then the additional code would not be separately assigned. If the attending provider orders additional monitoring or treatment to evaluate the condition, such as continued x-rays to monitor the progress and resolution of the Atelectasis, it would be a reportable condition. Some other examples of integral conditions would be an “ileus” following bowel surgery, or “pleural effusions” in a patient with congestive heart failure that is not aggressively treated.

Before we assign a code for a secondary diagnoses, we need to ask ourselves, does it meet UHDDS criteria for a secondary diagnoses? The CDI specialist needs to determine if the condition required:

  • Clinical evaluation
  • Therapeutic treatment or a diagnostic procedures
  • An extended length of stay
  • Increased nursing care and/or monitoring
  • Is it supported by at least one clinical indicator

Additionally, consider whether:

  • Other providers would arrive at the same conclusion/make the same diagnosis?
  • The diagnosis integral to another condition?
  • This diagnosis relates to this episode of care?
  • The diagnosis was documented by a treating provider?
  • There is a conflict with the attending provider?

Since abnormal findings (laboratory, x-ray, pathology, and other diagnostic results) are not coded and reported unless the attending provider indicates their clinical significance you first need to ensure the finding is a reportable diagnosis before you can query for the associated diagnosis to be added. If findings are outside the normal range and the attending has ordered other tests to evaluate the condition or prescribed treatment, it would be appropriate to query the physician to have the clinical significance clarified and diagnosis added.

Editor’s Note: CDI Boot Camp Instructor Sharme Brodie RN, CCDS, answered this question. Contact her at sbrodie@blr.com. For information regarding CDI Boot Camps offered by HCPro visit www.hcprobootcamps.com/courses/10040/overview.

CDI Week Cartoon Caption Contest

It is time for the CDI Week Photo/Cartoon Caption Contest. Post your (tasteful and respectful please) suggested captions for the following cartoon in the comments section and ACDIS Members Services Specialist Penny Richards will chose a favorite to win a prize.

Cartoon 6

Share your love of ACDIS: Refer a friend

Join ACDIS. Get the Journal. Get informed.

Join ACDIS. Get the Journal. Get informed.

As an ACDIS member, you’ve come to rely on the in-depth Forms and Tools Library, the quarterly CDI Journal, quarterly conference calls, and invaluable networking opportunities. Now it’s time your colleagues enjoyed these benefits too!

Now through September 30th, refer a colleague to ACDIS and receive 30% off your next book, newsletter, webcast, or video purchase on www.hcmarketplace.com.* The process is easy, and you’ll receive your discount regardless of whether or not your colleague joins!

*Upon submission of your referral, you’ll receive a discount code via email to use towards your next book, newsletter, webcast, or video purchase on www.hcmarketplace.com. This discount expires October 16, 2014 at 11:59 p.m. ET. Discount cannot be combined with any other offers.

Don’t just tell your colleagues about ACDIS, refer them!

CDI Week Photo Caption Contest

Here’s the next CDI Week Photo/Cartoon Caption Contest. Post your (tasteful and respectful please) suggested captions for the following photograph in the comments section and ACDIS Members Services Specialist Penny Richards will chose a favorite to win a prize.

 

Pic 6

CDI Week Photo Caption Contest

Here’s the next CDI Week Photo/Cartoon Caption Contest. Post your (tasteful and respectful please) suggested captions for the following photograph in the comments section and ACDIS Members Services Specialist Penny Richards will chose a favorite to win a prize. This one also comes from the 2014 ACDIS National Conference!

 

Pic 4-2

CDI Week Photo Caption Contest

It is time for the CDI Week Photo/Cartoon Caption Contest. Post your (tasteful and respectful please) suggested captions for the following photograph in the comments section and ACDIS Members Services Specialist Penny Richards will chose a favorite to win a prize. This one comes from the 2014 ACDIS Conference in Las Vegas!
Pic 5-2

CDI Week Cartoon Caption Contest

It is time for the CDI Week Photo/Cartoon Caption Contest. Post your (tasteful and respectful please) suggested captions for the following cartoon in the comments section and ACDIS Members Services Specialist Penny Richards will chose a favorite to win a prize.

 

Cartoon DRGs

Free Optum webcast rescheduled for CDI Week; additional free webinar on PSI and CDI offered

Join us this for these free audioconference/webinars

Join us this for these free audio conference/ webinars.

Natural language processing (NLP), an emerging technology for CDI professionals, can help drive clinically relevant queries and optimize physician engagement in your CDI program. Learn how Optum360™ case finding technology, powered by LifeCode® NLP technology, can transform your CDI program during this free one-hour webinar on September 17, 1 to 2 p.m. ET.

Join Kelly Gates, RN, MHA, CCDS, and Tom Darr, MD, as they showcase the “next generation” of CDI software, expanding on how technology can perform checks and balances between documented diagnoses and clinical indicators. This enables CDI specialists to quickly and efficiently review potential query opportunities. Clinical indicators identified by the technology route to the CDI specialist for review, and are automatically included in the physician query. These new tools optimize manual tasks, and result in improved response and adoption by physicians.

Click here to learn more about this webcast.

In addition, to kick off CDI Week, ACDIS is offering a 60-minute free webcast on Tuesday, September 16, at 1 p.m. (ET) regarding the role of CDI specialists in review of Patient Safety Indicators (PSI) on a concurrent basis. Join Cheryl Ericson, MS, RN, CCDS, CDIP, AHIMA-Approved ICD-10-CM/PCS Trainer, as she explains PSIs and their function as well as the CDI specialists’ role in their review. The program will also take a deeper dive into PSI 90 to help CDIs focus on the required documentation elements in the medical record and provide practical tips for working in conjunction with quality.

If you have any questions, please contact our customer service department at customerservice@hcpro.com or call 800-650-6787.

TBT: CDI input helps EHR implementation succeed

Learn how new technologies will affect CDI efforts in this week's free webinar.

CDI involvement in EHR implementation is key.

Editor’s Note: In social media memes Throw-back Thursday generally means sharing an old high school photo, something you wish had been left unpublished–like your 80s bouffant or 70s bell bottoms. We thought we’d pick up on the theme and occasionally go back into our CDI archives to highlight some salient CDI tid-bit. This week’s installment comes from the April 2012 edition of the CDI Journal.

“We saw the EHR train as it was whisking by. We were shouting ‘Wait! Wait! What about CDI?’ ” says one CDI specialist. “They didn’t know CDI existed. The [implementation team] hadn’t thought about us and how we interact with the record or what we might need from an electronic system. So now we’re trying to play catch-up and do the best we can with what we’ve got.”
CDI specialists probably think phrases like “interoperability” and “meaningful use” need not cross their minds—EHR implementation belongs in the hands of the IT or HIM department, right? The answer to that question is yes and no, says Barbara Hinkle-Azzara, RHIA, (formerly) Vice President of Operations for Meta Health Technology in New York City. The individual end-user (i.e., the CDI specialist reviewing medical records on the hospital floor) “may not need to be involved in ‘checking off the boxes’ to certify meaningful use is met, but certainly adapting to an EHR and adhering to meaningful use requirements affects the information CDI professionals review and how they will ultimately perform their jobs.
“EHR systems will change the CDI specialists’ experience,” she says.
A CDI program director or physician champion can play a pivotal role in the implementation of initial and ongoing assessment efforts for EHRs and their components, says John Pettine, MD, FACP, CCDS, CDI director at Lehigh (PA) Valley Health Network.
“CDI staff should get involved and do it now before it is too late. Otherwise, CDI professionals are at the mercy of decisions made without their input, which can be tragic to the success of the program going forward into ICD-10,” he says.