Dear Clinical Documentation Improvement (CDI) professional,
The Association of Clinical Documentation Improvement Specialists (ACDIS) is currently seeking speakers to present at the 2015 ACDIS eighth Annual Conference, to be held May 19-21, 2015 at the San Antonio Convention Center in San Antonio, TX.
Is that special person you or a colleague?
We seek speakers to present on all aspects of clinical documentation improvement. Advanced CDI sessions that push the profession forward are particularly welcome. Based on the learning needs identified by participants of the successful 2014 ACDIS Conference, several topics have emerged as areas of great interest within the ACDIS community. We are seeking potential speakers for the 2015 ACDIS conference with expertise in the following tracks and sessions:
Track 1: Management and leadership
- Metrics: Selecting metrics to measure individual and program progress, analysis and interpretation of data, and presenting to administration
- Managing CDI staff, including training new CDI, establishing career ladders, auditing staff, and rewarding high performers/managing under performing CDI specialists
- Coverage of floors/CDI specialization by service line
- Remote CDI: Management and operational issues
- Dual coding and CDI, including benchmarking, team building, and education plans
- Electronic health records, including implementation, battling note bloat and copy/paste, managing problem lists, etc.
- Engaging physicians in CDI
- Educating physicians (veteran docs, first year residents, etc.)
- Principles of effective leadership
Track 2: Clinical and coding
- Coding Clinic and Official Coding Guidelines updates
- Surgical procedures (CDI/coder with surgeon co-presenters welcomed), emphasis on ICD-10-PCS
- Complex diagnoses in ICD-9/ICD-10 (i.e., functional quadriplegia, respiratory failure, acute kidney injury, neurology/encephalopathy, etc.)
- Advanced chart review techniques, including interpreting subtle clinical indicators
- Complications of surgery vs. inherent to procedure
- Dealing with unsupported diagnoses in the medical record
- ICD-10 preparation
Track 3: Quality and regulatory initiatives
- Reviewing for Patient Safety Indicators
- Reviewing for Hospital Acquired Conditions and Present on Admission
- Value Based Purchasing
- Readmission Reduction program
- Utilization review and CDI (medical necessity, 2 Midnight Rule, CMS Hospital Admission Reduction Program, etc.)
- Hierarchical condition categories (HCCs)
- Mortality/retrospective reviews
- Recovery Auditor and denials management
- Incorporating core measures (i.e., CMS Quality Measures) into CDI review
Track 4: Innovative CDI
- Revenue cycle: Overview and its relationship to CDI
- Outpatient CDI: Definitions (ER, observation, ambulatory surgery, clinics, etc.), starting/implementing a program, and defining metrics for success
- Other settings, including Long Term Acute Care, inpatient psychiatry, critical access, etc.
- CDI in the ED
- Physician advisor specific sessions
- Risk models (Healthgrades, Leapfrog, etc.)—a review of their formulas and using them to promote physician buy-in
- ACOs, healthcare reform, and the future of CDI
Note: If you don’t see your hot topic listed here, please write and let us know what expertise you can bring to the podium! Original ideas not included above are welcomed.
Submission form and deadline
Please click this link, complete the form, and submit it to us no later than end of day Friday, Sept. 5. Speakers are welcome to submit more than one session, but must fill out a separate form for each submission. Conference sessions are typically one hour in length. Selected presenters will be expected to submit materials at a later date.
Please be sure to complete all the fields. Leaving the form open for a lengthy period may cause it to “time out,” so you may wish to draft your submission in a separate word document and paste it into the appropriate fields to ensure proper transmission.
We look forward to hearing from you! If you’d like more information or wish to discuss a speaking topic, please e-mail ACDIS Director Brian Murphy.
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 3, 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.
When I started learning how to be an educator, I quickly learned the saying “seven times, seven ways.” The idea being we need to hear information repeatedly and receive it in a variety of ways before we are able to learn and incorporate that information in our daily practice.
Consider querying for clarification between renal insufficiency and renal failure, where the physician reads the query and asks you to just tell him what he should write. I would not start explaining the differences within the code set applied to these two terms or enter into a lengthy conversation about why the specificity is needed. Instead, point out the clinical indicators relevant to the patient as compared to the diagnostic criteria established for acute renal failure. Ask the physician to clarify if the kidneys are exhibiting failure or insufficiency based on the established criteria.
Stick to the facts. Keep it simple. Keep it relevant to the specific patient at the moment of conversation.
In this scenario, the physician needed a quick explanation. But let’s apply our “seven times, seven ways” theory by later following up on that interaction with an educational mailer or documentation tip via email to the physician. This second round of information could further highlight the needed differentiation and why this added level of specification is important to support issues such as extended length of stay, severity of illness, or resource consumption. Other ways to provide education include hanging posters in the physician lounges or documentation areas. I once even threatened to place fliers on a physician’s windshield!
The point is, that you may not always have the time (or the physician may not have the time) to engage in one-on-one education but you can use your physician queries as the first step in a more prolonged, detailed education campaign. We need to build upon each educational opportunity to reinforce the teaching. Repetition can be very valuable.
First into the Fix ‘em Up Clinic today is Jeff. He took part in a s’more eating contest at camp last night. I’ve personally never understood the appeal of burned marshmallows, but Jeff, well he was so determined to claim the s’mores title that he ate a few marshmallows that were a little too hot. As in, they were on fire. And while fire eating is fine for professionals, for a kid at camp, it’s not such a great idea.
Dr. Sunni Daze examines Jeff and documents burns to the mouth, pharynx, tongue, and lips. The burns of the mouth, pharynx, and tongue are easy. One code covers all three and it does not specify degree of the burn. Since this is Jeff’s initial visit, we would report T28.5XXA.
The lip burns require a little more information. We need to know what degree of burns Jeff suffered on his lips. Fortunately for him, Dr. Daze notes the burns are first degree, so we would report T20.12XA (burn of first degree of lip[s]).
ICD-10-CM does not include separate codes for the upper and lower lip, so T20.12XA covers one lip or both.
We also find the following note under pretty much all of the burn codes:
- Use additional external cause code to identify the source, place and intent of the burn (X00-X19, X75-X77,X96-X98, Y92)
We definitely need an X00-X19 code, which in Jeff’s case is X10.1XXA (contact with hot food, initial encounter).
The X75-X77 codes are for intentional self-harm. Overeating burning marshmallows doesn’t quite qualify as planning to hurt yourself. Jeff just got caught up in the moment.
The X96-X98 are codes for assault. Again, not applicable in Jeff’s case.
For our place of occurrence, we’ll use Y92.833 (campsite as the place of occurrence of the external cause). Notice we do not need a seventh character for this code.
Your Certified Clinical Documentation Specialist (CCDS) re-certification is due by the two-year anniversary of the date you passed the exam. You may re-certify at your convenience and if you need more time, there is a 45-day grace period.
For example if you passed the CCDS exam on August 1, 2014, you need to re-certify by August 1, 2016. Using the 45-day grace period, it will be due no later than October 15, 2016. To re-certify, you need to submit continuing education credits earned during the two year period that you held the CCDS certification (so, from August 1, 2014 to August 1, 2016).
When you are ready to renew, complete the re-certification application, and send it, along with proof of CEUs and the applicable fee, to the address on the application (mail, fax, or email). The application is available on the ACDIS website.
It is your responsibility to know when you recertification is due. We send several courtesy email notices as your renew date approaches, but you may not hear from us if we don’t have your correct email address or if our notices are blocked on your end. Make note of when your recert due date (your original exam date is on your certificate and on the score sheet you got when you took the exam). If you’re not sure of your exam date, drop me an email and I’ll look it up.
There is no current plan to restructure the CCDS re-certification requirements to include any specific number or level of ICD-10-related continuing education units.
The next ACDIS Quarterly Membership Conference Call is scheduled for Wednesday, August 27 (note: not typical Thursday), from 1 to2 p.m. Eastern. Dial-in instructions will be sent to ACDIS members this week (please check your spam filters and email permissions to ensure you receive important information from ACDIS about your membership benefits). If you are an ACDIS member and do not receive your dial-in instructions, contact Member Services Specialist Penny Richards at email@example.com.
These quarterly calls are a means for ACDIS members to network with one another and to discuss any CDI-related issues. We encourage your comments, thoughts, and questions during the call. If you have a question to ask the ACDIS advisory board, or general suggestions for discussion on the upcoming call, please email firstname.lastname@example.org.
Please note that due to heavy call volume, we recommend you dial in 10 minutes early.
The new pediatric listserv message board was finished this week. It works just like CDI Talk and can be accessed on the CDI Talk page. For those of you unfamiliar with CDI Talk, simply subscribe using the button on the page.
Once approved, you can visit the Talk group and adjust your settings via the “my account” tab. You can chose to receive messages in your email as they are submitted or pick a different option that works for you, such as a daily or weekly digest of messages.
A lot of work went into the creation of this service and we appreciate the help of our technology and design team here at ACDIS for bringing this wonderful idea to fruition. We hope you all get a lot out of the ability to network with each other on a more continuous basis via this great new membership benefit.
Reminder: Now through August 31, current ACDIS members are encouraged to refer a colleague to ACDIS and receive 25% off your next membership renewal fee. Should your colleague join, they receive a discount, too. Look for additional details coming soon to your inbox.
The Kentucky and Southern Indiana ACDIS chapters join for their annual group meeting Wednesday, August 20, from 1 to 4 p.m., at Baptist Health in Louisville. Topics include hepatorenal and cardiorenal syndrome. RSVP to Rita Fields at email@example.com.
The Southwest Ohio ACDIS Chapter will hold an informal gathering and cookout later this summer. If interested, email Kay Kolb Huber at Kay.Huber@khnetwork.org.
The Maryland ACDIS Chapter meets Friday, August 22, from 1 to 3 p.m., at the Maryland Hospital Association Headquarters in Elkridge. Contact Andrea Norris at ANorris@uchs.org for information.
The Tennessee ACDIS Chapter meets Friday, August 22, at TriStar Division office, 110 Winners Circle, Brentwood. For information, email Sherri Clark at firstname.lastname@example.org.
The Northern Illinois ACDIS Chapter meets on Wednesday, August 27, from noon to 3 p.m., at Northwest Community Hospital. For information, email Nancy R. Ignatowicz at NRMIgnatowicz@comcast.net or Colleen Stukenberg at CStukenberg@fhn.org.
The Minnesota ACDIS Chapter meets Wednesday, August 27, from 1 to 2 p.m., via teleconference, hosted by St. Cloud. For information, email Tracy Boldt at email@example.com; Barbara Smith at bsmith7@Fairview.org; or Laurie Engeldinger at Laurie.A.Engeldinger@HealthPartners.com.
The South Carolina ACDIS Chapter meets Friday, September 5, 9 a.m. to 3:30 p.m., at Providence Hospital in Columbia. The agenda includes:
- Registration/Check in
- Welcome/Chapter Business
- CDI Pre-Bill Review Process, Mary Hopkins, MSHI, RHIA, HCA, Division Manager, CDI
- Managing Psych Diagnoses in CDI, Bradley Clayton, MD, Providence Hospital
- CDI Reporting/Department Metrics, Kay Blue, RN, BSN, ACM, IQCI, Regional Director of CDI, Carolinas Healthcare
- Pressure Ulcers and Debridement, Elizabeth Jones, RN, CWOCN, CFCN, Providence Hospital
- Compliant EHR Systems: CDI Tasks to Ensure Medical Record Accuracy, webcast, HCPro
The South Carolina ACDIS Chapter also seeks nominations for two open positions on the leadership board—secretary and vice president. Cost is $10; $20 for non-members, lunch and CCDS CEUs included. For information, email PJ Floyd at firstname.lastname@example.org.
The Colorado ACDIS Chapter meets Wednesday, September 17, 4:30 to 6:30 p.m., at Lutheran Medical Center, Learning Center Room 1, 8400 W. 38th Ave., in Wheat Ridge. For information, email Natalie Esquibel at email@example.com.
Complex metrics regarding physician response rates and staff productivity help the CDI manager quantify the CDI program benefits to facility administrators and to CDI program staff when presented properly. The manager helps communicate facility priorities to his or her team and to illustrate the needs of the CDI department to hospital administrators. Furthermore, the manager must maintain awareness of any changes in government regulations and industry guidance. Changes in the larger industry will affect the CDI team’s productivity, and any metric must be discussed within the context of these changes.
The manager should review not only the percentage of charts examined by the team, but also the number and type of queries needed each month. It is important to document the outcomes of these reviews. The aggregate data can then be used for process improvement and to support corporate compliance activities. The following is a list of items to review routinely and share with the compliance committee and administration when relevant.
- Trends in types of queries: one condition being queried routinely (e.g., a type/phase of congestive heart failure [CHF])
- Trends by physicians: multiple queries to the same physician regarding the same condition (e.g., a physician continuing to use the term urosepsis after repeated queries and communication as to the need for further specificity)
- Trends by individual CDI specialists (e.g., a CDI specialist continuously querying for specification that is already documented in the chart)
A change in ICD-9-CM Official Guidelines for Coding and Reporting may affect the query percentage for a period of time. A good example is the increased documentation specificity required for heart failure when coding guidelines were revised and reindexed to allow for greater specificity in reporting the phase and specific type of heart disease. Prior to the implementation of MS-DRG, it was only necessary for the physician to document “heart failure” or “CHF.” Both terms were considered CCs.
If one looks back far enough, many CDI teams’ data show a surge in queries for the period of time immediately prior to and following the implementation of the MS-DRG system.
In summary, team performance cannot be determined solely through measurement of query volume. Many factors influence this indicator and it should not be used to determine a program’s effectiveness, but rather should be used as an indicator of opportunities for improvement (e.g., physician education, form revision) or performance improvement over time.
Q: How would the following be viewed if it was included in a cardiology consult note:
“Mr. X has paroxysmal atrial fibrillation. He had a recurrence last night which was asymptomatic. We think this happens all the time at home. This is not a pacing post-conditioning (PPC). He is back in normal sinus rhythm (NSR). I would restart his warfarin if Dr. Y will allow. Goal International Normalized Ratio (INR) is 2-3.”
A: Because code assignment can be based on documentation of other physicians (e.g., consultants, residents, or anesthesiologists) that note meets criteria for a secondary diagnosis and doesn’t conflict with the attending physician. I can see where this case could be tricky, since it looks like the condition did not require further evaluation or diagnostic testing, and did not increase nursing care or increase the length of stay. However, the cardiologist did want to restart the patient’s warfarin and if that occurred during this admission, then it would be treatment and make it a reportable condition. This could be a vulnerable claim if the physician does not document the atrial fibrillation in the discharge summary, with the need for continued follow up-care regarding the warfarin and/or if the paroxysmal atrial fibrillation is the only CC.
Editor’s Note: Sharme Brodie RN, CCDS, AHIMA-approved ICD-10-CM/PCS trainer, CDI education specialist and CDI Boot Camp instructor for HCPro in Danvers, Massachusetts, answered this question. For information, contact her at firstname.lastname@example.org. For information regarding CDI Boot Camps offered by HCPro, visit www.hcprobootcamps.com/courses/10040/overview.
The Association of Clinical Documentation Improvement Specialists (ACDIS) is sponsoring the fourth annual Clinical Documentation Improvement Week on September 15-19, 2014. As part of the week’s offerings, we are providing an industry outlook survey on a handful of hot topics, with a special focus on quality. The summary results of the survey will be made publicly available.
Please take a few minutes to complete the 40-question survey by clicking here.
If you cannot access the survey, please copy and paste the following link into your web browser: https://www.surveymonkey.com/s/LV5T3YJ
Thanks for your participation, and if you have any questions about the survey or Clinical Documentation Improvement Week don’t hesitate to email ACDIS Director Brian Murphy at email@example.com.