New Advisory Board members chosen

Susan Belley

Susan Belley, M.Ed., RHIA, CPHQ
Project Manager
3M HIS Consulting Services
Atlanta, GA
sebelley@mmm.com

A project manager within 3M HIS, Belley has more than 30 years experience in HIM performing a variety of roles in academic medical centers, multi-hospital systems, and teaching institutes ranging from 200 to 1,300  beds. She has direct experience in managing coding and data abstraction, auditing, accounts receivable (A/R), case mix index management, clinical documentation improvement, corporate compliance, quality management, converting computer systems (transcription, coding, and master patient index), and electronic medical record implementation.

Belley is responsible for development of new service offerings and content development for educational programs and software for 3M HIS Consulting. These include the ICD-10 Claims Impact Analysis, ICD-10 Modeling and Translation Services, ICD-10 Comprehensive Assessment and Roadmap Service, ICD-10 Documentation Assessment Service, and Clinical Documentation Improvement System software and data monitoring tools. These tools provide comprehensive case mix index and profiling analysis to assist hospitals in improving quality outcomes, ensuring the accuracy of performance reports, and achieving appropriate reimbursement.

Belley has taught coding for 20 years (ICD-9-CM, CPT-4 in an accredited HIM program) and is an experienced coding auditor for inpatient services. She holds a post-graduate certificate in Healthcare Corporate Compliance from George Washington University in Washington, DC.

Timothy Brundage, MD

Timothy N. Brundage, MD
Physician Champion
Kindred Hospital North Florida District
Tampa, FL
DrBrundage@gmail.com

Brundage has served as the medical director for case management and CDI departments for Kindred Hospital Central Tampa since 2004 and became the physician champion for its north and central districts in 2008.

At Kindred, he acts as a liaison between the case management department and the attending physician and helps to render opinions regarding admission status based on Interqual criteria and sound medical judgment. In addition, Brundage reviews patient charts selected for Medicare audits and prepares for admission audits and RAC record reviews.

Brundage is in active practice as a hospitalist at St. Petersburg (FL) General Hospital where he teaches resident physicians through daily hospital rounds, reviews their documentation, proofs their dictated history and physicals, discharge summaries, and progress notes. He is also a Diplomat of the American Board of Internal Medicine.

Fran Jurcak

Fran Jurcak, RN, MSN, CCDS
Director, CDI Practice
Huron Healthcare
Chicago, IL
fjurcak@huronconsultinggroup.com

Jurcak has more than 25 years of experience as a nurse, nursing professor, and consultant, with clinical experience in critical care and emergency medicine. Currently a director in the CDI Practice at Huron Healthcare, Jurcak has helped implement CDI programs in more than 50 hospitals in the past five years. Prior to joining Huron Healthcare, Jurcak was a project manager for J. A. Thomas & Associates providing clients with assessment of CDI opportunities, implementation of CDI programs, and ongoing CDI education and program support.

Her expertise encompasses utilizing outcome data to mentor and train staff in providing strategic direction and application. Jurcak taught as an assistant professor of nursing at Madonna University in Livonia, MI, for more than 15 years, and earned recognition as “Faculty Advisor of the Year” in 2006.

Jurcak obtained her CCDS in 2009. She is the author of The CCDS Exam Study Guide, serves on the CCDS Exam Advisory Board, and is a member of the Michigan chapters of ACDIS and HFMA.

Dee Schad

Dee Schad, RN, BSN, CCDS
Director Care Coordination and CDI
Clark Memorial Hospital
Jeffersonville, IN
dee.schad@clarkmemorial.org

With more than 17 years nursing experience and more than 12 years specializing in CDI, Schad currently serves as the director of care coordination and CDI at Clark Memorial Hospital in Jeffersonville, IN. She is actively involved in the hospital’s ICD-10 assessment and preparation, integrating physician education and CDI efforts into the process. She also is a member of her facility’s RAC and utilization review committees.

Schad’s CDI experience includes the implementation of new CDI programs, managing a multi-facility program, and CDI software implementation. Her area of focus is staff and physician education with an emphasis on engagement.

Schad earned a certificate in coding technology from Indiana University in 2009 and a Bachelor of nursing degree from Indiana University in 1995. An ACDIS member since 2008, she is the founder and current president of the Kentucky/Southern Indiana ACDIS chapter growing its membership to more than 60 professionals in under two years. She also served on the 2011 ACDIS National Conference Planning Committee.

Central Indiana Chapter chooses leaders

By Susan Bradford, RN, BSN

Central Indiana ACDIS Chapter picks 2012 leadership team

I am pleased to announce the following people have accepted their nominations and will serve as the 2012 ACDIS Central Indiana Chapter officers:

President: Susan Bradford, RN, BSN
Current position and organization: Clinical Documentation Specialist, Riverview Hospital, Noblesville, IN.
Past positions and organizations: Operating room staff nurse, medical-surgical staff nurse, OB/labor and delivery charge nurse, case manager, lead case manager Marion General Hospital (MGH), in Marion, IN.
Education: Bachelor of Science in nursing, Ball State University, Muncie, IN.
Professional organization memberships: ACDIS member since 2009; participated on the executive leadership team of the Central Indiana ACDIS Chapter since January 2010.
Professional experience and attributes: I have 19 years of clinical experience as well as 10 years of experience in utilization review and case management. As the lead case manager, I served as a liaison between case management and IT core team. I represented case management in a hospital-wide process to gain Magnet recognition for nursing at MGH and served on a task force for rapid process change in case management. Currently, I’m the CDI specialist for a small 154-bed community hospital. I’ve enjoyed the challenge of implementing a CDI program along with learning and applying inpatient coding guidelines and processes. I strive to build collaborative relationships with the medical staff as well as quality improvement, case management and the revenue cycle team at my facility. I believe that a complete medical record which accurately reflects medical necessity and facilitates continuity of patient care is of the utmost importance in today’s healthcare climate.
Objectives and vision for 2012: I would like to continue to offer continuing education opportunities to the Central Indiana ACDIS Chapter membership, promote best practices, share resources, encourage collaboration, and facilitate networking of CDI professionals in Indiana. With regard to continuing education, one specific goal I have for 2012 is to pool our resources with the Kentucky/Southern Indiana Local Chapter to plan a larger combined chapter meeting offering prominent speakers addressing key CDI topics and issues.
Contact: sbradford@riverview.org

Vice President: Kathy Wilson, RN BA, BSN
Current Position and organization: CDI specialist, Community Health Network in Indianapolis.
Education: BSN, BA in education/English literature, HCPro Certified Coder Boot Camp® – Inpatient Version, HCPro Certified Coder Boot Camp®.
Professional organization memberships: ACDIS, Executive Women in Healthcare, AHIMA.
Professional experience and attributes: As the medical auditor/coding manager at All Children’s Hospital in St Petersburg, FL, I became aware of the urgent need for improved physician documentation in the medical record as this documentation directly related to the amount of reimbursement the hospital received from insurance payers. I began networking with other RN medical auditors and found a group of nurses from another hospital called documentation specialists. They had also just begun this journey and helped me tremendously to get such a program started at All Children’s. From this small group of dedicated nurses, one of the very first organizations of documentation improvement specialists began. I have been a CDI for the past six years taking my unique skill set to three different hospital organizations to teach them the importance of detailed and accurate physician documentation.
Objectives and vision for 2012: As the vice president of the local Central Indiana ACDIS Chapter my main objective is to support the elected president and serve in her absence. I am passionate about CDI specialists becoming recognized as professionals. Our unique knowledge is based on years of clinical expertise, an understanding of the relationship between documentation and revenue, and the ability to relate to physicians in a professional manner. In the coming year I would like to see our chapter become firmly established within the national ACDIS organization and eventually take the lead in seeking education and knowledge for CDI specialists.
Contact: kwilson4@ecommunity.com

Secretary: Angela Birch, RHIA
Current position and organization: Clinical documentation liaison in the CDI program at Indiana University Health in Indianapolis
Past positions and organizations: Revenue cycle solutions coordinator for CDI, inpatient coding supervisor, inpatient coding coordinator, inpatient coding coordinator-float coder, inpatient coder for Indiana University Health (formerly Clarian Health Partners); HIM services assistant director at the Rehabilitation Hospital of Indiana.
Education: Bachelor of Science in health information and administration, Indiana University-Purdue University of Indianapolis.
Professional organization memberships: AHIMA.
Professional experience and attributes: I have 11 years of experience in the health information profession in various inpatient coding and CDI positions. I have spent the last four years as a member of the CDI team at IU Health and in that role I use my many years of experience with coding and quality auditing to effectively contribute to the documentation improvement efforts at my organization. In my role as CDI liaison, I concurrently review inpatient medical records to identify potential opportunities for further clarification of diagnostic and procedural documentation and query medical staff when appropriate. I also provide education to physicians on CDI opportunities in formal and informal sessions and oriented and trained new CDI staff members. In addition, I audited inpatient medical records to assess accuracy of coded data and to identify potentially missed documentation opportunities and its impact on quality measures such as severity of illness and risk of mortality. I embrace new ideas and keep an open mind when encountering different opinions and thoughts. I love to teach others about what I know as much as I love to learn new things and take on new challenges and experiences.
Objectives and vision for 2012: I would like to incorporate more continuing education opportunities into our meeting times that would be applicable to as many certification areas as possible. I plan to keep everyone connected and informed about clinical documentation improvement efforts discussed within our local Central Indiana chapter and those at the national level.
Contact: abirch@iuhealth.org

Thank you to everyone who responded, special thanks to Angela Birch, who drafted the candidate bio form and to Carla Payne at Community Hospital East, who created our chapter web page to provide a safe and secure election as well as a forum for chapter communication. I appreciate their combined efforts and input to facilitate a fair election.

Editor’s Note: For more information about the Central Indiana ACDIS Chapter visit the Local Chapter tab on the ACDIS website, visit the ACDIS Blog, or e-mail Bradford at sbradford@riverview.org.

WWRD: What would the RAC do?

RAC focus areas need to be on your CDI program's radar screen but it need not take over your program's focus.

There has been much discussion based on what Recovery Audit Contractors (RAC) and other state and federal regulatory bodies are doing or what their next move will be (though does anybody really know?!?).

We’ve all heard the stories of denials of well documented and clinically substantiated conditions; of the role the RAC reviewer incentive structure plays in RAC determinations, of confusing correspondence addresses, etc. Whether or not the stories are true doesn’t matter as much as the attention such stories garner. We’ve also heard of the fear that prevails and this makes me wonder about the effect of these reviews on our day-to-day workflow.

I recommend we stop, take a deep breath, and think…Why not switch our focus from “what would the RAC do” back to what care was provided and how was it documented in the medical record?

Now, I’m not saying we should ignore RAC, or forget that they are there. Believe it or not, they do keep us grounded. I’m just saying let’s try not to make them the focus.  Let’s try not to work according to the WWRD principle.

We are currently in the midst of a nationwide movement toward quality and public reporting. It is commendable that our national focus has turned to the quality of healthcare. And providing quality care is all about doing the right thing at the right time. If we stay true to who is at the center of this movement, ‘the patient,’ and set the stage for the right process to ensure that we do the right thing at the right time, good outcomes will prevail.

Let us take that thought and apply it to the world of CDI.  The concurrent process of CDI, in and of itself, takes place at the ‘right time,’ while the patient is still in the hospital and we have all the necessary medical record, laboratory, and dietary information available to us. Through our consistent, thorough review of the information contained within the record we can help clarify ambiguous information, identify potentially omitted diagnoses, and ensure the record accurately captures all the clinically relevant care provided.

Although our task can be complicated, we have  available to us several documents that assist us in our endeavors to do the ‘right thing:’ ACDIS’ Code of Ethics, AHIMA’s 2008 practice brief, Managing an Effective Query Process, the 2010 document, Guidance for Clinical Documentation Improvement Programs, and their 2010 publication, Clinical Documentation Improvement Toolkit.  In order for our day-to-day CDI practices to be able to withstand audit scrutiny we must use these guidances, plus our own facility-specific policies and procedures to guide us.

When we stray from our ethical and moral core, and away from the guidelines in place to protect us, we could find ourselves alone and exposed. There have been several discussions (most recently during the November 17, 2011 ACDIS Quarterly Membership Conference Call) regarding the dangers of leading queries and the potential legal implications involved. We all need to operate within the guidelines and be prepared to stand up and defend the information contained within the medical record.

If we center our attention on doing the ‘right’ thing, focus on our responsibility to the patient, and continue to assist in the precise and complete representation of the patient encounter within the medical record, we will have done our job, and possibly kept the RAC at bay. Let us do what we do best, according to the guidelines, and let the policies and procedures that are in place steer us on the right path.

Don’t think about what RAC would do; think about doing the right thing at the right time for the patient.

Reminder: Eight tips for social media etiquette

Does the social medial world sometimes make your head spin? Here are some simple tips to help you.

Do you mix your personal and professional lives on your Facebook page? I separate my personal and professional relationships on Facebook. My personal life is just that, and I don’t need or wish to share some things with my professional associates. There’s nothing randy, more like exchanges with my 20-something nephews, girly gossip about fashion and martinis, or grumblings about local politics. I don’t play Farmville (and have no patience for such postings), don’t care about daily horoscopes, or 99% of posted YouTube videos.

These posts don’t belong on professional pages. Facebook gives us a fabulous opportunity to network on the topics that bind us as colleagues. We can share ideas, techniques, and processes. We can ask one another for advice and guidance.  We can commiserate with our cyber friends about our jobs and careers, encourage those who undertaking new challenges, and cheer for those who achieve their goals.

Most Facebook pages are open to the public, which means your comments, posts, and pictures are searchable. You need to be very careful about what you say and post on Facebook—or on any social media platform, whether on a personal or professional page.

I found a Facebook etiquette list published by the Association of Women’s Health, Obstetric, and Neonatal Nurses and got their permission to adapt it here as recommendations for our association’s interactivity on our social networking sites including Facebook, LinkedIn, CDI Talk, and soon (believe it or not) Twitter.

Consider these tips for smart social media conduct:

1. Be respectful of people’s comments. If you don’t agree with a comment, state your point without being rude, confrontational, disrespectful, angry, or vulgar. Better still, don’t reply at all.
2. When you post a comment, ask a question, or respond to others, give your opinion about important topics in a professional manner.
3.  Remember HIPAA – don’t post patient information in ANY form. Don’t post particulars about a patient or a situation that might be identified. Don’t post photos of patients.
4. Share articles from reputable sources that you believe will educate your peers on different topics. Take a page from Glenn Krauss and Lynne Spryszak who frequently share links to government auditors’ transmittals on the ACDIS Facebook page.
5. Be careful how you express an opinion about your current facility, work, or a co-worker. Remember that your managers and co-workers are also interested in these CDI professional networking opportunities and may be members themselves. Don’t forget that your employer and/or future employer could view what you have posted. Don’t divulge confidential and/or proprietary information and don’t spread gossip. If you would not want them misconstruing your conversation if they overheard it in the hallway, don’t put it on the Internet either.
6. If you choose to post pictures, select those that are in good taste. If a photo of a friend is unflattering (and you’d be horrified to see that image of yourself posted for all to see) don’t post it.
7.  Don’t spam. Some people like to eat it (believe it or not) with fried eggs, but reposting advertising or promotional materials to social networking sites isn’t good etiquette.
8. Ask questions of your peers and participate in Wall or Discussion Boards regarding a specific topic. Share your expertise when you can, and thank those from whom you take suggestions.

Note: This list was adapted and reprinted with permission from the Association of Women’s Health, Obstetric, and Neonatal Nurses, www.awhonn.org. For

Book Excerpt: Clearly establish your program query processes

According to AHIMA, the query process has become a common communication and educational method to advocate proper documentation practices to ensure data accuracy and integrity.  Queries may be made for the following situations:

• Clinical indicators of a diagnosis but no documentation of the condition
  

  The 2012 CDI Pocket Guide.

• Clinical evidence for a higher degree of specificity or severity
• A cause-and-effect relationship between two conditions or organism
• An underlying cause when admitted with symptoms
• Only the treatment is documented (without a diagnosis documented)
• Present on admission (POA) indicator status

Definition of a Query:

A question posed to a provider to obtain additional, clarifying documentation to improve the specificity and completeness of the data used to assign diagnosis and procedure codes in the patient’s health record.

Whom to Query?

Any physician or other qualified healthcare practitioner who is legally accountable for establishing the patient’s diagnosis, including

(Attending Physician, Consultants, Specialists, Emergency Physician, Anesthesiologist, CRNA, Intern, Resident, Fellow, Physicians Assistant, Podiatrist  , Nurse Practitioner). When there is conflicting information, the attending physician should be queried since he/she is ultimately responsible for the final diagnoses.

When to Query?

When there is conflicting, incomplete, or ambiguous information in the health record regarding a significant reportable condition or procedure.

AHIMA states that a query may be appropriate when documentation in the record fails to meet one of the following five criteria:

1. Legibility
2. Completeness (abnormal results without comment)
3. Clarity (cause of symptoms)
4. Consistency (disagreement/conflicting info)
5. Precision (more specific)

When Not to Query

• Codes assigned to clinical data should be clearly and consistently supported by provider documentation.  Coding Clinic 2000 Q2 P 17:  “When documentation in the medical record is clear and consistent, coders may assign and report codes.”
• Queries should not be used to question a provider’s clinical judgment, but rather to clarify documentation when it fails to meet the five criteria:  legibility, completeness, clarity, consistency, or precision.
• In situations where the clinical information or clinical picture does not appear to support the documentation of a condition or procedure, hospital policies should provide guidance on a process for addressing the issue without querying the attending physician.

Editor’s Note: This post is an excerpt from the 2012 CDI Pocket Guide by Richard D. Pinson, MD, FACP, CCS, and Cynthia L. Tang, RHIA, CCS.

New groups, meetings promote CDI efforts in February

The Las Vegas, NV chapter at its first meeting in June 2011. Pictured above from left to right: Sharon Yens (Centennial Hills Hospital), Kathy Bird (Southern Hills Hospital), Karen Thorsteinson (St Rose Hospital – De Lima), Kathy Hurst (Kindred Hospital – Flamingo), Lori Mejia (Southwest Medical Associates), Sherry Siewers (DDCM Kindred Desert District), Sherry Shariff Hall (St Rose Hospital – Siena), and Marissa Schanbacher (Mountain View Hospital). Taking the photo: Ailsa Kompare (Kindred Las Vegas Market).

New networking groups

Philadelphia: The Philadelphia CDI network has new energy and is planning its first meeting for 2012. For information, contact Judi Bates at Lourdes Health System at 856/757-3161 or e-mail at BatesJ@lourdesnet.org. Or call Debby Dallen at Albert Einstein Medical Center at 856/786-0897 or e-mail dallend@einstein.edu.

Rochester, NY: Ruth Pfrengle, BSN, RN, director of utilization management at the University of Rochester Medical Center, has volunteered to help facilitate networking opportunities in the region. For information, contact 585/273-3816 or e-mail ruth_pfrengle@urmc.rochester.edu.

Texas: Barbara Presley, RN, CDI specialist at the University Medical Center Brackenridge in Austin has volunteered to help professionals from the San Antonio/Austin area to network. For information, contact her at 512/324-7679 or e-mail baPresley@seton.org.

Vermont: Suzanne Schultz, RN, BSN, CCM, CCDS, CDI specialist at the University of Vermont Medical Center in Burlington, has volunteered to connect CDI professionals in the state. For information, contact her at 802/847-2140 or e-mail suzanne.schultz@vtmednet.org.

Washington: The Evergreen ACDIS Chapter of Northwest Washington seeks new volunteers to help lead the group in 2012. For information, contact Jennifer Woodworth, RN, BSN, CCDS, director of CDI at Swedish Medical Center in Seattle by phone at 206/215-2073 or e-mail Jennifer.Woodworth@swedish.org. Or contact Cathie Murphree, LPN, CCDS, Documentation Improvement Specialist/HIM, at St. Joseph Medical Center, in Bellingham, at 360/788-6300 ext. 3429 or e-mail CMurphree@peacehealth.org.

West Virginia: Sheila Harrison, RN, BSN, CDI specialist at the Charleston Area Medical Center, Teays Valley Division, has volunteered to help get networking efforts started in the state. For information, contact 304/389-0689 or e-mail Sheila.Harrison@camc.org.

February meetings

New Hampshire: The next meeting will be held Wednesday, February 8, 1-2:30 p.m., at Elliot Hospital in Manchester. For information, contact Carla A. Heyn at 603/663-3452 or by e-mail at cheyn@Elliot-HS.org

Albany, NY: The Albany (NY) ACDIS Regional Chapter holds its next meeting Wednesday, February 8, 2-4 p.m., at St. Peter’s Hospital. The group will discuss documentation regarding acute renal failure. For information, contact Lois Rubin at 518/525-1081 or e-mail lrubin@sphcs.org.

Virginia: The next Virginia ACDIS Chapter meeting will be held Saturday, February 11, 10 a.m. to 2 p.m., at 1222 Jefferson Park Ave., in Charlottesville. Each attending facility will present/discuss what works well in their facility and what needs improvements. There will also be a teleconference/webinar presentation by ACDIS Advisory Board member Glenn Krauss.

Continuing its “ACDIS gives back” tradition, UVA has decided to donate to The HAVEN, a safe and welcoming place for the homeless in our community. Donations can range from warm items such as gloves, hats, or scarves to nonperishable food. A complete list can be obtained at www.thehavenatfirstandmarket.org/give/. For information, contact Sequana Webb 434/760-4491 or e-mail sck8u@virginia.edu.

Wisconsin: Will hold its winter meeting Saturday, February 18, 9 a.m. to 3 p.m., at Wheaton Franciscan Health Care, in Wauwatosa. Continental breakfast and lunch will be provided. CCDS and AHIMA credits will be offered. The meeting agenda includes:

• “A Clinical Perspective on Chart Review and Diagnoses Assignment: A QIO Reviewer’s Perspective,” by Jessica Whitley, MD, MBA, hospitalist and QIO reviewer.
• “CDI’s Impact on the Recovery Audit Contractor Initiative: Capitalizing on our Strengths to Minimize Hospital Financial Exposure,” by Diane Draize, RN, CPUR, CCDS, CDI specialist at Ministry Health, and Joan Korn, BSN, RN, CDI specialist at Wheaton Franciscan Health Care.
• “What You Don’t Know About Principles of Multiple Significant Trauma is What You Don’t Know!,” by Kathy Thomas, RN, CDI specialist at Wheaton Franciscan Health Care, and Renee Hedtcke, RN, CCDS, at Aurora Summit Medical Center
• Open Discussion/Roundtable: Opportunities for CDI Initiatives in the Ambulatory Care environment as well as inpatient setting beyond reimbursement

Deadline to register is Sunday, February 12. Registration is $25 for WI ACDIS members; $50 non-members.

For information, contact Kathy Thomas, RN, at Wheaton Franciscan Health Care, kathleen.Thomas@wfhc.org; Renee Hedtcke, RN, CCDS, at Aurora Health Care, renee.hedtcke@aurora.org; Diane Draize from Ministry Door County Medical Center Sturgeon Bay  at diane.draize@ministryhealth.org, Joan Korn from Wheaton Franciscan St. Francis in Milwaukee at joan.korn@wfhc.org, or Glenn Krauss, independent consultant, glennkrauss@earthlink.net.

N. Illinois: The next meeting will take place on Thursday, February 16, from noon to 3:30 p.m., at Northwest Community Hospital in Arlington Heights. The agenda includes:

• Participation in the ACDIS Quarterly Conference Call
• Presentation by Maralee Gray, BSN, CDI specialist at Rockford Memorial Hospital regarding “CDIS and ICD-10 Crossing Over: How to Safely Make it to the Other Side”
• Presentation by Karolee Fill, MSN, APN-CNP, at Northwest Community Hospital regarding “Basic Review of Echocardiography in the Heart Failure population”

For information, contact Nancy R. Ignatowicz at 815/806-2322 or e-mail nancy.ignatowicz@provena.org. Or contact Colleen Stukenberg MSN, RN, CMSRN, CCDS, at 815/599-6820, or e-mail CStukenberg@fhn.org.

California: The California ACDIS Chapter holds its regular meeting the fourth Wednesday of the month, February 22, 9-10 a.m. Those interested in volunteering to help lead the chapter are invited to step forward at this time. For information, contact Dexter D’Costa at 573/529-1791 or e-mail dr_dexterdcosta@yahoo.com.

Maine: The next meeting will be held Thursday, February 23, noon to 4 p.m., at Mid-Coast Hospital in Brunswick. For information, contact Cathy Seluke at 207/872-1796 or e-mail Cathy.Seluke@mainegeneral.org.

New England: The next New England Regional ACDIS Chapter meeting will be held Tuesday, February 28, 2-4 p.m., at Tufts Medical Center, Stearns Auditorium. Janet Cavagnac from Baystate will review ICD-10 coding in 3M software. Participants should bring a 3M equipped laptop if possible. Volunteers are needed to schedule future meeting and help lead the group. For information, contact Kelley Sears at 508/954-7432 or e-mail Kelley.Sears@steward.org.

Georgia (Southeast): The next Southeast ACDIS meeting will be Wednesday, February 29, 10 a.m. to 2 p.m., at Parkridge Medical Center in Chattanooga, TN. For information, contact Bonnie I. Epps at 404/712-4550 or e-mail Bonnie.Epps@emoryhealthcare.org.  Or visit the Southeast Regional ACDIS Chapter Facebook page for meeting announcements and other information.

Upcoming events

New Jersey: The next NJ meeting will take place Friday, March 2. For information, contact Deborah Gardner-Brown at 732/238-4511, or e-mail Deborah@RRA-INC.com.

Tennessee: The next TN-ACDIS meeting will be held at Baptist Hospital in Nashville on Friday, March 16, 9 a.m. to 1 p.m. For information, contact Sherri Clark at 865/804-6561 or e-mail SClark@mc.utmck.edu.

Long Island, NY: St. Francis Hospital hosts the next networking meeting on Tuesday, March 6, 3-5 p.m. For information, contact Adelaide M. La Rosa at 516/562-6229 or e-mail Adelaide.LaRosa@chsli.org.

Mid-West Regional: The Michigan, Wisconsin, and Minnesota state ACDIS networks’  mid-west regional conference, has been postponed.

Meeting minutes

The following minutes and/or presentations have been made available from the following chapters:

• Southwest Ohio January newsletter
• Minnesota January meeting minutes and presentation regarding shock
• Northeastern Ohio December 2011 newsletter
• Florida November 2011 newsletter

Q&A: How to resolve DRG confusion

Q: Confession. I am very frustrated. I am fairly new to CDI. I have a nursing background. I’m trying to understand how

Learning how to navigate the coding and DRG landscape can be daunting. Don't worry. Others have had to learn this too. Ask for help and know you are in good company.

the coding and DRG system works. But when I look up a diagnosis in the DRG Expert in the alphabetic index to diseases it is not listed as I would expect it to be.

Take for example, bradycardia. It is not listed under that term or arrhythmia.  Yet, it is listed under cardiac arrhythmia. For another example, how about anorexia? The only listing is anorexia nervosa—not unspecified.

I also find it ironic that I cannot infer what a physician is stating (it has to be documented precisely) but when I have to look up a term I have to guess its meaning.

Do you have any advice for me?

A: Your frustration is very common among new clinical documentation improvement (CDI) specialists.  The publishers of the DRG Expert did not include the same type of Index to Diseases that you would find in Volume I of an ICD-9 code book—probably to save space. The Index to Diseases alone in my code book is 380+ pages.

This is one reason that during the CDI BootCamp I mention so many diagnoses as we review Medicare Severity Diagnosis-related groups (MS-DRGs) in a major diagnostic category (MDC) and either have you highlight them or write them in, because I, too, had exactly the same issues you are having.

Every CDI team should also have a coding book in their department to use as a reference (ask your facility HIM department if they have an old one you can have), especially if you do not have access to the encoder (coding and reimbursement software), which would let you look up whatever you wanted—however, even that has limitations, because search terms often use “coding language” rather than the everyday language of clinicians.

As far as your comment regarding the irony of the situation, all I can say is “Right on, girl!”  It is the reason we have taken on this role. We were hired to become the “translators” or “interpreters” to ensure that the clinical language matches the language needed by the coders. Acquiring the skills to understand both of these languages, along with the ability to translate from one to the other, is what makes us, as CDI professionals, unique.

As a final note, I just want to share that my very first DRG Expert was COVERED from end to end with handwritten notes, stickies, and slips of paper. I used this book for three years, copying my info into each new edition until I was granted encoder access. Every time I asked a coder where to find something I wrote it in the book—especially those diagnoses that had really strange “code” descriptions.

I hope that I can assure you, that by this time next year, you will have many of these coding terms memorized.

I tell all my CDI BootCamp students that there is a long learning curve to this position, so don’t worry. While some people catch on quickly, for most it may take up to six months before that proverbial light bulb finally goes on and frequently it takes up to a year to feel confident in the role.

Don’t get discouraged. Most CDI specialists will tell you the same thing! Before you know it, you will find yourself sitting in traffic, converting license plate numbers into DRGs or diagnosis codes.

2012 CDI professionals’ salary survey

The 2012 CDI professionals’ salary survey was sent to ACDIS members on Tuesday, January 24. In less than 24 hours more than 400 people participated. In 2008, 132 individuals completed the survey. In 2009, responses doubled to roughly 300. In December of 2010, nearly 900 people responded.

I restate these numbers for two reasons. First, I want to encourage all those working in clinical documentation improvement to participate. The larger the pool of responses, the more valid the data. If you are a CDI specialist who reviews medical records please participate. If you are a CDI manager or CDI program director, please participate. If you are a physician advisor whose primary responsibility is oversight and assistance for CDI efforts at your facility, please participate.

Second, over the past few years these numbers have illustrated an interesting point, one which we have internalized anecdotally; the CDI profession is growing. While that may seem like an obvious observation, there have been discouraging stories from around the country of late about CDI programs being dismantled, their duties coupled with those of case managers or quality improvement, or worse, abandoned altogether.

In speaking with consultants and many of you, we have pondered the reasons as to why some healthcare systems seem to be ramping-up their documentation improvement efforts, hiring upwards of 20 CDI specialists, while others simply turn their back on CDI.

Some suggest that facilities have too many initiatives underway right now; they have too much to worry about, too many people to hire to accomplish other, higher priority tasks. They worry over compliance with HIPAA’s 5010 technology initiative, implementation of computerized physician order systems and electronic health records, never mind ICD-10 preparation and training and the rest of the worries associated with healthcare reform.

Others suggest that the programs that closed did not do a good enough job analyzing their CDI program’s effectiveness and communicating that success to facility managers. (Read the blog posts “Asset or Liability” by Glenn Krauss or “The Importance of Metrics and Goals on Behavior” by Donald A. Butler, among other great information previously shared here.)

“Once the case-mix index stops improving administrators stop seeing the value in the program,” one CDI specialist indicated during a telephone conversation. We commiserated, talked about all the other ways CDI specialists’ efforts affect facility prosperity and discussed the role of CDI programs will play in the onslaught on changes coming to the healthcare landscape.

I believe that despite these “stories” of short-sightedness the profession of CDI truly is growing. For each tale of sorrow, I have heard of program expansion into areas of outpatient and emergency clinical documentation, expansion and collaboration between CDI professionals and other internal departments such as audit preparation and physician education for the coming ICD-10 needs. Now, all I need is the data to back this up.

Please take a minute to participate in this year’s 2012 CDI professionals’ salary survey.

Oh, by the way, the other great thing about the salary survey is that it gives you a benchmark against which you can compare your salary to those performing similar tasks. Does anyone out there think it might be time for a raise?

Here is a sneak peak of what people indicated they earn thus far.

ACDIS Advisory Board final nominees: Cast your vote

If you are an ACDIS member please vote for four new volunteers to represent you on the Advisory Board.

Voting is now open for four ACDIS advisory board positions, for terms of service starting in 2012 through the end of 2014. Log on to the ACDIS website to select the four candidates you believe are the best fit for the association, and then cast your vote.

The results of the election will be announced in early February.

ACDIS advisors are important, volunteer positions that help shape the direction of the association and provide leadership, expertise, and representation for the membership. The term of service is a maximum of three years.

The voting page includes the nominees’ background in CDI and information on why they are seeking election. The vote will close end of business day on Tuesday, January 31.

If you have any questions, please e-mail ACDIS Director Brian Murphy at bmurphy@cdiassociation.com.

Brian Murphy, CPC
Director
Association of Clinical Documentation Improvement Specialists (ACDIS)
200 Hoods Lane
Marblehead, MA 01945
781-639-1872, ext. 3216
bmurphy@cdiassociation.com

Your CCDS isn’t tied to your ACDIS membership

I’ve been reaching out to people whose CCDS credential expired in 2011. Most of these folks are among the first who

I wonder who else will be wearing a purple hat in San Diego.

earned the credential, and knowing how hard they worked to earn it, we hate to see them lose it.

In the course of chatting with people, a few were confused about the relationship between their CCDS credential and their ACDIS membership. They thought that renewing their ACDIS membership each year automatically translated to the CCDS credential.

One has nothing to do with the other. You become an ACDIS member when you pay the membership fee. There is no exam required.

The CCDS credential has strict educational training and experience requirements. Additionally, those who wish to earn the credential must pay a fee, pass an exam, and then renew the credential every two year by submitting proof of 20 continuing education credits and paying a renewal fee.

To summarize:

• Anyone can join ACDIS
• ACDIS members may be qualified to take the CCDS exam
• CCDS holders may be ACDIS members

(That list reminds me of those awful logic problems from middle school. Remember those? Here’s one: Penny, Melissa, and Brian went to the ACDIS Conference, one by plane, one by train, and one on horseback. One carried a suitcase, one carried a newspaper, and one carried a laptop. Who wore the purple hat?)

You don’t need to be an ACDIS member to hold the CCDS. Plenty of stuff is free on the ACDIS site, like this blog. So, why join ACDIS?

(Here comes “the pitch”). Your ACDIS membership connects you on a deeper level with other CDI professionals, products, and services. You get:

• Free participation in quarterly conference calls and in the ACDIS e-mail group CDI Talk
• Free full access to the ACDIS web site, including the online Forms & Tools Library full of documents you can download and customize, and archives of featured articles
• A free subscription to the quarterly electronic CDI Journal
• Free access to the ACDIS elearning library for online courses that offer CDI, coding, and case management continuing education credits
• Member-only discounts for the annual ACDIS conference, CDI products, and the CCDS exam and/or re-certification

ACDIS membership is well-priced at $129 a year. (Members of local ACDIS chapters receive a discount on National membership which brings that cost to under $100. Talk to your local chapter leaders to learn more. Take advantage of the discounts and it will more than pay for itself every year.  For instance, you can earn free CEUs for your CCDS and save $100 on the CCDS renewal fee. (End of “the pitch”.)

When does your CCDS expire? Are you ready with at least 20 CEUs? Got a renewal question? E-mail me at prichards@cdiassociation.com. I’m here to help.

P.S.
I’ll be the one in San Diego in the purple hat.