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CDI Week Q&A: CDI Expansion

Peppers, Rhonda

Rhonda Peppers, RN, BS, CCDS

As part of the seventh annual Clinical Documentation Improvement Week, ACDIS has conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Rhonda Peppers, RN, BS, CCDS, a CDI specialist at Care Coordinators, MedPartners, in Tampa, Florida, and a member of the 2017 CDI Week Committee, answered these questions on CDI expansion. Contact her at rhondapeppers@benefis.org.

Q: When did you first get involved in CDI, and what was your CDI program’s focus?

A: I started working in CDI in 2011, and our program’s focus was on earning money. We were given monthly monetary totals on the queries we wrote. We were very competitive. Our goal was to see who could make the most money. As a matter of fact, I was told when I first started that we were not to write the query if it was for severity of illness (SOI) or risk of mortality (ROM), just write the ones for MCCs and CCs.

Q: How has the focus of your CDI program changed over the years? [more]

CDI Week Q&A: Career Advancement

Ng, Brenda

Brenda Ng, MS, RN, CCDS, CCS

As part of the seventh annual Clinical Documentation Improvement Week, ACDIS has conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Brenda Ng, MS, RN, CCDS, CCS, a CDI consultant at MedPartners in Greenwood Lake, New York, and a member of the 2017 CDI Week Committee, answered these questions on CDI and career advancement. Contact her at ngbrnd@yahoo.com.

Q: What, in your mind, does the “typical” CDI specialist role entail?

A: The typical CDI specialist role entails knowledge of best practices, quality reviews, continuity of care, and ensuring that patients are receiving the right communication.

Q: As CDI programs advance, they begin to branch out into other review areas. What areas do you think programs should move into first? [more]

Q&A: Credentialing for outpatient CDI

Have CDI questions?

Have CDI questions?

Q: I’ve heard lately that outpatient CDI specialists are less likely to be registered nurses. Is there a reason there may be more coders in this arena?

A: While many outpatient CDI specialists do hold an RN credential, there are good reasons for having coders fill the roll, says Allen Frady, RN, BSN, CCDS, CCS, CDI education specialist for HCPro in Middleton, Massachusetts.

“There are a lot of very specific documentation requirements for evaluation and management (E/M), observation codes, interventional radiology, etc., which RN CDI specialists don’t typically learn,” he says. Additionally, coders may already be comfortable working in a physician practice setting and have a familiarity with hierarchical condition categories (HCC). [more]

Guest post: 2018 ICD-10 codes—when the heart needs a helping hand

McCall_Shannon_darkbg

Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS

by Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS

Congestive heart failure (CHF) is a commonly diagnosed condition where the ventricles or the lower chambers of the heart do not work effectively. The heart serves as a pump to get blood in and then out of the heart to circulate to the rest of the body. When any type of pump doesn’t work efficiently backups can occur.

The most common form of CHF is left ventricular failure, however left-sided failure can also lead to right ventricular failure as a ripple effect. There are two common types of CHF, one whereby the ventricle cannot contract normally, known as systolic heart failure, and one where the ventricle cannot relax normally due to stiffness, known as diastolic failure. Some patients may have a combination of both systolic and diastolic failure.

The causes of heart failure include hypertension, coronary artery disease, and valvular diseases, as well as cardiomyopathies. [more]

Guest Post: Communication eases challenges of fiscal year 2018 code changes

coding changes

On October 1, over 800 code changes take effect!

by Crystal Stalter, CDIP, CCS-P, CPC

It’s that time of year again—time to wonder just how the 2018 IPPS final rule will affect CDI and coding efforts.

The 2018 IPPS final rule includes more than 800 ICD-10-PCS changes. Previously recognized operating room codes have become non-operating room codes, affecting DRG assignment, changing surgical DRGs to medical DRGs, and thus affecting reimbursement. Some diagnoses are gaining new definitions and explanations that will result in new ICD-10-CM code assignments and shift DRGs as well.

[more]

Membership Update: ACDIS 2018 speaker proposal deadline extended

Join us in San Antonio!

Join us in San Antonio!

The Association of Clinical Documentation Improvement Specialists (ACDIS) is currently seeking speakers to present at the 2018 ACDIS 11th Annual Conference, to be held May 21-24 in San Antonio, Texas at the Henry B. Gonzalez Convention Center. The deadline for submissions has been extended due to the devastation brought by hurricanes Harvey and Irma. The new deadline is September 25. Click here to view and complete the speaker application.

We seek speakers to present on all aspects of clinical documentation improvement (CDI). Advanced CDI sessions geared for mature programs are particularly welcome and will receive additional consideration but the 2018 Conference Committee also seeks to meet the needs of those new to the profession and those at an intermediate level. Click here to meet the volunteers.

CDI and/or HIM/coding professionals typically present at ACDIS, but we also welcome practicing physicians, case management and quality personnel, healthcare auditors, lawyers, and other professionals with a tie to or an interest in CDI. Accepted speakers and co-presenters will have their admission fee waived.

Based on the learning needs identified by participants of the successful 2017 ACDIS Conference, several topics have emerged as areas of great interest within the ACDIS community, including two new tracks—outpatient CDI and pediatric CDI. Click here to read a full list of suggested sessions and tracks.

UnitedHealth Group, Inc. vs. the United States of America: The case for CDI, part 2

Brian-Murphy

ACDIS Director Brian Murphy

By Brian D. Murphy

In Part 1 of this series I introduced the developing story of UnitedHealth Group, Inc. vs. the United States of America, and my intent to write a series of articles on this civil fraud action. Why? Because I find this to be an incredibly interesting case with broad ramifications for CDI and coding departments.

So let’s review the basic at the facts of the case, starting with the who and when. [more]

Tip: The four E’s of staff education

journal banner summer

Brush up on some education tips and tricks!

by Amanda Southworth

Educating CDI staff and physicians alike can be a challenge. With busy schedules, resistant physicians, and a constantly changing healthcare environment, even the most seasoned educator can feel like pulling their hair out.

By keeping in mind four E’s, however, educating becomes a bit more manageable.

Efficient: Educational sessions should seek to get to the point quickly. With busy and fluid schedules, each educational session should have a focused point. Even if the timeframe incorporates a couple different subjects—say, clinical indicators and querying—each section still needs a point and direction. This will cut down on wasted time during your limited education space. [more]

Q&A: Receiving query responses from providers

Have CDI questions?

Have CDI questions?

Q: Our hospital is having a hard time getting our physicians to respond to queries, do you have any suggestions on how to get them to reply?

A: The most important thing is make sure the query is concise and contains clinical indicators from the record. You also want to use different methods of contacting the physician as well. Various points of contact include within the electronic health record, via e-mail, by phone, or by having your CDI team visit them on the floor. [more]

CDI Week: Only 11 days till 2017 kick-off

CDI Week committee

Meet the members of the 2017 CDI Week committee!

Every year, facilities across the country celebrate the efforts of their CDI teams for one week in September. Though ACDIS believes CDI professionals deserve accolades throughout the year, CDI Week is a time to pull out all the stops.

This year’s festivities take place September 18-22 and the theme is “The Wild West: New Frontiers for CDI.” Don’t forget to let ACDIS know what you’re planning for this year’s celebration and send plenty of pictures! We’d love to celebrate with you!

One change this year is the incorporation of the CDI Week Committee. As the ACDIS community and activities grow, ACDIS includes more of its members in planning festivities. [more]