All Entries in the "CDI Recognition Week" Category
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!
A post-CDI Week poem
At Greenville (SC) Hospital System University Medical Center, we have had a great week of celebration, learning, and team building. I would like to share with everyone what the HIM department did for the CDI department this week. The coders composed a poem, printed it, and placed it in a wooden frame for us to display in the department. It has been great to be recognized by our peers as a professional group. Here is the poem:
To our friends in documentation integrity
We want you to know
How much you mean to us
We hope this poem tells you so!
Get creative! Send in team photos of CDI/HIM! We'll add them to a special CDI section.
We know our “coding world”
Makes no sense to you
That is why we are here
To help figure out the clues
Clear documentation can not be stressed enough
If it is not written in the record
We can not code the stuff.
That is why this week is so cool
It let HIM tell you what it means
To have nurses like you on our team!
Happy CDI Week—September 2011.
Cartoon caption contest
Post your caption suggestions below and you may win a prize... could be a book, audio, or ACDIS coffee mug!
CDI Week Team Slide Show
Over the past few weeks we have been gathering photos from CDI teams across the country. Big or small, from those one-person-bands to those larger multi-disciplinary CDI programs, the photos came pouring in. We’re happy to present this CDI Team Slide Show as part of our CDI Week celebrations. If you have a team photo that didn’t make it into this post, please send it along to ACDIS Associate Director Melissa Varnavas at mvarnavas@cdiassociation.com. If we continue to get enough photos we’ll post a follow-up show next month.
The art of clinical documentation improvement
I feel like saying a little bit about why we do what we do, or at least why I do what I do. In the course of my 26-year nursing career, I worked in many venues. For about 14 years, I was an ICU nurse, and although many patients have merged in my memory, there are those whose memory will always remain as fresh as yesterday. Somehow, I seem to remember everything about these chosen few, as if they had been painted in my mind.
The painter of the old harbor.
I no longer provide direct patient care. In fact, these days I rarely see a patient in the flesh. Yet, every day I come to know anywhere from 40 to 90 individuals who come to the hospital in varying states of health. I know them through their charts. I know them because I am a clinical documentation specialist.
For me to do my job effectively, I must insure that the artists—the bedside caregivers—paint the most strikingly vivid picture possible of each and every one of these unique individuals.
When I read their charts, I visualize that patient in the bed. I see them complete with a face and a body. I see family members, monitors, tubes, medications. I see the physicians establishing—and sometimes struggling with—the big picture, and I see the nurses working as they provide hands-on care.
I read about the 32-year-old new mother with metastatic cancer and I feel her worry and her pain. I read about the noncompliant dialysis patient on his 10th admission for fluid overload and wonder what conditions could possibly lead to inpatient hospitalization being preferable to outpatient compliance. I read about the 90-year-old woman with a lump on her breast and I know she’s been agonizing over whether a mastectomy is worth it.
I see symptoms and I anticipate diagnoses. I see diagnoses and anticipate procedures. I see procedures and anticipate paths to recovery. Clinical documentation improvement is about making sure that the words match the reality. I need the physicians and nurses to write exactly what they see, what they think, and what they do. And I need them to say it in a way that satisfies government and managed care regulators.
Sometimes, I think of physician documentation in the context of the Blind Men and the Elephant. The Blind
A 17th Century Ukiyo-e print of blind monks examining an elephant.
Men and the Elephant is an old tale from India in which six blind men each take hold of a different body part, unaware that they are touching an elephant. One man touches the tail and thinks it is a rope; another grasps the trunk and thinks it is a tree branch; a third thinks the tusk is a solid pipe, and so on. The reality is that they are all right and they are all wrong; it’s a matter of perspective.
As clinical documentation improvement specialists, we take the findings of the nephrologist and the cardiologist and the surgeon and the internist and we try to bring them together to understand the health concerns of the whole person so that everyone can recognize them. When we only see evidence of a tree branch or a rope instead of an elephant, we intervene.
When I was a nursing instructor, I used to tell my students that their path to becoming a nurse was not linearly following a series of tasks, but rather, slowly solving a complex jigsaw puzzle. Every new experience allowed them to add another piece, but the pieces might not be found in the order in which they looked for them. In time, though, one should eventually have a vision of the nurse taking shape, and fewer white spots on the table.
So it is with patients. A patient comes in with a vague complaint, and they expect the doctor to make a diagnosis. In the current status of healthcare’s revolving door, the physician has less and less time to make those determinations; determinations which nevertheless must be made. At times, a physician resists writing a possible diagnosis for fear of being wrong. I encourage doctors not to fear the diagnosis. A differential diagnosis, honestly considered, does not hurt either the patient or the physician. It merely shows the level of effort expended by the physician and the healthcare team in trying to solve the puzzle, and often that effort will be rewarded with greater severity of illness scores and perhaps even higher reimbursement.
A painting by impressionist Claude Monet.
I will help the physician understand how to write the diagnosis in a compliant manner that protects the patient, the physician, and the hospital.
The portrait has to be painted with some consistency. When one physician writes, “CHF,” while another writes, “pulmonary edema,” and a third writes, “fluid overload,” regarding the same set of symptoms experienced by the same patient, it’s the equivalent of three artists each trying to paint a perfectly pink dress with three different tubes of paint. One uses red paint, one uses white paint, and one uses orange paint. Without working together, none of them gets the color quite right. In the end, sometimes it isn’t even clear that the painting is of a woman in a dress, much less a woman wearing pink.
So, I help hand them the right paint, explain about the various rules of shading and perspective. In this metaphor I give them the right paint brush to use, offer up the appropriate words—acute systolic heart failure—and let them add it to their paintboxes. With the correct verbiage, everyone reading that chart, not only the regulators, sees the woman in her pink dress, sees the patient with acute systolic heart failure, and understands the diagnosis.
Nurses like to talk about the art and science of nursing. There is much science in the clinical documentation improvement role, but a lot of art, too.
Celebrate CDI Week!
Get creative! Send in your team videos of why CDI is so important.
The first Clinical Documentation Improvement Week takes place from September 18th – 24th. Its purpose is to recognize and celebrate the value of clinical documentation improvement programs and the unique skills and expertise of CDI specialists.
This week of recognition is brought to you by ACDIS, with support from our partners Chartwise and MetaHealth, (www.acdis.org), the premier professional organization for CDI specialists. As a part of our CDI Week activities, ACDIS has fielded a national CDI Week Industry Overview Survey, examining the state of the industry in areas including career advancement, data mining and reporting, electronic queries, and more.
We invite you to click here to visit the CDI Week section of our website, and download the PDF survey report free of charge.
You’ll also find a number of helpful resources at your disposal, including the following:
- Suggested CDI Week activities:
http://www.hcpro.com/acdis/cdi_week_activities.cfm - An electronic toolkit, including a poster, logo, powerpoints, and branded items for sale: http://www.hcpro.com/acdis/cdi_week_toolkit.cfm
- A media kit: http://www.hcpro.com/acdis/cdi_week_media_kit.cfm
- A special video message for your physicians about the importance of CDI: http://www.hcpro.com/acdis/cdi_week.cfm
The Association of Clinical Documentation Improvement Specialists (ACDIS) is a community of over 2,500 members in which CDI professionals share the latest tested tips, tools, and strategies to implement successful CDI programs and achieve professional growth. Its mission is to serve as the premier healthcare community for clinical documentation specialists, providing a medium for education, professional growth, program recognition, and networking. For more information about membership in ACDIS, please visit our website at www.acdis.org.
New video touts CDI profession in honor of CDI Week
As I told former ACDIS Advisory Board member Wendy DeVreugd, when I first watched this video I began to tear up a bit. Call me overly sentimental. That’s fine. As far as I’m concerned, Wendy and her co-workers at Kindred really captured the value of the CDI profession. That she also took the time to acknowledge the efforts of the ACDIS team as supports of the CDI endeavor made me feel as though I too serve as valuable assest to CDI efforts.
Please share the video with your physicians and others within your facility to let them know the importance of this growing CDI profession.
If you have a moment or two to take a trip down memory lane, here is another wonderful video you can share courtesy of Forsyth Medical Center.
You can create a CDI video, too. It need not be as fancy as these two examples. Most digital cameras these days include a video option. Simply conduct a brief interview of your CDI team members asking them about what they like most about their profession then send the clip in a .mov file to mvarnavas@cdiassociation.com.
CDI Week: Time to revisit our scope of practice
Opportunities abound to expand CDI efforts.
The growth in the profession of CDI has been nothing more than phenomenal over the course of the few years. ACDIS membership now stands at more than 2, 500 members. Fueling this tremendous growth in CDI is the increased need for accurate, concise, and effective medical record documentation to support data reporting processes; processes such as ICD-9 (and the 2013 transition to ICD-10), MS-DRG assignment, and quality outcomes. Our healthcare data is coming under intense scrutiny from MAC, CERT, and RAC auditors as Medicare intensifies efforts save money and improve healthcare quality before 2017 when the Medicare Trust Fund is projected to run out of money.
Expanding scope
The first annual CDI Week slated for September 18-24 is fast approaching. While the traditional focus of CDI has been the inpatient arena, now is an excellent time to consider expanding into the outpatient arena, a high volume service line for most hospitals with the potential for large revenue losses. In several previous blog posts, I stressed the virtue of CDI specialists playing an active role in the establishment of medical necessity through clinical documentation. Now, I would like to take a moment to outline how our profession can affect outpatient efforts as a logical, natural progression of the CDI scope of practice.
From my experience as an outpatient clinical documentation facilitator (as I assist various programs capture documentation improvement opportunities in my role as an independent CDI consultant), I see the chance for CDI to become an integral part of the revenue cycle denials management process the volume of the denials in outpatient setting is higher than those facilities experience on inpatient side.
Let’s take a look at one example, that of pillow endoscopy. This is an endoscopy carried out by using a wireless video capsule which the patient swallows and which ultimately passes through the digestive system. For this procedure, two capsules are available, one designed for the small bowel and one for the esophagus. Indications for the procedure include: GI bleeding, small bowel neoplasm, Crohn’s disease, and evaluation prior to surgery, according to National Government Services, a CMS MAC contractor for the Midwest. (The LCD for Endoscopy by Capsule can be accessed here.)
In order for the facility and physician to receive reimbursement for these procedures the patient’s record must contain documentation which fully supports the medical necessity for this service. This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures. It also requires that photographic copies of the video images, with the beneficiary’s name and the date of service included in the picture, must be available for review. Furthermore, the medical record must document the need for capsule endoscopy and contain reports or reference to the previous appropriate negative endoscopies performed prior to endoscopy by capsule. There are a number of other documentation considerations included in the Local Coverage Determination as well.
Let me emphasize the statement that the documentation must contain reference to the previous appropriate negative endoscopies since this lack of documentation leads to numerous avoidable denials. The lack of this documentation in the pre-operative history and physical (H&P) and/or operative note precludes the necessary reporting of ICD-9 code V45.89-Other Postsurgical Status, a code that needs to be on the claim in conjunction with another covered diagnosis as spelled out in the LCD in order for the claim to be considered a covered benefit and reimbursable to the provider.
I found that physicians often document anemia (285.9) as the indication for the pill endoscopy of the small intestine. However, this is not considered a covered indication for the procedure, resulting in unnecessary write offs of a Medicare allowed payment amount of $701.55. Notice that iron deficiency anemia secondary to blood loss (280.0)(chronic) is considered a covered benefit. When I provide this information to physicians in a medical staff meeting as part of an education session, I receive many hard stares and comments from the audience.
Getting started
To convince hospital administration of the relevance CDI in the outpatient setting, highlight denial reduction and loss of revenue due to ineffective patterns of clinical documentation. The amount of avoidable revenue lost to Medicare and other third-party payer denials is mind boggling. Equally mind boggling is the volume of self-inflicted denials hospitals subject themselves to due basically to poor clinical documentation, something our profession can capitalize on as CDI programs continue to expand their influence.
I personally find the role of CDI to be rewarding, challenging, and most importantly varied. Each day is unique, I am rarely in the same location every day, and no longer preoccupied with searching for CCs and MCCs and solidifying principal diagnoses. More on the role of CDI in the outpatient setting will be introduced in an upcoming white paper. Stay tuned.
September meetings include CDI Week after-hours events
Connecticut
The CT CDI networking group meets Thursday, September 8, 9-10:30 a.m., at The Hospital of Central Connecticut, Bradley Memorial Campus in Southington. For information, contact MaryAnn Shanley at mshanley24@yahoo.com.
Georgia
The next Southeast ACDIS meeting will take place Friday, September 9, 10 a.m. to 2 p.m., at the Medical Center of Central Georgia in Macon. RSVPs are requested to Jamie Doster at james.doster@emoryhealthcare.org or by phone at 404/578-0262.
Plan to arrive by 9:20 a.m. to allow time for parking, registration, morning refreshments, and networking. Save time by submitting your membership application (see below) and pay dues to the treasurer prior to the meeting date. Attached are:
- Membership application if you wish to join the chapter. Annual dues are $25 with check made payable to “SECACDIS.” All quarterly meetings are included in the membership dues.
- Meeting attendance application: Application to attend just one meeting for non-chapter members. Cost is $10 per meeting.
- Agenda: Note the meeting will be from 10 a.m. to 2 p.m. There will be an optional Facebook crash course following the meeting for those wishing to learn how to interact on the chapter’s Facebook site.
- Minutes from the last meeting in June to be voted on.
- Bylaws to be voted on at next meeting.
New York
A CDI round table discussion will be held on Thursday, September 15, 11 a.m. to 3 p.m. at Mount Sinai Medical Center in New York City. For information, contact Than Than Lee at 212/824-8180 or email ThanThan.Lee@mountsinai.org.
CDI Week Meetings
(Editor’s Note: Meeting locations listed in italic denote special, after-hours events associated with CDI Week not necessarily formal “chapter” events.)
San Francisco Bay, CA
Is organizing a happy hour meet-and-greet for CDI and related professionals on Wednesday, September 21, 5-8 p.m. at the Clement Street Bar and Grill. All CDI-related professionals are welcome to drop by for drinks and/or appetizers and dinner. RSVP to dexter.g.dcosta@kp.org or call 573/529-1791.
N. Illinois
The next Northern Illinois CDI chapter meeting will be at Delnor in Geneva, on Thursday, September 22, 1-3:30 p.m. For information, contact Colleen M. Stukenberg by phone at 815/599-6820 or by e-mail at CStukenberg@fhn.org.
Las Vegas, NV
The Nevada ACDIS Chapter will host a CDI Week happy hour Friday, September 23, 5-8 p.m., at the Fire Fly, 3900 Paradise
Take a peek at the Fire Fly menu. Those Vegas CDI professionals sure know how to celebrate CDI Week. Want to host an after-hours event for CDI in your area? Post the information below or email mvarnavas@ cdiassociation.com
Road, Las Vegas. The event is a “buy your own” but because it is a tapas bar, items are typically under $10. It should be a bunch of fun and a great networking opportunity! Here is a link to their website if you want to see what they have.
RSVP to Alisa Kompare at Ailsa.Kompare@kindredhealthcare.com or call 702/343-7232.
Los Angeles, CA
A gathering of CDI-colleagues from the Los Angeles and San Gabriel Valley areas are invited to attend a happy hour event in honor of CDI Week Friday, September, 23, 5-8 p.m., at the Yard House – Paseo Colorado in Pasadena. For information and to RSVP contact, Cris Gumayagay at cris.gumayagay@ahmchealth.com.
California
Our next ACDIS-CA Chapter meeting is scheduled for Wednesday, September 28, 9-10 a.m. The speaker will be Wendy DeVreugd from Kindred Healthcare who will be presenting on Kindred’s model of CDI. For information, contact Dexter D’Costa at dexter.g.dcosta@kp.org or by phone at 573/529-1791.
Save-the-date
New England
The NE Regional CDI network meets Wednesday, October 5, 1-3:30 p.m., at Lowell General Hospital’s Clark Auditorium. The meeting will feature a presentation by Richard Birkhead, MD, FACC, Chief of Cardiology regarding documentation for fluid overload vs CHF, Cor Pulmonale, pericarditis, and tamonade, among other topics. For information, contact Kelley Sears at Kelley.Sears@steward.org or call 508/954-7432.
Tri-State (WI, MI, MN)
The ACDIS Chapter leaders from Wisconsin, Michigan, and Minnesota invite CDI specialists and related professionals to join them for the first Tri-State Regional Meeting Saturday, October 15, 9 a.m. to 5 p.m., at Kalahari Resorts in Wisconsin Dells, WI. The agenda includes:
- Registration
- Strategies for dealing with difficult physicians
- Physician query process: The ins and outs
- Lunch
- Continually educating physicians to avoid staleness in your program
- Over documentation: Challenges and Solutions
- Collaboration between coders and CDI professionals to break down the silos
- Roundtable discussion
Continental breakfast and lunch will be provided. Five CEs will be provided for those who need CEs for the CCDS credentials. For those needing lodging a block of rooms has been reserved for October 14 and 15 at $129 per night inclusive of taxes. Reservations can be made by calling the Kalahari directly at 877/253-5466 by Wednesday, September 14 and request the WI-ACDIS room block. After this date, the prevailing hotel room rate may be charged at the discretion of the hotel.
Registration is $50 and the deadline is October 1. For information, contact Heidi Hillstrom at HHillstrom@slhduluth.com or call 218/249-5461.
Virginia
The fifth quarterly ACDIS Virginia Chapter will meet Saturday, October 22, with Robert Gold, MD, CEO of DCBA, Inc., as the guest speaker. Gold will discuss “CDI Initiatives: Start now for ICD-10.” For information, contact Linda Steinhoff by phone at 757/312-5154 or email Linda.Steinhoff@chesapeakeregional.com.
CDI Week: Fun with photographs
The CDI staff at Provena and Resurrection. You can turn your team-building photo in an educational opportunity for your physicians, too.
If you’re looking for an easy, inexpensive way to celebrate the first annual Clinical Documentation Improvement Week September 18 through the 24, consider having some fun with photographs of your CDI team.
Provena and Resurrection Hospitals which includes eight hospitals plus Provena Corporate gathers the CDI team together every year and takes a group photo, says Nancy R. Ignatowicz, RN, MBA, CCDS, System Manager, Clinical Documentation at Provena Health in Frankfort, IL. She then has photo mugs made which have the hospital photo/logo on one side and the team photograph on the other. Each CDI team member gets one.
Ignatowicz knows how to make a photograph work for her. She didn’t stop with photo mugs. She developed a place mat which uses the photo as a focal centerpiece and frames the CDI team with documentation tips, best practices, and even a “how to avoid a query” section. The CDI team will use these during special education sessions and celebrations they’ve planned during the month of September.
Creating the place mat gave her a little bit of technical difficulty, Ignatowicz admits, since it was a lot of information to fit on a simple document. So she expanded it to 11 by 17 inch paper. “It was a simple, cheap idea that anyone can use, as long as you have a printer than can accommodate that size paper and have someone patient enough to help you figure out how to change the paper size on the machine setting,” she jokes.
Finally, Ignatowicz also took photos of each individual facility’s CDI team. These she inserted into special welcome letters for physicians which provides a short overview of the CDI program mission and scope and also introduces them to their CDI team members (she even included their extension numbers under their photographs).
If you have a photograph of your CDI team or local chapter meeting please send it along with identification of the individuals included in .jpg format to mvarnavas@cdiassociation.com by September15. We will compile the photos for a special slide show and post it during CDI Week.
