RSSAll Entries in the "Growing your program" Category

Guest Post: Expanding the CDI focus to the outpatient arena, part 2

Editor’s note: Crystal Stalter, CPC, CCS-P, CDIP, is the CDI manager for M*Modal in Pittsburgh. She has over 30 years of experience in the healthcare industry, with most of her focus on coding, compliance, and physician documentation. She has spent many of those years as a consultant, working with physicians and hospital HIM departments to improve their workflow processes and revenue cycles. Contact her at crystal.stalter@mmodal.com. Opinions expressed are that of the author and do not represent HCPro or ACDIS. This article was previously published in Briefings on APCs and JustCoding. This is the second part of a two-part series. To read the first part of this article, click here.

There are multiple outpatient places of service the CDI specialist can have an impact. One such place is the ED, where capture of ancillary services, start and stop times (as well as medications and dosages for injection/infusion coding), and evaluation and management (E/M) code (the codes assigned for physician reimbursement) levels often get missed or are incomplete, causing subsequent coding issues.

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Note from the ACDIS Director: It’s time for outpatient CDI to step out on its own

ACDIS Director, Brian Murphy

ACDIS Director, Brian Murphy

By Brian Murphy

We knew it was going to happen.

Eventually, the ACDIS Conference was going to get so big that we couldn’t give every CDI topic justice or the full coverage it deserved. Outpatient CDI was one of those topics. There is so much going on between Medicare Advantage and Hierarchical Condition Categories (HCCs), the complexities of patients admitted versus treated in observation, to outpatient opportunities in the emergency department and in the physician office setting, that the time had come to give outpatient CDI its own event.

Enter the ACDIS Symposium: Outpatient CDI.

This all-new ACDIS event will be held September 18-19 at the Hilton Oak Brook Resort & Conference Center, located just outside of Chicago.

Back when inpatient CDI was still relatively new in 2007, we received large numbers of basic questions, and there was an overwhelming need for nuts and bolts “how to get started” ideas and education. Because we anticipate the same kinds of concerns at the ACDIS Symposium: Outpatient CDI we are accommodating with three specific ideas:

  1. Case studies of how programs have implemented successful outpatient CDI programs. Hear from Cooper University Health Care, Novant Health, Mount Carmel Health System, and others about how they got started, their challenges and their successes.
  2. A “Morning Ideas: Lightning Round” general session on Day 1. This innovative one-hour session combines four to five quick-hit, “here was a problem we had and a solution that worked/here is a process that worked for us and might work for you” ideas from your peers that have worked in the field. This will get your brain working overtime!
  3. A dedicated Q&A panel session to conclude the program. Ask your top questions at this session—and listen to your peers’ questions. Chances are you might have the same questions.

Just like the ACDIS Conference, the Symposium will feature plenty of networking opportunities and idea-sharing over our breakfasts and lunches (food, including breaks, is provided with registration) as well as in our exhibit hall. Come see the many innovative outpatient CDI solutions several vendors are offering in this space.

There is far more on the agenda than I could mention here—sessions on the nuts and bolts of evaluation and management coding (E/M) and how to improve physician E/M billing, a session on the key differences between inpatient and outpatient coding (as taught by our top coding instructor Shannon McCall, RHIA, CCS, CCS-P, COC, CPC-I, CEMC, CRC, CCDS), and much more.

In short, I hope you can make our inaugural ACDIS Symposium. To learn more or to register, please click here.

Editor’s note: If you have specific questions about the Symposium’s content, please send them to ACDIS Associate Director of Membership and Product Development Rebecca Hendren at rhendren@acdis.org. Murphy is the director of ACDIS. Contact him at bmurphy@acdis.org.

Guest Post: Expanding the CDI focus to the outpatient arena, part 1

Editor’s note: Crystal Stalter, CPC, CCS-P, CDIP, is the CDI manager for M*Modal in Pittsburgh. She has more than 30 years of experience in healthcare focused on coding, compliance, and physician documentation concerns. Contact her at crystal.stalter@mmodal.com. Opinions expressed are that of the author and do not represent HCPro or ACDIS. This article was previously published in Briefings on APCs and JustCoding. This is the first part of a two-part series. Please return to the blog next week to read the second part!

The focus for CDI specialists has historically been on the inpatient hospital stay. Reviews of the chart for conditions not fully documented and/or evidence of conditions not documented at all, has been standard practice.

However, with so many changes in the industry facing providers in their outpatient practices, the importance of CDI in places of service such as physician offices, ambulatory clinics, and urgent care clinics is even more vital.

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Symposium update: Early bird pricing ends today

outpatient early bird

Early bird pricing ends today!

Today is the last day to get the Early Bird price for the first ever ACDIS Symposium: Outpatient CDI. Reserve your seat today, July 17, to take full advantage of the discount. The conference takes place from September 18-19 at the Hilton Oak Brook Resort and Conference Center in Oak Brook, Illinois.

ACDIS members receive a $100 discount on their conference tickets, bringing the price down to $805. [more]

TBT: 2017 Conference Committee member shares session insight

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Faisal Hussain, MD, CCDS, CDIP

By Faisal Hussain, MD, CCDS, CDIP

It was a real privilege to serve on the 2017 ACDIS Conference Committee, even though it involved a lot of hard work, and tough decisions regarding the selection of speakers and award winners.

One of the sessions that caught the interest of the entire committee concerned objectively measuring providers’ clinical engagement. What made this session even more special was the fact that the presenter, Nicole Draper, RN, BN, MHA, DH-C, was responsible for putting together one of the first CDI programs in Australia.

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Symposium Speaker Highlight: McCall demystifies outpatient coding

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Shannon McCall, RHIA, CCS, CCS-P, CPC-I, CCDS

Editor’s note: As we did with the 10th annual ACDIS conference in May, we’ll take some time leading up to the ACDIS Symposium: Outpatient CDI to chat with a few of the speakers. The event takes place September 18-19 at the Hilton Oak Brook Resort & Conference Center in Oak Brook, Illinois. Today, we talked with Shannon McCall, RHIA, CCS, CCS-P, CPC-I, CCDS, the director of coding and HIM at HCPro in Middleton, Massachusetts. She manages the instructors of the Certified Coder Boot Camps and has extensive experience with coding for both physician and hospital services. She will be presenting “The Ins and Outs: Inpatient and Outpatient Coding” on Day 1 of the Symposium.

Q: There are so many differences between inpatient and outpatient coding! What would you say is the most difficult one(s) for those moving from the inpatient CDI world to wrap their minds around? (e.g., that words like probable, likely, suspected don’t count toward a diagnosis, that outpatient facilities not only use ICD-10 but also CP[SM] T, the different code sets each have their own set of guidelines and rules governing use?)

A: Documentation for outpatient encounters is much briefer than documentation for an inpatient admission so the application of the guidelines of only assigning codes for relevant diagnoses is important. Providers typically lack the documentation in their notes to clearly identify chronic conditions being clinically relevant in their decision making process. Since risk adjustment is based on diagnosis coding, the differences in procedure coding has no bearing.  [more]

Note from the Associate Editorial Director: Setting the outpatient CDI table

outpatient CDI table

Join us for the ACDIS Symposium: Outpatient CDI!

By Melissa Varnavas

The stew’s been simmering in the pot for a while now. All the separate ingredients are melding and the overwhelming aroma in the room is enticing. The stew is outpatient CDI. Its ingredients are multitudinous, varied.

  • Pinch of evaluation and management (E/M) coding
  • Few cups of hierarchical condition category (HCC) groupings
  • Sampling of risk adjustment methodology
  • An awareness of current procedural terminology (CPT) codes
  • Knowledge of ICD-10-CM/PCS Official Guidelines for Coding and Reporting
  • Several specks of physician practice business savvy

And that’s not a comprehensive list of ingredients by any stretch of the imagination. Each cook in this CDI kitchen (just as in the inpatient world) follows its own recipe—drawing from its unique set of programmatic goals and overarching system mission and focus.

Yet, we have a basic recipe to follow thanks to those taste-testing the mixture over the past few years and sharing their samplings with rest of the CDI community. Now all we need to do is set the table and invite others to join us.

The ACDIS Symposium: Outpatient CDI invites you to the feast. Hope to see you there.

Editor’s note: Varnavas is the Associate Editorial Director for ACDIS and has worked with its parent company for nearly 12 years. Contact her at mvarnavas@acdis.org.

Guest Post: Minute for the medical staff, part 2

James Kennedy, MD, CCS, CDIP

James Kennedy, MD, CCS, CDIP

By James S. Kennedy, MD, CCS, CDIP

Definitions matter

Many clinical documentation improvement (CDI) programs now look to capture risk-adjusted conditions which help improve the capture of a patient’s severity of illness and risk of mortality regardless of setting. Since risk-adjusted outcomes depends on the definitions of coded diagnoses, let’s discuss current literature which supports specific clinical terms:

Shock: a life-threatening, generalized form of acute circulatory failure associated with inadequate oxygen use by the cells. In assessing the potential presence of shock, abnormalities of the skin (degree of cutaneous perfusion); kidneys (urine output); brain (mental status) are examined. While arterial hypotension (defined as systolic blood pressure of less than 90 mmHg, or mean arterial pressure of less than 65 mmHg, or a decrease of greater than or equal to 40 mmHg from baseline), is commonly present, it should not be required to define shock. As such, lactate levels in shock states are typically less than 2 mEq/L (or mmol/L) in shock states. In neonates, significant shock stigmata, such as decreased capillary refill, mottling, cool extremities, and tachycardia, can define shock in the right clinical circumstance.

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Note from the ACDIS Editor: Help identify CDI industry trends

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ACDIS Editor Linnea Archibald

By Linnea Archibald

As you read last week, the theme for CDI Week 2017 will be “The Wild West: New Frontiers in CDI.” Though the theme offers numerous opportunities for fun CDI Week activities (cowboy hats and boots, anyone?), the theme also speaks volumes about the CDI industry as a whole.

As with any industry that’s been around for a while, things change. With more and more updates, regulations, and payment methodology changes, it seems the CDI field changes more rapidly than others. And ACDIS always seeks to keep its finger on the pulse of those changes.

To aid in this purpose, ACDIS undertakes a CDI industry survey each year to accompany the festivities of CDI Week. The survey analyzes trends in CDI, helping us report on the direction of the profession, new areas of expansion, and any other developments on the frontiers of this field.

This year’s survey consists of 38 questions spanning seven distinct sections, each probing a different area within the CDI profession. Click here to take the 2017 survey. [more]

Summer Reading: A letter to new CDI staff

LauriePrescott_May 2017

Laurie L. Prescott, RN, MSN, CCDS, CDIP

by Laurie L. Prescott, RN, MSN, CCDS, CDIP

Dear Clinical Documentation Improvement Specialist,

I remember my first day as a new CDI staff member very well. I had been through an extensive interview process—three interviews, a written test, and a meeting with the consulting firm that trained me. At the time, all I understood was that I was going review records and help medical staff meeting documentation needs. After more than 20 years of nursing experience, and time spent as a nursing school clinical instructor and in management, staff development, and healthcare compliance roles, I figured this would be an easy jump for me. It was a jump that felt like I had leapt right off a cliff.

I spent my first day training with two inpatient coders and the consultants. These two ladies were an interesting pair. One had been coding for more than 25 years, and I concluded she could diagnose most disease processes better than a number of physicians I knew. The second was new to the inpatient process, having coded in outpatient and clinic settings for a few years. We were implementing a new CDI program. Everyone looked to me to make this program a success. I soon understood this was much more of a challenge than I ever imagined.

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