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Guest post: Keep up with coding compliance for physicians facing MACRA changes

James S. Kennedy, MD, CCS, CDIP

James S. Kennedy, MD, CCS, CDIP

by James S. Kennedy, MD, CCS, CDIP

What’s a physician’s favorite radio station? When it comes to coding compliance and revenue cycle management of their practices, WII-FM, What’s In It For Me, is what physicians listen to.

Physician salaries have traditionally been based on CPT-driven relative value units in a fee-for-service environment, meaning the more that the physician did, the more he or she got paid. As a result, many physicians diminished their understanding or application of ICD-10-CM diagnosis coding because, most of the time, these don’t affect physician reimbursement unless it is to determine medical necessity for a procedure they want to perform. [more]

Tip: The four E’s of staff education

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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]

Tip: Improving CDI-physician relationships

Experts agree that a collaborative healthcare environment leads to better patient outcomes and improved organizational success. Despite this, long-standing tensions between nurses, coders, CDI specialists, and physicians can be difficult to overcome.

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Tip: Diversify your CDI education to keep staff engaged

Every CDI specialist knows how difficult it can be to set aside a whole hour or more for dedicated training and education. With productivity expectations and quotas, cutting out a sizable chunk of time for learning can be challenging. Diversifying CDI education tactics can help engage staff in more meaningful ways.

Though electronic health records (EHR) and technology sometimes complicate the CDI process in select ways, CDI managers and leaders can harness technology to increase educational reach. [more]

Note from the ACDIS Editor: CDI Journal provides training tactics

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ACDIS Editor Linnea Archibald

By Linnea Archibald

New hire training. Ongoing education. Physician education. Each area holds unique difficulties for the CDI professional in all stages of their careers. Keeping all the CDI staff and physicians on the same page can be a daunting and headache-inducing task. For that reason, the July/August edition of the CDI Journal seeks to outline a few strategies, tips, and tricks from seasoned veterans in the field for keeping your whole team engaged and up-to-date in their CDI education.

Within the pages of the newest edition of the CDI Journal, you’ll find valuable information from a variety of perspectives—from CDI specialists conducting daily reviews, to CDI educators, to the ACDIS Advisory Board members, to the ACDIS leadership team and staff. [more]

Summer Reading: Physician Education Discussion Scenarios

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

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

The following clinical scenarios illustrate where clarification would be indicated and include examples of differing communication methods.

Clinical example: The record states the patient was admitted for treatment of pneumonia and the patient was placed on IV antibiotics. A swallow evaluation indicates the patient is at risk for aspiration. The patient is placed on aspiration precautions and thickened liquids. For the coder to assign a code for aspiration pneumonia, the relationship between the pneumonia and aspiration needs to be documented in the record.

Approach #1 (verbal query): “Dr. Smith, I’m Jane from the documentation improvement team. Do you have a minute to work with me? This chart indicates the patient is at risk for aspiration and needs thickened liquids. Could you identify a probable etiology for her pneumonia? The physician responds, “It is probably due to aspiration.” The CDI specialist thanks the physicians and asks, “Could you please clarify that possible cause-and-effect relationship in the record?” She then reminds the physician that “Unlike outpatient coding, the use of possible or probable is permitted and can be coded for inpatient cases.” The physician immediately writes an addendum to his progress note: “Jane, thanks for your help.”  Jane should then document this verbal query and the results as part of the CDI notes for this account. [more]

Behind the scenes at ACDIS: E-learning producer brings back industry-leading tips

Editor’s note: From time to time, we like to take a moment to share a behind-the-scenes look at what the ACDIS and broader HCPro team has been working on. Today, we wanted to shed some light on one of our e-learning producers, Amanda Southworth. Amanda recently attended the Association of Talent Development International Conference and Exposition (ADT) in Atlanta and brought back a number of important lessons about education, training, and e-learning. To see the complete list of HCPro’s e-learning opportunities, click here.

I recently had the privilege of attending the ADT, a massive four-day educational and networking event that included 10,000 learning and development professionals from all over the world. While there, I learned about the latest trends in the training world as well as the specific struggles, challenges, and successes specifically related to providing continuing education to those working in the healthcare field.

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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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Guest Post: Minute for the medical staff, part 1

James Kennedy, MD, CCS, CDIP

James S. Kennedy, MD, CCS, CDIP

By James S. Kennedy, MD, CCS, CDIP

Those of us who care for critically ill patients intuitively know who will have a long hospital stay and who will die. As such, intensive care unit (ICU) scoring systems based on clinical indicators such as Acute Physiology and Chronic Health Evaluation Three (APACHE-3) or Simplified Acute Physiology Score Three (SAPS III) in adults or Pediatric Index of Mortality Two (PIM2) in children have been developed, though validity in an individual patient varies.

Medicare, state governments, and private enterprise, such as Vizient, Truven, Quantros, and 3M, also have scoring systems based on the ICD-10-CM codes derived from explicit, clear, and consistent provider documentation. As such, how we define and document diagnoses that predict morbidity and mortality is essential if we want our patient’s risk to be accurately portrayed.

Physician definitions and documentation are crucial

In navigating the ICD-10-CM maze, we must remember the following as written in the Coding Clinic for ICD-10-CM, Fourth Quarter, 2016: [more]

Note from the Associate Director: Learn from the best around in CDI

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Rebecca Hendren

By Rebecca Hendren

One of the tasks I enjoy most in my role as the ACDIS associate director of membership and product development is getting to interact with our book authors and CDI Boot Camp instructors. Many of these talented professionals have been involved in CDI longer than they’d care to admit, but through that experience have developed a keen insight into advancements in the industry along with a desire to share that knowledge with ACDIS and with the larger clinical documentation improvement community.

Once a year, at the ACDIS national conference, we also get to see their expertise in action as they share pearls of wisdom in one of three pre-conference events.

This year, CDI Education Director Laurie Prescott, MSN, RN, CCDS, CDIP, CRC, and Shannon McCall, RHIA, CPC, CCS, CCS-P, CPC-I, CCDS, CEMC, CRC, director of the HCPro suite of coding Boot Camps, bring a two-day version of their risk-adjustment record review and coding program.

If you never been in a class with these two, trust me, it’s a blast. I know. I know. As the associate director of membership and product development, I’m supposed to tell you that—but I mean it. As someone who comes from neither a clinical or coding background, diving into something as complex as coding guidelines’ application to CMS-Hierarchical Condition Category (HCC) methodology is more than intimidating but these lovely ladies do a tremendous job of providing detailed instruction on the individual HCCs and opportunities for improved documentation with clinical scenarios to demonstrate how these concepts can be incorporated into CDI practice.

As an ACDIS staff member, I’m particularly lucky because I get to bounce around to a number of different sessions. So, I’m also looking forward to catching up with two of my favorite CDI people Richard Pinson, MD, CCS, and Cynthia Tang, RHIA, CCS, co-creators of the beloved CDI Pocket Guide. They’re teaching a pre-conference event designed to help CDI programs break down departmental silos into a collaborative, cohesive team. It’s called “Building a Best Practice CDI Team,” and throughout the program Pinson and Tang will explore the importance of understanding how your medical staff thinks and learns—and adjusting CDI efforts accordingly.

“A successful CDI team is based on engagement of medical staff obtained through effective communication,” says Pinson. “For example, physicians often respond to education using evidence-based literature and consensus guidelines. By collaborating with your team, you will find the methods that work.”

Over the course of the past year, I’ve also had the distinct pleasure of being able to work with Trey La Charité, MD, FACP, SFHM, CCDS, medical director of clinical documentation integrity and coding for UT Hospitalists at the University of Tennessee Medical Center (UTMC), as he crafted not one but two books—The CDI Companion for Physician Advisors and The CDI Field Guide to Denial Prevention and Audit Defense. That’s in addition to the volume, The Physician Advisor’s Guide to Clinical Documentation Improvement, that he co-wrote with James S. Kennedy, MD, CCS, CCDS, CDIP, president of CDIMD-Physician Champions.

I know how beloved both doctors La Charité and Kennedy are within our community and know how much people love their pre-conference deep-dive into essentially everything a CDI physician advisor needs to know to help CDI programs flourish. The second day of this preconference event includes a second track case study featuring Erica E. Remer, MD, FACEP, CCDS, and Kelly Skorepa, BSN, RN, CCDS, corporate manager of clinical documentation integrity for University Hospitals Health System in Cleveland. I’ve heard Remer speak during ACDIS Radio programs, so I’m interested in learning more from her as well.

If you’re already signed up for one of these pre-conference events, I’m sure you’re as excited as we are. If you’re still on the fence about whether these extra courses will meet your CDI program’s educational needs, check out the agendas on the ACDIS website or feel free to reach out to me to learn more.

Editor’s note: Rebecca Hendren is the associate director of membership and product development at ACDIS. If you have any questions, please reach her at rhendren@acdis.org.