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Next ACDIS quarterly conference call on Thursday, May 29

ACDIS quarterly conference call Thursday.

ACDIS quarterly conference call Thursday.

The next ACDIS quarterly conference call will be held on Thursday, May 29, 1-2 p.m. ET. Please note that due to heavy call volume, we recommend that you dial in 10 minutes early. Among other subjects, discussion will include the following topics:

  • CDI beyond reimbursement: Medical necessity (special guest Glenn Krauss with reference to Novitas Solutions: E/M Service: Face-to-Face Documentation; and the following .ppt:  Medical Necessity.
  • Implementing electronic queries (special guest Michael McKelvey)
  • Querying for hyponatremia in the setting of hyperglycemia
  • Including physician “teaching” in queries/functional quadriplegia
  • Obesity/BMI as a secondary DX
  • Meditech and queries
  • Clinical vs. coding guidelines

These calls are offered as a means for ACDIS members to network with one another and to discuss any clinical documentation improvement related issues. We will have a few ACDIS Advisory Board members on the call as well. Conference calls are a great way to ask a question, air any and all CDI concerns, or gather input on a policy or procedure at your hospital. While we cannot guarantee your question or discussion point will be addressed on the call, we will try to work in as many as possible. Note that we cannot answer questions relating to specific code assignment (i.e., which code to assign in a given clinical situation). However, questions about diagnosis sequencing, DRGs, ICD-10 preparedness, etc. are welcomed.

If you are an ACDIS member and did not receive your dial-in instructions please email Penny Richards at prichards@cdiassociation.com at least one-hour prior to the start of the program.

Membership Quarterly Conference Call Thursday

ACDIS quarterly conference call Thursday.

ACDIS quarterly conference call Thursday.

The ACDIS Quarterly Membership Conference Call is scheduled for Thursday, Feb. 20, from 1-2 p.m. ET. Dial-in instructions for ACDIS members were sent out this week.

The call features special guest Bernadette Slovensky who will discuss CDI in the Emergency Department as a preview of her 2014 National Conference presentation. Additionally, the new members of the ACDIS Advisory Board will be introduced and available to discuss pre-submitted and live questions.
These quarterly calls are offered as a means for ACDIS members to network with one another and to discuss any clinical documentation improvement related issues. This call has also been opened to members of local ACDIS chapters. For information, please contact your local chapter leadership.
We encourage your comments, thoughts, and questions during the call. If you have a question to ask the ACDIS advisory board, or general suggestions for discussion on the upcoming call, please email bmurphy@hcpro.com.
Please note that due to heavy call volume, we recommend that you dial in 10 minutes early.

Quarterly Conference Call for ACDIS members scheduled

Don't miss the November quarterly conference call for ACDIS members.

Don’t miss the November quarterly conference call for ACDIS members.

Our next quarterly conference call is scheduled for Thursday, November 21, from 1-2 p.m. ET. To access the call, please dial the toll-free number that was emailed to you.

If you did not receive the email dial-in information please email Penny Richards at prichards@cdiassociation.com at least one-day prior to the call.

Due to heavy call volume, please dial in 10 minutes prior to the start of the program. These calls are offered as a means for ACDIS members to network with one another and to discuss any clinical documentation improvement related issues.

We will have a few ACDIS Advisory Board members on the call as well. We encourage your comments, thoughts, and questions during the call. If you would like to submit a topic or question for discussion please email ACDIS Director Brian Murphy at bmurphy@cdiassociation.com

Reminder: Quarterly membership call Thursday

ACDIS quarterly conference call Thursday.

ACDIS quarterly conference call Thursday.

ACDIS members are invited to participate in a Quarterly Conference Call taking place, Thursday, Aug. 22, 1-2 p.m. (EST). Dial-in instructions were sent via email to ACDIS members. If you are an ACDIS member but did not receive your dial-in instructions please email prichards@cdiassociation.com for information.

Please note that due to heavy call volume, we recommend that you dial in 10 minutes early.

These calls are offered as a means for ACDIS members to network with one another and to discuss any CDI related issues. We encourage your comments, thoughts, and questions, as ACDIS Advisory Board members will provide feedback during the call. If you would like a particular topic discussed email ACDIS Director Brian Murphy at bmurphy@cdiassociation.com.

Q&A: How to determine an appropriate physician query response rate

Ask your question by leaving a comment below.

Ask your question by leaving a comment below.

Q: I enjoyed listening to the ACDIS quarterly conference call in May. Someone on the call stated they have a physician response rate of 95%. That caused me to wonder what the typical time frame for physician response might be; ours is 48 hours after discharge. I have heard some facilities give two weeks and some give up to 30 days, so I am wondering if there is some standard there

A: Different facilities structure their programs differently. Many have no policy in place regarding expectations related to the timing of the physician’s response. That said, the most successful programs do set expectations typically of about 72 hours, and indicate on the query form, itself, that a response is expected within that time frame.

The goal is to have a high query response rate within that 72 hour time frame.  In other words, there is a difference between an organization with a 95% response rate where the queries are closed within 72 hours and one that has a 95% response rate, but the queries are left open indefinitely.  Best practice would be to resolve any open query before billing.

Few organizations will hold a claim for 30 days pending a query response, which can result in a re-billing situation if the query response changes the DRG assignment. An effective CDI department can positively impact bill hold times as they work to resolve open queries so the record is complete for coding within days of discharge.  Most organizations have a bill hold goal of three to five days.  Be sure to address how long a query can remain “open” or awaiting a response  within your CDI program policies and procedures.

One of the most important aspects of tracking physician responses is to determine which physicians need extra support and education regarding the importance of CDI efforts. An internal escalation process (such as the samples recently published in the CDI Journal) may be another way to address habitual non-responders.  Be sure to get hospital and physician leadership support for your deadlines and share them with the medical staff.

Also, you need to know if your organization voids those queries that no longer impact the DRG. For example, if a CDI specialist leaves a query for a CC but a different CC was coded, that query would be “voided” in some organizations. Then, when calculating your response rates you’d also have to void or remove those queries from the calculation so rather than a non-response counting against the query rate, that particular query would be removed from the equation.  Additionally, some organizations “close” a CDI query and “open” a coder query when a patient is discharged if their coding department then follows up on the query so that can impact response rates as well by lowering the CDI response rate.

As you can see, there are a lot of factors to consider when calculating a query response rate so it is difficult to compare organizations without knowing how long queries can remain “open” awaiting a response and what query resolution processes are in place.  Remember the value of the CDI department is in issuing queries to clarify incomplete, vague or missing documentation so query resolution should be a prominent task within the CDI role.

Quarterly Conference Call for members May 9

Join us this week for the Quarterly ACDIS Conference Call

Join us this week for the ACDIS Quarterly  Conference Call.

ACDIS members are invited to participate in a Quarterly Conference Call taking place today, Thursday, May 9, from 1-2 p.m. (EST). Dial-in instructions were sent via email to ACDIS members. If you did not receive your dial-in instructions please email prichards@cdiassociation.com for information.

Today’s agenda includes a discussion of how one hospital implemented an electronic health record and computer assisted coding in conjunction with CDI input, as presented by special guest Mark Dominesey, a presenter at the 2013 ACDIS conference.

It also includes a discussion of record reviews for quality metrics associated with APR-DRGs, presented by ACDIS Advisory Board member Sue Belley. You can download a few slides Belley plans to present on the call here: www.hcpro.com/content/291981.ppt.

In addition, advisory board members will address member questions regarding renal failure, seizure documentation, capturing patient mortality documentation, and will also answer live questions from participants.

Not an ACDIS member? Consider joining more than 3,000 of your peers in the only association for CDI professionals.

Quarterly membership call slated for May 9

Don't miss the May quarterly conference call for ACDIS members.

Don’t miss the May quarterly conference call for ACDIS members.

Dear ACDIS Member,

Our next quarterly conference call is scheduled for Thursday, May 9, from 1-2 p.m. ET. To access the call,  dial the toll-free number that was emailed to you. It will also prompt you for a password (guest code). If you have not received your password via email, please contact ACDIS Members Services Specialist Penny Richards at prichards@cdiassociation.com.

Please note that due to heavy call volume, we recommend that you dial in 10 minutes early.

These calls are offered as a means for ACDIS members to network with one another and to discuss any CDI related issues. We will have a few ACDIS Advisory Board members on the call as well. We encourage your comments, thoughts, and questions during the call.

We want your ideas and questions!
If you have a question to ask, or suggestions for discussion on the upcoming call, please e-mail me at bmurphy@cdiassociation.com. Conference calls are a great way to ask a question, air any and all concerns, or gather input on a policy or procedure at your hospital. While we cannot guarantee your question or discussion point will be addressed on the call, we will try to work in as many as possible.

Q&A: Coding ‘hepatic encephalopathy’ as a secondary condition

Have a question you'd like ACDIS experts to answer? E-mail mvarnavas@cdiassociation.com

Have a question you’d like ACDIS experts to answer? Email mvarnavas@cdiassociation.com

Q: What are the pros/cons of coding ‘hepatic encephalopathy’ as a secondary condition? For example, here is a clinical scenario that happened at our facility: A patient is admitted for pneumonia and the history and physical (H&P) states the patient has a ‘history of Hepatitis C with encephalopathy controlled with Lactulose, current grade 0 (zero).

In the opinion of the ACDIS Advisory Board members, is it compliant to code the Hepatitis C as with encephalopathy?

Donna Wilson: If a patient is admitted with viral hepatitis and also has hepatic encephalopathy, do not code hepatic encephalopathy (572.2) as a secondary diagnosis. Hepatic encephalopathy/coma is included in the code for the viral hepatitis (see AHA Coding Clinic for ICD-9-CM, 2007, 2nd Quarter, p. 6.)

Robert Gold:  My concern is that the name of the code is “with coma.”  When the patient is awake, alert, and not comatose, and therefore not being actively treated for coma, much less active delirium from hepatic encephalopathy (i.e., patient is stable on benchmark lactulose), do not code “with coma” just because the patient is under standard treatment—he doesn’t have it now.  This is a Recovery Auditor target.

Sylvia Hoffman: I agree with Donna. It would be inappropriate to code the encephalopathy. The Coding Clinic referenced also states if a patient is admitted with viral hepatitis and also hepatic encephalopathy, do not list hepatic encephalopathy as a secondary diagnosis. Hepatic encephalopathy/coma is included in the code for the viral hepatitis.

Donald Butler: Although I find the logic of the question very seductive, I’ve finally realized how to perhaps express why I have not been comfortable with this concept for a while. Coding for a chronic condition that is under control with treatment, etc., is one thing (i.e., end-stage renal disease [ESRD], congestive heart failure [CHF], etc.). The nuanced difference for me on this particular item is that coding the hepatic encephalopathy would be capturing the acute manifestation of the chronic problem (i.e., the underlying liver disease) that is not currently present but which the patient had previously. Encephalopathy is (per the National Institute of Neurological Disorders and Stroke) a global brain dysfunction, and the patient described in this scenario does not have that. One would not consider coding acute pulmonary edema or acute CHF in an ESRD patient is who stable and compliant with their treatment regime.

Secondly, although there is a non-essential modifier for hepatic encephalopathy (acute), it still suggests that the intent is for an acute problem. Furthermore, there is no index entry for chronic hepatic encephalopathy, and clinically I’m not sure such a condition exists. There are better ways to capture the treatment focused on the chronic liver condition, especially if the liver disease is advanced to the point of chronic failure.

Editor’s Note: This question was submitted for the ACDIS quarterly conference call of February 14, 2013, and  were answered by Donna Wilson, RHIA, CCS, CCDS, Robert Gold, MD, Sylvia Hoffman, RN, CCDS, CCDI, CDIP, and Donald Butler, RN, BSN, of the ACDIS advisory board.

ACDIS membership quarterly conference call Thursday, February 14

Happy Valentine’s Day from ACDIS. Join the Quarterly Conference Call Thursday, February 14.

Our next quarterly conference call is scheduled for Thursday, February 14, from 1-2 p.m. ET. To access the call, ACDIS members have been provided a toll-free number via email. If you have not received this email please contact ACDIS Member Services Director Penny Richards at prichards@cdiassociation.com or by phone at 781-639-1872, ext. 3423.

These calls are offered as a means for ACDIS members to network with one another and to discuss any clinical documentation improvement related issues. We will have a few ACDIS Advisory Board members on the call as well. We encourage your comments, thoughts, and questions during the call.

If you have a question to ask, or suggestions for discussion on the upcoming call, please e-mail me at bmurphy@cdiassociation.com. Conference calls are a great way to ask a question, air any and all concerns, or gather input on a policy or procedure at your hospital. While we cannot guarantee your question or discussion point will be addressed on the call, we will try to work in as many as possible.

Reminder: Quarterly Conference Call tomorrow

Quarterly conference call tomorrow.

The next ACDIS Quarterly Conference Call is scheduled for Thursday, November 15, from 1-2 p.m., ET. ACDIS members have received e-mail regarding how to access the call. If you have not received instructions, please contact Member Relations Specialist Penny Richards at prichards@cdiassociation.com.

Due to heavy call volume, we recommend that you dial in 10 minutes early.
These calls are offered as a means for ACDIS members to network with one another and to discuss any industry-related issues. We will have a few ACDIS Advisory Board members on the call as well. We encourage your comments, thoughts, and questions during the call.
If you cannot attend the call, a digital recording will be available for members to download on the ACDIS website. In addition, we will now be offering one CE credit towards the ACDIS CCDS certification.