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A Note from the CCDS Coordinator: Exam prep tips from our education director

CCDS Exam Study Guide

CCDS Exam Study Guide

by Penny Richards

As the coordinator for the Certified Clinical Documentation Specialist (CCDS) exam program, lots of folks ask me for CCDS exam prep tips. But I’m not a CDI professional—I don’t even play one on television—so I asked our CDI Education Director and Boot Camp instructor, Laurie Prescott, RN, MSN, CCDS, CDIP, CRC, for her expert advice.

“Some of getting ready for the exam is mental,” she told me. “If you’ve been working as a clinical documentation specialist for the minimum two years required [to sit for the exam], and you understand the role, you likely have the skills you need to pass.”

Prescott also provided me with a list of great tips that I thought I’d share with you:

  1. Use the CCDS Exam Study Guide, which comes with an online practice test.
  2. If you are an ACDIS member, take advantage of the great information on the website and the ACDIS Forum to talk to other members about their preparation and exam experiences.
  3. Read the 2016 ACDIS/AHIMA Query Practice Brief to help you understand compliant query practices.
  4. You must know how to use the DRG Expert. If you are encoder dependent and don’t know how to use the book, you’re going to have a difficult time. Find someone who can show you how to use the book, perhaps a member of your CDI or coding department. It’s not easily self-taught.
  5. Read the Official Guidelines for Coding and Reporting and be aware of the importance of the AHA’s Coding Clinic for ICD-10-CM/PCS. I am always amazed by the number of people working in CDI who have never picked up a coding book or read coding guidelines.
  6. Understand sequencing rules.
  7. A CDI Boot Camp would be helpful if you have the time and resources.
  8. Think about how you perform the role of CDI, how you review a record, and prioritize patient care.
  9. Metrics and analytics measure department success and some CDI specialists may not be familiar with this aspect of the program. Sit with your manager and ask him or her how to develop and interpret the data. Learn how to define and calculate the case mix index. Know what a query response rate is.
  10. Think about areas you may not have a lot of experience in, such as a specific clinical subject, procedures, etc., and study up on this area. Remember, this exam tests the overall function of CDI practice, meaning it may cover information not currently pertinent to your role due to the limitations of your facility.
  11. Finally, while it’s important to study and prepare, don’t try to do it all the night before.  Eat a good dinner and get a solid night of sleep.

Thank you, Laurie, for providing these tips! For more information on CCDS certification, click here.

A Note from ACDIS: What do you mean ‘Log in?’ I am logged in!

Logging in to the ACDIS website.

Logging in to the ACDIS website.

Our customer service team gets calls from people who have trouble accessing the ACDIS website.  They’re logged in with their username and password—or think they’re logged in—but they’re actually not.

It’s confusing and it’s frustrating, but it is very easy to check if you are logged in.

Go to the ACDIS website and look at the black bar at the top of the page. Follow it over to the right. Do you see a green box with “Become a Member” and a small white icon of a person in a black box? If you do, you are not logged in.

Logging in is easy to do. Hover over that little white person and you’ll see a “Log In” box appear. Click on it and you’ll come to page where you can enter in your information. Alternatively, look to the very top of the page, just below the banner ad and above the search box. If you see the words “Log in,” click on them and you’ll come to the page to enter your username and password. If you don’t know your user name or password (or either), contact the customer service team for assistance (customerservice@hcpro.com).

If you are not logged in and try to search for information, you may see a screen that says, “you have requested access to member-only content” with a prompt to log in. Once you log in, that small white icon of the person will be in a green box and you will be able to access all the content ACDIS has to offer.

Okay, what about free content?

What if you’re not an ACDIS member but still want access to the great free information that’s available?

The ACDIS website has lots of free content, but you do need to register to access it. That only takes a few seconds and you’ll be on your way. Once you register, you’ll be able to access all of our free content, which includes the ACDIS Blog, our weekly e-newsletter, CDI Strategies, ACDIS Radio, and select resources, and free webcasts. Please note, only members have access to the CDI Journal.

Keep your username and password handy

Jot down your username and password in a safe place and refer to them to log in as a member or for free content access and to order from the HCMarketplace store. Note that if you use a different Internet browser to access ACDIS you may need to enter and save your password to each browser. Additionally, if you close down your browser and return to ACDIS later in the day or later that week, you’ll likely need to log in again.

Please note, if you forget your login information and have to reset with a different e-mail or password, the new e-mail or password will apply wherever you have to log in.

If you are still experiencing issues with logging in or any other website concerns, please contact our customer service folks at 800-650-6787 or customerservice@hcpro.com.

Local Chapter Update: Show-me state chapter holds first regional event

Pic caption: Starting from the left: Leanne Ridolfi (Alton), Bonita Baer (University of Missouri Hospital), Mariann Dinello (SSM), Karen Elmore (Boone/BJC), Rebekah May (University of Kansans Hospital), Michael McKelvey (Progress West), Christine Shattenfield (St. Luke's KC), and Tammy Brandes (Boone).

 Starting from the left: Leanne Ridolfi (Alton), Bonita Baer (University of Missouri Hospital), Mariann Dinello (SSM), Karen Elmore (Boone/BJC), Rebekah May (University of Kansans Hospital), Michael McKelvey (Progress West), Christine Shattenfield (St. Luke’s KC), and Tammy Brandes (Boone).

Collaboration makes us better, which our Missouri chapter proved last week after successfully hosting its first ever regional event at the beautiful Boone Hospital in Columbia.

The day went off without a hitch, says chapter leader Karen Elmore, RN, BSN, CCDS, as the group of nearly 100 attendees—including nurses, physicians, coders, and HIM professionals—tackled an ambitious agenda of six sessions, multiple networking breaks, and giveaways. Speakers included ACDIS Advisory Board member Sam Antonios, who discussed the physician advisor’s role in CDI, Jennifer Grub who discussed CDI in recovery auditor denial prevention, and Rebekah May who discussed severity of illness/risk of mortality, among other great presenters.

Other highlights of the day included a welcome breakfast, networking lunch, prize drawings, and special exhibitions from vendors, MedPartners, The Claro Group, and Chartwise. Attendees also enjoyed a view of the hospital’s healing gardens, which attendees boasted about throughout the event, says Elmore.

The planning committee consisted of those from Boone, Progress West, Alton, BJH, BJC, SSM, MU Healthcare, The University of Kansas Hospital, St. Luke’s KC and Cox Heathcare. Congratulations to the group on a successful event!

Q&A: Morbid obesity

Have a question that is troubling you and your team? Ask us!

Have a question that is troubling you and your team? Ask us!

Q: Coding Clinic, Third Quarter 2011, p. 4 states:

“…morbid obesity is a chronic condition and; therefore, can be coded as a secondary diagnosis without treatment.” (emphasis added)

An article in the CDI Journal, “From the Forum: Manage denials for BMI morbid obesity,” seems to indicate that providers should document how the obesity affects patient care.

What level of patient care needs to be documented?

A: The Coding Clinic you are referring to states:

Question:

If the provider documents obesity or morbid obesity in the history and physical and/or discharge summary only without any additional documentation to support clinical significance of this condition, can it be coded? There is no other documentation to support clinical significance such as evaluation, treatment, increased monitoring, or increased nursing care, etc., for this condition.

Answer:

Individuals who are overweight, obese or morbidly obese are at an increased risk for certain medical conditions when compared to persons of normal weight. Therefore, these conditions are always clinically significant and reportable when documented by the provider. In addition, the body mass index (BMI) code meets the requirement for clinical significance when obesity is documented. Refer to Coding Clinic, Third Quarter 2007, pages 13-14, for additional information on coding chronic conditions.

Coding Clinic clearly states that morbid obesity should be coded when it is documented by the provider. It speaks to the fact this condition is always clinically significant. That said, morbid obesity is almost always addressed by both the provider and the nursing staff caring for the patient. These patients are more prone for infections, musculoskeletal injury, skin breakdown, respiratory compromise, etc., and, therefore, the medical decision making and care for this patient will be more complicated. This is why we are able to code this diagnosis whenever it is documented by the provider.

After this Coding Clinic was released, I have not seen a denial for this diagnosis. If you feel you need to expand documentation related to the condition, ensure your nursing plans reflect care of a morbidly obese patient. Your provider should also include their concerns related to the condition in their assessments.

Editor’s note: Laurie Prescott, RN, MSN, CCDS, CDIP, CRC, answered this question. Prescott is the CDI Education Director at BLR Healthcare in Middleton, Massachusetts. Contact her at lprescott@hcpro.com. For information regarding CDI Boot Camps visit http://hcmarketplace.com/clinical-doc-improvement-boot-camp-1.

Guest Post: Organizations respond to sepsis changes

James Kennedy, MD, will present a two-day preconference regarding the role and responsibilities of physican advisors for CDI.

James Kennedy, MD, CCS, CDIP

by James S. Kennedy, MD, CCS, CDIP

This October celebrates the eight month anniversary of the February release of the intellectually stimulating, yet controversial, third international consensus definitions for sepsis and septic shock (Sepsis-3). This new definition has generated significant discussions among those invested in ICD-10-CM-based documentation and coding integrity and compliance.

As we negotiate the fiscal year (FY) 2017 ICD-10-CM Official Guidelines for Coding and Reporting and revisions to the CMS Severe Sepsis/Septic Shock Core Measure (SEP-1), we in coding compliance must develop strategies that preserve the clinical integrity of the definition and diagnosis of sepsis in clinical care, support the proper cohort selection for SEP-1, and compliantly assign defendable ICD-10-CM codes based on provider documentation and coding conventions.

Authored by 19 critical care physicians and endorsed by many critical care societies, including the United States-based Society for Critical Care Medicine and the American Association of Critical Care Nurses, Sepsis-3’s goals were to better differentiate sepsis from uncomplicated infections, and to update definitions of sepsis and septic shock as to be consistent with improved understanding of their pathobiology. In recognizing that sepsis is a clinical syndrome without a validated diagnostic test, the committee sought to promulgate clinical criteria that could be standardized as to meet their objectives.

In so doing, the Sepsis-3 committee redefined sepsis as a “as life-threatening organ dysfunction caused by a dysregulated host response to infection,” which eliminated the concept of sepsis as a systemic inflammatory responses syndrome due to infection which was established with SEP-1 in 1991.

SEP-1 was built into ICD-9-CM in 2001 (though systemic inflammatory response syndrome (SIRS) due to infection cannot be coded as sepsis in ICD-10-CM), required only two out of four simple criteria (temperature above 101° F, WBC count over 12,000, tachycardia, and tachypnea), and did not require organ dysfunction to be present. The new Sepsis-3 also removed the SEP-1 term “severe sepsis,” which is sepsis with acute organ dysfunction.

In identifying a “life-threatening organ dysfunction” for the purpose of diagnosing sepsis, Sepsis-3 changed the Sepsis-related Organ Failure Assessment (SOFA) score to two or more. On the other hand, the CMS SEP-1 Core Measure, severe sepsis, and septic shock bundle, use different criteria than SOFA in defining severe sepsis (criteria available here), and relies on the documentation and coding of the word “severe sepsis,” no matter how its defined.

While agreeing with Sepsis-3 in concept, the Surviving Sepsis Campaign (SSC) rebutted that other clinical indictors of organ dysfunction besides SOFA, such as a lactate level over two, ileus, or sepsis-induced hypotension, should also meet the new criteria for sepsis. View the SOFA criteria and the SSC clarification.

One would think that this thoughtful conclusion would be welcomed by clinicians, clinical documentation improvement (CDI) specialists, and coders alike, much like the acceptance of the 2012 Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition’s criteria for adult malnutrition, or the 2013 Kidney Disease: Improving Global Outcomes’ criteria for acute kidney injury. Not so. Almost immediately upon the publication of Sepsis-3, Steven Simpson, MD, of the Division of Critical Care Medicine at the University of Kansas in Lawrence, Kansas, wrote a strong rebuttal and advocated that clinicians not adopt the new definition. Read his reply here.

The comment and response section for the July 26, 2016 issue of the Journal of the American Medical Association contained similar rebuttals, including a statement by Lemeneh Tefera, MD, of CMS in Windsor Mill, Maryland, that states, “although the task force’s definition structure may identify patients with the highest likelihood of poor outcomes, it does not clearly identify patients in the early stages of sepsis when rapid resuscitation provides the greatest patient benefit and improves survival.” Read his comment here.

The Advisory Board of the American Clinical Documentation Improvement Specialists also urged caution; read their position paper. As of September 5, AHIMA sponsored only one article in its CodeWrite newsletter, available to AHIMA members, which focused on the new definition and emphasized that background material published in Coding Clinic cannot be used as clinical criteria for code assignment.

I’m not aware of any forthcoming changes to ICD-10-CM as a result of Sepsis-3; if there are, we won’t see them until at least October 1, 2017. Therefore, at time of press, unless Coding Clinic publishes advice that changes the landscape, we now have a Sepsis-3 definition in a Sepsis-1, Sepsis-2, SSC, or ICD-10-CM definition, documentation, or coding environment.

Editor’s note: This post is an excerpt from an article originally published in JustCoding. Click here to read the full version.

A Note from the CCDS Coordinator: Recertifying your CCDS is easier with new application

CCDSpinby Penny Richards

Is it time to recertify your CCDS certification? You’ll find the process faster and easier now that ACDIS has introduced the new editable PDF application and pay-online features.

Visit the “Recertification” section on the Certification page on the ACDIS website to download the application. Fill it in, save it, and email it to the address shown on the first page. Click the link to pay online. If you prefer to pay by check you can print out the completed application and mail it to us.

You may submit your application no earlier than 60 days before your recertification due date. Remember, it’s your responsibility to know your recertification due date. It’s due every two years from the date you passed the exam (look at your certificate or score sheet). We send at least three reminders to the email address we have on file. We are not responsible for emails your facility may block or if you changed emails or jobs.

To recertify, you need to submit evidence of having earned 30 continuing education units (CEUs). All CEUs must have been earned in the time you held the certification or since your last recertification period. Additional CEUs cannot be used for a future recertification. Note the restrictions outlined on the recertification application and on the list of accepted CEUs (link above). Keep copies of your CEU certificates in case your application is selected for an audit.

Editor’s note: Penny Richards is the CCDS Coordinator for ACDIS. Need to know your recertification due date? Contact her at prichards@hcpro.com.

A Note from the Associate Editorial Director: A birds-eye view of ACDIS publications

shutterstock_381367021by Melissa Varnavas

At our office in Middleton, we sit beside a row of windows overlooking a parking lot and—at the moment—rolling hills of autumnal foliage shrouded in mist. About an hour ago, a big ‘ole crow landed on the window ledge and poked at each window pane before spreading its blue-black wings and sailing off to a nearby tree.

So, I thought I’d spend this note “crowing” about the publications available to ACDIS members and let you know about a few items coming in the next month or so.

In case you missed it, the September/October edition of the CDI Journal, covers a number of controversial concerns including:

  • The professional background of CDI specialists
  • The state licensure needs for nurses in CDI
  • Changes to Official Guidelines for Coding and Reporting
  • Tips for appealing denials
  • Sepsis-3 in the pediatric realm

Speaking of Sepsis-3, ACDIS Advisory Board member Paul Evans, RHIA, CCDS, CCS, CCS-P, delves into some thoughts about addressing reviews and queries in the white paper “How ‘R’ are you coding severe sepsis? Why the R-code matters.” In it, Evans reviews the various clinical guidelines for sepsis diagnosis as well as coding and documentation requirements. He offers case study examples of situations CDI professionals may very well face within their typical record reviews and provides some query examples.

ACDIS white papers are in-depth articles which discuss CDI best practice, advances new ideas, increases knowledge, or offers administrative simplification. It is less formal than a position paper, so as Evans writes in this release, his aim is to simply “review some of the aspects of differing definitions of severe sepsis and demonstrate why the coding of severe sepsis is important while providing some practical tips.”

Another white paper released just this week focuses on the need for a consensus of clinical definitions related to pediatric respiratory failure. A work group consisting of coders, pediatric nurses, physicians, and CDI professionals from the ACDIS membership met over the course of a year to review data from the field and coalesce various documentation conundrums those working in this area face.

“The lack of specific clinical criteria for the diagnosis of acute respiratory failure in the pediatric population, without intubation or arterial blood gas measurements, have led to the development of numerous institution-specific criteria for this disease,” the work group states.

While the white paper outlines prevailing CDI-related concerns, provides clinical scenarios, and offers some suggested actions. It also seeks additional insight and clarity from the institutions, such as The Society of Critical Care Medicine and The Society of Pediatric Critical Care Medicine, regarding clinical definitions of pediatric respiratory related diagnoses.

Finally, I very much enjoyed working with our friends over in HealthLeaders Media on a special section titled “From Finance to Quality: CDI Departments Expanding Their Reach,” in its most recent magazine.

Many CDI program leaders agonize over how to make the case for expanding their program efforts into quality-related record reviews, says Dee Banet, RN, MSN, CCDS, CDIP, director of CDI at Norton Healthcare in Louisville, Kentucky, and a past ACDIS Advisory Board member in the report. And yet, as government increasingly ties payment to quality with initiatives like pay-for-performance, the dividing line between patient care and fiscal concerns is slowly dissolving.

These highlights represent just a few of the items recently released by ACDIS. Members of the ACDIS Advisory Board have nearly completed work on a special white paper regarding career ladder creation in the field as well as a new report based on survey data regarding CDI productivity expectations. And, the 2016 CDI Salary Survey garnered more than 1,000 responses this year. So, no doubt, CDI professionals will be excited to dig into that data once the analysis is released later this month!

Now that’s something to crow about!

Editor’s note: Varnavas is the Associate Editorial Director for ACDIS with responsibilities related to its various publications and website offerings as well as the more than 40 local chapters across the country. Contact her at mvarnavas@acdis.org

Local Chapter Update: Maryland chapter event a success

0916161508a-1The Maryland ACDIS Conference hosted its inaugural event, thanks to the chapter’s leadership team and volunteers who put so much time and effort into planning and coordinating. The knowledge gained, networking that took place, and overall fun and comradery were enjoyed by all.

Participants were treated to networking breakfast and lunch sessions and were encouraged to ask questions of one another.

A robust guest speaker lineup included Janice Jacobs, who broke down hierarchical condition coding; Ingrid Connerney, who shared her facility’s experiences with potentially preventable conditions (PPCs); Glenn Krauss who offered up his thoughts on the “New CDI Paradigm;” and Kristen Geissler, who discussed “hot-off-the-press” updates for Maryland’s pay-for-performance programs. Sessions were interactive and participants had the opportunity to gain insights from the experts as well as their colleagues.

P1000797Here’s what one attendees had to say:

“What a wonderful Maryland ACDIS-First Annual Conference! You all did an awesome job! The Conference packets were super, and appreciated (I like taking notes). Excellent choice of speakers! I found each presenter to be extremely knowledgeable and their content very pertinent. And thank you to the MD ACDIS members who volunteered to help with the set-up, registration, packet prep, breakfast, lunch, afternoon snack bag, and parting gift. If there were any hitches during the day they were not apparent to me.”

Click here to see additional photos from the event.

Q&A: Query peer-auditing  

Go ahead, ask us!

Go ahead, ask us!

Q: Is it written in ACDIS Code of Ethics that, as CDI specialists, we are to “pull” bad or non-credible queries from patient charts and report them to our manager? This is what I have been taught in my current position.

A: As a manager, I would never ask my staff to be confrontational with each other. Queries should be audited on a regular basis—the manager or designee should regularly perform random audits of queries to ensure they are written compliantly and are appropriately assigned (no queries for unwarranted reasons), as well as identifying missed query opportunities.

Many departments also conduct peer reviews where each CDI specialist performs a selected audit of coworkers reviews and queries against facility and industry standards (such as the ACDIS/AHIMA Guidelines for Achieving a Compliant Query Practice). The group then discuss their findings and exchange ideas about what may have been missed or how a given query may have been more effectively worded.

I would never ask a CDI specialist to pull a query by another coworker like that. If they found something terribly concerning, it should be reported to the manager, and the manager can determine if the query should be pulled, etc.

This example, in my opinion, is not related to CDI ethics as much as it is management and leadership. Every program should have an established method of query audit.

Editor’s note: Laurie Prescott, RN, MSN, CCDS, CDIP, answered this question. Prescott is the CDI Education Director at BLR Healthcare in Middleton, Massachusetts. Contact her at lprescott@hcpro.com. For information regarding CDI Boot Camps visit http://hcmarketplace.com/clinical-doc-improvement-boot-camp-1.

Featured Member: Nominate a colleague to be featured on the ACDIS Blog

What's your top 10 common CDI specialist idioms?

If you read the ACDIS Blog, you’ve probably come across our featured member series. In it, ACDIS spotlights a member working on the frontlines in an effort to showcase the incredible things CDI specialists do every day. It’s also a chance for readers to get to know one another, to see what other members are doing in their facility, learn a little more about their peers’ backgrounds, how to get involved with ACDIS, along with a few fun personal facts about our members.

Want to volunteer to be our next featured member? The process is simple. Just e-mail us with your interest or nomination a colleague. We will reach out to you and/or your nominee with a series of questions that can be answered via phone or e-mail. We then turn those questions into an article, like this one.

This isn’t a competition or a formal recognition but an opportunity to share a little bit about yourself and connect with the ACDIS community in a conversational way. It’s also an opportunity for us at ACDIS to meet members from across the country and get their feedback.

To submit a nomination, or for any meet-a-member-related questions, please contact ACDIS Editor, Katy Rushlau, at krushlau@hcpro.com.