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Tip: Adapt policies and procedures for physician queries

One policy fits all.

One policy fits all.

When AHIMA released its “Managing an Effective Query Process” brief in September 2008, it raised a number of concerns among them the responsibility of a CDI program to draft consistent policies and procedures for conducting physician queries.  In a recent ACDIS poll, 29% of respondents said they did not have a query policy in place and 43% said their facility allows CDI staff a “flexible” query system.

Be careful about developing multiple rules for your facility query process, says Garri Garrison, RN, CPUR, CPC, CMC, director of consulting services for 3M Health Information Services in Atlanta.  The Department of Justice and the Office of the Inspector General “don’t care who asked the question”—either the HIM professionals in the coding department or a registered nurse in the CDI program—if the query leads the physician to document in an inappropriate way. So make sure when you develop your policy that you establish one approach and that everyone involved in the CDI program—coder, nurse, physician advisor—follows that approach.

Hear what Gloryanne Bryant, RHIA, CCS, senior director corporate coding HIM compliance department at Catholic Healthcare West in San Francisco had to say during the ACDIS quarterly conference call:

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The quarterly conference calls allows ACDIS members to speak with each other and industry experts as an informal networking opportunity. Those who are unable to listen to the call “live” may access the MP3 recording of the call on the ACDIS Web site.

ACDIS has a number of sample policies and procedures available in the Forms & Tools section of the Web site. Download a sample inpatient physician query policy that you can adapt to your facility’s needs.

CDI Professional of Year nomination forms due April 1–send them in!

Hi everyone,  I just wanted to send out a final reminder that nomination forms for our CDI Professional of the Year award are due in next Wednesday, April 1.

What makes a CDI Professional of the Year ? Well, there are no hard-and-fast guidelines. Here’s a few suggestions:

  • A manager who helped implement a successful program
  • A colleague who works hard at their job and is passionate about what they do
  • A persistent CDI specialist who got a difficult physician to finally break down, buy into a program, and document in the record
  • A CDI specialist working on their own in a small hospital on a shoestring budget, doing all that he or she can to get their program off the ground (if this matches a description of someone you know, nominate them!)

This is your chance to help a colleague recieve the recognition he or she deserves. We will be handing out our second CDI Professional of Year award at our upcoming conference in Las Vegas on May 14-15. The winner will receive a trophy and free admission. We also plan to hand out two awards for Recognition of CDI Achievement to two other deserving professionals. All three winners will recieve their awards and be recognized at our networking luncheon.

ACDIS members can read the story of last year’s winner, Randi Ferrare, published in CDI Journal.

Submitting a nomination is simple. Just go to to our awards page, fill out the form, and e-mail it to myself at

Finally, you can expect a sneak preview of some current nominees later this week.

Thanks, and best of luck!


Reminder: Florida ACDIS Chapter meeting Friday

I can’t tell you how thrilled I was to see the Florida ACDIS Chapter’s new logo! floridalogo1It even earned a “groovy” from our chief operating officer.

As a reminder the group holds its  its first meeting Friday, March 27, 2-4:40 p.m. The agenda includes  a review of the history of CDI and an analysis of the role of the physician advisor in the CDI program.

If you plan to attend please fill out the survey form and send an email to

No blarney, you’ve got the luck of the Irish

Feeling lucky?

Feeling lucky?

There’s not much time left in the good old Irish holiday of four leaf clovers and other Celtic mythologies. So before all your luck runs out, we here at ACDIS wanted to offer our own sort of celebration in the form of a quick contest.

It’s simple. We’ll  pick one random winner from those who leave a comment on this post to receive a free copy of “Coding and You: What every healthcare professional should know.” The handbook comes in packs of 10 so you can hand them out to finicky physicians or stubborn (not like the Irish) healthcare workers who don’t seem to understand the importance of coding and appropriate documentation yet.

We know sometimes the RSS feed doesn’t always post to your inbox right away so we’ll give you until noon Wednesday, March 18.

Good luck!

Birds of feather: ACDIS chapters start to soar

Let's get every state with the cardinal as its chosen mascott to start a CDI Chapter!

Let's get every state with the cardinal as its chosen mascot to start a CDI Chapter!

There’s been a number of additions to the roll of local ACDIS chapters. Most notably, we’ve received interest from Ohio and Virginia to meet with fellow members.

Imagine my surprise to find that both these states’ also call the cardinal their state bird. Look out North Carolina! As it turns out, seven states have the bright-hued aviator as the soaring emblem of their respective aviary prowess (and that’s not including state affinity for the bird associated with the names of sports teams St. Louis Cardinals nor the Arizona Cardinals).

Okay, so here’s a challenge. I put the call out to any clinical documentation improvement specialists from Indiana, Kentucky, and West Virginia (which all say the cardinal is their state bird, too) to start local ACDIS chapters in their neck of the woods. After all as the saying goes. . . birds of a feather. . . right?

Download this document for some tips for how to get a CDI chapter started including advice from state organizations which have been gathering for a few years now.

Click on this link to download a list of current local groups, meetings, and contact information.

CMS cheat sheet on IPPS basics available

Page three and four of CMS’ revised Acute Inpatient Prospective Payment System Fact Sheet (January 2009) contains a number of pastel looking charts outlining what seems to be mathematical equations. These graphical details show how IPPS payments are derived through a series of adjustments applied to separate operating and capital base payment rates.

Although I don’t recommend it for bedtime reading, the Medicare Learning Network Payment System Fact Sheet should be on your CDI required reading list.

Maybe you’ve read it before, maybe you’re already well-versed in the IPPS process and know all about how DRGs became MS-DRGs and how the wage-index fits into the final cost analysis, but maybe all this sounds like you need an accounting degree or a master’s in business healthcare administration. Either way, it’s always good to keep an eye on what CMS says about its own systems.

Maybe make it your lunch-time reading instead.

KISS method applies to CDI physician education too

One really great way to get the message about your clinical documentation improvement program out to the medical staff members is through the use of group presentations.

The presentation is a challenge in itself-trying to teach that proverbial old dogs new tricks-but, it turns out that organizing and scheduling those presentations can be just as challenging. Physicians have a small amount of time to get a great deal accomplished. Getting physician to give you five minutes of their time is fantastic but getting them to commit to half-an-hour or a whole hour is downright miraculous. That is, if you aren’t routed by way of the overprotective secretary.

The CDI specialist must not get disheartened. Persistence is the key (and a hearty supply of bribes, I hear they love chocolate). Once the presentation is finally set, remember to remain respectful of the physicians’ limited availability. They are used to moving fast and juggling multiple tasks at once.

Your presentation must be on the point and have enough visual interest to pack a punch. You must grasp their attention and hold it. Do not talk about DRG’s MCC’s and CMI’s. Keep it simple and let them know what is in it for them. In this world of increasing quality data reporting the physician needs to understand the impact of their documentation on their physician scores. Tell them what they need to know.

Oh, in the forms and tools library on the ACDIS Web site there’s a few sample presentations and physician education e-mails available for members to download.

Your name in lights! Where’s your ACDIS award nominations?

You can stop dreaming there's still time to get your nominations in!
You can stop dreaming there’s still time to get your nominations in!

C’mon ACDIS members, don’t you want to see your name etched on that shiny shard of silicone? There’s only a few weeks left to submit your entry for your favorite clinical documentation improvement specialist. The deadline for nominations is Wednesday, April 1, 5 p.m.

The nomination process is simple. Go to the ACDIS Web site ( click on the left hand button that says annual award, and download the form. The form asks a few basic questions such as the name, title, and contact information of the nominee. It also asks for a list of significant accomplishments and a 150 word description of why your choice exemplifies the qualities of CDI Professional of the Year.
Over the coming weeks we’ll post some examples of those who have already been nominated by their peers. Entrants so far are being recognized for a variety of reasons such as the implementation of new physician education tools or methods, tackling new managerial opportunities, developing a new CDI database, improving the facility’s risk of mortality statistics, and more.
We know you are as proud of your programs as we are of how the CDI profession is progressing. Tell us about your success stories. Submit your nominations.
By the way, winners get free admission to the ACDIS annual conference in Vegas in addition to the prestige and glamor of the award. I’m just saying.

How to handle multiple reasons for admission

When the physician directs medical treatment toward one condition, or when one condition is the only reason for the inpatient admission to the hospital, select that condition as the principal diagnosis (PDX). The PDX is the condition that the physician determines to be the primary reason for admitting the patient to the hospital.hands

Okay, let’s say Mrs. Happy Hinklebottom (yes, I just made that up) comes to the hospital complaining of a urinary tract infection (UTI) and exacerbation of congestive heart failure (CHF). The physician orders all sorts of tests and treats both conditions. The coder/clinical documentation specialist still needs to determine which condition justifies the inpatient admission. It could be the UTI. It could be the CHF. It could be both.

If the answer is truly both, then select the optimal DRG, writes Colleen Garry, RN, BS, clinical documentation improvement specialist at the New York University Medical Center in NYC, in The Clinical Documentation Improvement Specialist’s Handbook. However, if you are unsure as to which condition is the PDX you’ll need to query the physician. In Mrs. Happy Hinklebottom’s case, the CDI specialist should query about the type of CHF to determine if it is acute, chronic, systolic, diastolic, or both systolic and diastolic.

Editor’s note:This excerpt was adapted from the book The Clinical Documentation Improvement Specialist’s Handbook.

Stilted superstitions: Early-bird conference specials extended

Better luck on the way.

Better luck on the way.

It’s Friday the 13th. Today was the last day to get in on the early-bird registration for the 2nd annual ACDIS conference in Las Vegas. It was also the last day to book your Caesar’s Palace room at the early-bird, $199 rate.

If you’re superstitious you might be hiding under the bed waiting for Jason Voorhees to arrive in his blood covered hockey mask. The more triskaidekaphobic might surround themselves with counter curses. We’ve got a counter curse or two to help ease your worries.

With special thanks go to our ACDIS conference coordinators, we’ve negotiated with Cesear’s Palace to extend the early-bird hotel rate through April 13. That’s more than a month longer than initially planned. And we’ve arranged to extend the early-bird conference registration discount through April 17.

Hopefully, this information helps to turn some of those superstitions around. After all some people believe that Friday, 13th actually brings good luck. . . .