RSSRecent Articles

ACDIS member weds while attending 2009 conference

This cake by Freed's Bakery in Las Vegas bears the title "Lucky in Love"! We're sure happy that ACDIS member Vicki McMahon decided to marry her sweetheart Ron! Talk about lucky!

This cake by Freed's Bakery in Las Vegas bears the title "Lucky in Love"! ACDIS member Vicki McMahon and now hubby Ron tied the knot while there for the conference-talk about lucky!

Vicki and Rod lived in the same small town most of their lives and although they each knew of each other’s families, they’d never met. Then about four years ago, Vicki and a friend decided to go out for dinner and drinks. Rod and his friend played music on the jukebox. They asked the ladies to dance. . .

Ah, romance.

Of course, there weren’t immediate sparks, but over time Rod and Vicki realized how much they enjoyed seeing each other. Soon they were inseparable. In February of 2008, Rod asked Vicki to marry him and of course she said “yes!”

When she signed up for the 2nd Annual ACDIS Conference in Las Vegas the couple joked about having “drive-thru” wedding. “We both laughed and then reality sat in,” says Vicki (now) McMahon RN, MSN, Clinical Documentation and Coding Nurse Manager at St. John’s Hospital in Springfield, IL. “We both lead very busy lives so a formal wedding was totally out of the picture, and besides that is not what we wanted. We played around with the idea and by January that is what we decided we would do.”

The couple kept it a secret from everyone and when they arrived in Vegas on May 12, they checked into their hotel, freshened up, put their “wedding attire” on, and off they went to the court house to pickup their paperwork.

“As we were traveling there, we joked about if we would go through a drive up or a walk through wedding. Yes, we are kinda cheesy that way,” McMahon jokes.

With the appropriate papers in hand however the couple headed over to the Stained Glass Wedding Chapel in downtown Las Vegas, tied the knot, and proceeded to enjoy the Vegas highlights, and of course the ACDIS conference!

“I must say this was one of the better organized conferences I have ever attended,” McMahon says. While she and husband are looking forward to attending next year’s show in Chicago, she says, “I’m not sure what we will do to improve on this trip…”

Congratulations Vicki and Ron from all your ACDIS friends!

ACDIS seeks volunteers for work group projects

Update: These work groups are no longer accepting applications.

ACDIS is forming two work groups and is looking for volunteers to take part in these important projects. Participation in both groups is limited. Please note, you MUST be an ACDIS member in good standing to participate. Committees  include:

1. ACDIS 2010 Annual Conference Committee

As its name implies, the ACDIS 2010 Annual Conference Committee will help us plan and shape next year’s conference in Chicago. The committee will provide feedback on past conferences, help select sessions and speakers for 2010, help us decide on any other conference-related activities, and select our annual CDI Professional of the Year.

2. ACDIS CDI Work Group

The ACDIS CDI Work Group will meet on a regular basis to discuss best practices, definitions, and suggested benchmarks on a number of issues in the CDI profession. Its ultimate goal is to produce a series of best-practice articles available to the ACDIS membership.

Joining this group requires you to view its time commitment, objectives, and to fill out an application form. Please read and download the form here, fill out the necessary information, and e-mail it to ACDIS Director Brian Murphy at

We will have a few members of the ACDIS Advisory Board participating on the ACDIS CDI Work Group as well.

Thanks, and I hope to hear from you on these two important projects.

Brian Murphy, CPC
781-639-1872, ext. 3216

Nurses fight for rights as CDI professionals

Clinical Documentation Specialist?

I was reading an article (title undisclosed) recently that discussed the importance of hiring a CDI specialist in a certain hospital settings. They gave a glowing account of the attributes of the clinical documentation specialist and the benefits they have on the business side of medicine.

The article went on to describe how to select a trained applicant. It recommended that the hospital “select a clinically astute coding professional with a strong business background.” It went on to say that hospitals should “consider hospital coders with a business background as likely candidates, because they not only posses business experience, but they also have clinical knowledge and competency in IV infusion and other related coding areas.”

I was horribly disappointed with the implication that a (nurse) clinical documentation specialist could not do the job.

Last year our hospital hosted a team of CDI specialists from a nearby hospital who wished to gain information on growing their program. At the conclusion of the day the manager told us that prior to coming to our hospital he would not have hired an RN. He thought they were unable to understand coding rules and concepts. After spending the day with us, he no longer felt that way.

At the Florida Regional ACDIS meeting that same manager introduced us to his team and he was especially proud to introduce his newest team member—a nurse.

When are the walls going to come down? A majority of the ACDIS members who attended the meeting in Las Vegas were nurses, yet most of the resources for clinical documentation improvement are are geared for coders. I am confused!

When I made the transition from case management to CDI, I was excited to enter a new and growing field. CDI was presented as a new opportunity for experienced nurses who had a desire to grow professionally. Our department had no policies or procedures, or standards for recording or measuring success. We developed the program from scratch.

I am not a coder but I worked very hard to learn the little bit I have learned about coding. I read many books, have taken many courses and asked many questions. I am a Clinical Documentation Specialist. Why is it, that I am the only person who thinks so?

Feeding the brain on malnutrition documentation

Remember the old 80’s ad for the Big Mac? “Two all beef patties, special sauce, lettuce, cheese,

Documenting malnutrition might be easier than building a Big Mac.

Documenting malnutrition might be easier than building a Big Mac.

pickles, cheese, onions on a sesame seed bun.”

These lyrics and the associated fast food mania was a sign of what I will call food affluence, when we valued time over money, convenience over quality and taste over nutrition. And yet during that same period, the prevalence of malnutrition in hospitalized patients was investigated numerous times with results indicating the malnutrition was a major concern for elderly, hospitalized patients. The effects of malnutrition and the associated costs were also vastly studied in late 80’s and early 90’s. So why has this issue not resolved?

Of course, the issue is once again poor documentation of the severity of the diagnosis and decision making regarding care of this condition. Unfortunately, the malnutrition codes differ from the usual medical terminology. The severity of the malnutrition is indicated in the codes and while clinical severity is typically indicated in risk not actual diagnosis.

Most nutritional consult forms provide a method for the dietitian to indicate risk for malnutrition, not an actual diagnostic statement. Many forms actually ask the dietitian to specify the level of risk of malnutrition by checking the appropriate box for low, medium/moderate, or high. These indicators do not easily translate into an ICD-9-CM code forcing professional coders and CDI specialists to search for other indicators of the severity of malnutrition to clarify diagnoses with the physician.

In an attempt clarify the need to document the severity of malnutrition in adult hospitalized patients, Coding Clinic addressed the issue in the fourth quarter of 1992. It says:


CDI Journal posted on

The third quarter CDI Journal has been posted and is available for ACDIS members online at

Here’s a list of what’s included inside the July edition:

Director’s note
ACDIS members make conference a success. What will happen in Chicago?
Case study
CDI Professional of the Year Beth Kennedy earns kudos. CDI Professional Achievement honorees noticed for teamwork and leadership skills.
Malnutrition documentation
Guest columnist Jon W. Arnott, MD, CMQ, explores how to capture severity of illness through malnutrition indicators; includes sample query form and clinical data set.
Query protocols ease compliance risk
Setting appropriate query standards can keep potentially harmful practices at bay.
Inflammatory bowel disease
Guest columnist Helen Walker, MD, writes about the tricks of capturing accurate language for a host of possible gastrointestinal problems; includes sample query.

CCDS designees named
ACDIS is proud to recognize and congratulate our first group of professionals to pass the Certified Clinical Documentation Specialist (CCDS) exam. They are now free to begin using the CCDS credential after their name.

RAC: Complex reviews to arrive as soon as August

Those who haven’t seen the latest e-mail news blast, I thought I’d post it again here.

by Andrea Kraynak, CPC-A

CMS released further information June 24 on its RAC Web site letting healthcare providers know when they can expect RACs to begin auditing. The new “CMS RAC Review Phase-in Strategy,” details different types of reviews and dates CMS anticipates the reviews will begin in various areas of the country.

The new information is consistent with CMS’ previous indications that some providers may begin to undergo automated review this month.

According to the CMS, the earliest possible dates for RAC reviews in yellow and green states are:

  • June 2009—Automated reviews of black and white issues
  • August or September 2009—Complex reviews for DRG validation
  • August or September 2009—Complex review for coding errors
  • Fiscal year 2010, which begins October 1, 2009—Complex reviews for durable medical equipment (DME) medical necessity
  • Calendar year 2010—Complex reviews for medical necessity

The earliest possible dates for reviews in blue states generally fall a bit later:

  • August 2009—Automated reviews of black and white issues
  • October or November 2009—Complex reviews for DRG validation
  • October or November 2009—Complex review for coding errors
  • Fiscal year 2010—Complex reviews for DME medical necessity
  • Calendar year 2010—Complex reviews for medical necessity

CMS also reaffirmed that before RACs actively begin auditing in a particular state, outreach educational sessions must occur in that area.

Although the schedule calls for automated reviews as early as this month, any issue a RAC reviews must be vetted through the CMS’ “Issue Review Board.” In addition, RACs must post the approved issues to their Web sites before the reviews can begin.

“Providers should check their RAC’s Web site often for any newly approved issues for review to anticipate their vulnerability to reviews and take backs,” says Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance for HCPro, Inc.

Even though CMS has delayed the rollout of certain types of complex reviews, providers shouldn’t ease off on their RAC preparation activities.

“Use the time wisely to continue performing your own internal vulnerability audits and ensure that all of your policies and procedures are up-to-date. Consider this a little extra time to get your facility ready for those appeals,” says Tanja Twist, MBA/HCM, director of patient financial services at Methodist Hospital of Southern California.

Note: Twist and Hoy will be speaking at the upcoming conference, “Medicare Compliance Forum: A Strategic Approach to RACs, Observation Status and the Role of Physician Advisors,” which will be held in Atlanta this October. Twist will also be featured in the July 21 HCPro audio conference, Medicare Appeals: Practical and Compliant Procedures for Overturning Denials.

New ACDIS white paper available for download–encephalopathy

Hi ACDIS members, I wanted to let you know about a new white paper available for download in the Helpful Resources section of our Web site under the heading “White Papers.” It’s called “Cut through the confusion of altered mental status,” and it offers suggestions on what to when physicians document AMS, as well as how to appropriately query for encephalopathy and/or other more specific diagnoses. It also includes a sample AHIMA-compliant query form.

The source of the white paper is James Kennedy, MD, CCS, of FTI Healthcare. Dr. Kennedy is a unique combination of clinical and coding expertise.

I hope you find this white paper helpful. ACDIS publishes white papers on a quarterly basis on various topics in the CDI profession. If you haven’t seen our Helpful Resources page, check it out!

Take care,


Chapter 3: The MS-DRG Training Handbook

We’re constantly talking about to get the word out about the importance of clinical documentation improvement. How can we teach physicians that the specific language they use in the medical record affects their patient’s treatment, their quality scoring, hospital reimbursement, and their own reimbursement too?

First to answer the triva questions wins a set!

First to answer the triva questions wins a set!

Some of you may be familiar with The MS-DRG Training Handbook written by ACDIS Advisory Board member Gloryanne Bryant, BS, RHIA, RHIT, CCS, but for those who haven’t seen it yet there’s a collection of examples for explaining the MS-DRG system to physicians in Chapter 3, I thought I’d share with you:

“1. Call upon physicians to better document the character, underlying causes, complications, and severity using ICD-9-CM language. For example, in order to get decompensated CHF to count as an MCC, physicians must clearly state that it is acute and must document whether it is systolic or diastolic heart failure. Stating one without the other will result only in a CC.

“2. Ask physicians to clearly document the underlying mechanisms of certain manifestations. For example, if a patient has hyperkalemia as the result of the drug spironolactone, the physician needs to document the state of hypoaldosteronism. Similarly, if a patient has delirium due to narcotics, the CDI specialist needs to query the physician regarding the extent or possibility of toxic encephalopathy. “

The Handbook includes a good amount of basic, easy-to-understand information regarding the development and importance of the MS-DRG system, which I’m sure I’ll excerpt from again. Not to be pushing product but it comes in packs of 10, which. . . when we’re talking about educating physicians. . . can be a quick item for CDI specialists to hand out.

Educating physicians and others  about how the implementation of MS-DRGs increased the need for CDI is particularly important during a new CDI program’s inception. That’s when the only thing physicians want to know is: Who are you? Why are you doing this? What’s in it for me? Understanding MS-DRG basics can help them see the bigger picture behind the healthcare reimbursement system.

So here’s some trivia. First person to answer BOTH questions correctly will get a pack of the Handbooks.

  1. When did the MS-DRG system take affect?
  2. What three basic categories of the system?

CDIs tell the story behind the patient record

I came across this article from HealthLeaders Media the other day. It talks about the importance storytelling in healthcare. I don’t think they were talking about the “once upon a time” kind of storytelling, but more about the kind of storytelling that represents what we writer-types like to call the “narrative arc.”  Simply put, everything has a cause and effect whether it’s how some story-book character’s childhood upbringing comes to bear on their philosophical outlook or, in the case of clinical documentation improvement,  how a particular patient’s clinical indicators come to bear on his or her inpatient stay.

CDI professionals try to get all the story particulars from all the various characters as they each play their role in the development (and resolution) of a patient’s healthcare plot.

According to the article, facilities in the United States and the United Kingdom are using storytelling to enhance patient history information to get a better sense of how to treat the patient. Storytelling also helps providers develop a relationship with the patient and form a better understanding of an individual case, writes Sarah Kearns.

While I’m not suggesting that we rename clinical documentation improvement specialists “storytellers” I am suggesting CDI professionals take a second to consider the health record as if it represents the “story” of the patient’s life, the story of his or her care. Furthermore, I am suggesting that perhaps expressing your documentation improvement efforts in that way may actually resonate with the physicians and help them understand the important role you also play.

Florida ACDIS regional meeting a success

The Florida ACDIS regional meeting was a great success! Tampa General Hospital hosted the meeting with 25 members representing seven hospitals. Several more tuned in (after technical problems were solved) via the teleconference link.

Darlene Shelffo, RN, Manager, Tampa General Hospital greeted all the attendees and explained the new Florida ACDIS Web site, ( She also gave a brief description of the TGH CDI program.

Photos were taken outside on the veranda of TGH.

Photos were taken outside on the veranda of TGH, with its views of beautiful Tampa Bay and the flagship, Jose Gaspar.

Sylvia Hoffman presented a slide show titled “CDI Physician Education: How to make it interesting and get physician buy-in.” She covered a variety of tactics that can be used to interest physicians and the importance of making the presentation visually pleasing, interesting, relative to the practice of medicine, simple and to the point. She also discussed the need to include dynamic content such as SOI, ROM CMI and E/M Billing.

Dianne Martinez led the group with the business portion of the meeting. A vote was taken on the payment of dues and was approved unanimously. The amount agreed upon was $25 per person/per year. Checks will be mailed to the Secretary/Treasurer and only those members who have paid their dues will be Florida ACDIS members in good standing with the ability to access the Web site and receive the newsletter. Members need not be national ACDIS members to be members of the Florida Chapter. However, Florida Chapter members receive a discount on national memberships.

A vote was also taken to reduce the number of meetings to twice yearly. This was also passed unanimously.

Elections were held and the results were as follows:

  • Sylvia Hoffman RN, Tampa General Hospital- President
  • Virginia Baily RN, Morton Plant Hospital-Vice President
  • Mary Bennati RN, St. Anthony’s Hospital-Secretary/Treasurer