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CDI chapter developments

booksWe’ve learned about a number of new CDI local chapters since CDI Strategies hit e-mail inboxes this morning. (If you do not already subscribe to the free e-newsletter what are you waiting for? It’s free. And there’s lots of good information in there. Yes, I write it. That’s why I’m saying. . . )

 If you have a hankering for some Maryland Blue Crab, take a trip to the “Old Line State” (that’s it’s nickname, the World Wide Web wouldn’t lie!) for the Friday, March 20, from 1:30-3 p.m., for the Maryland Hospital Association (MHA) CDS Workgroup meeting.

Maryland has had a local CDS Chapter in place since July 2006, according to MHA CDS Workgroup co-chair Denise Otto RHIT, CCS. The group meets bi-monthly, the third Friday of the month. Contact Denise Otto at or her co-chair James Nagel, at

And over in Seattle, Joan Kloster, RN, Clinical Documentation Specialist at Overlake Hospital Medical Center in Bellevue, WA, is interested in starting a group. Contact her at 

Meetings this month
The second NE Regional CDS meeting will be held next Thursday, February 26, from 1:15-3:30p.m. at Norwood Hospital in Norwood, MA. Click on the documents here for more information.

The North Carolina Chapter meets at Gaston Memorial Hospital on Friday, February 27, 10 a.m. to 2 p.m. For information, contact Leah Taylor, RN, clinical documentation specialist at Iredell Memorial Hospital in Statesville, NC, at

Editor’s Note: Click on the “more” button below for an alphabetical listing by state of specialists who are interested in, or currently are, hosting local CDI meetings. Please reach out these generous individuals if you are interested in joining them. As always, feel free to contact ACDIS by e-mailing Melissa Varnavas at or by phone at 781-639-1972 ext. 3711.  


CCDS exam handbook posted!

Hi everyone, questions have been coming fast and furious about the forthcoming certification and credential for CDI specialists, the certified clinical documentation specialist (CCDS). I am happy to say that we have completed the CCDS examination handbook. This document should answer all of your questions regarding

  • the purpose of the credential
  • eligibility requirements
  • what to expect on the test, including a detailed content outline and sample questions 
  • how to apply for the test
  • how to take the test at an Assessment Center

You can download the handbook by clicking here:, or by visiting our certification page at You can expect more information on the certification in the coming weeks, including some brand-new informational web pages on the ACDIS Web site.

Thanks, and feel free to keep the questions coming,


Love, love, love: CDI profession amore

“Love has nothing to do with what you are expecting
to get-only with what you are expecting
to give-which is everything.”
-Katharine Hepburn

Ask any CDI colleague what they like about their job and they’re generally hard pressed to come up with an answer-not because they can’t think of anything but because they can’t think of any one thing. They genuinely love their jobs.

“I’ve been a CDI specialist for about five-and-a-half years now. It’s honestly the best job I’ve ever had,” says Mike Alcorn, LVN, Documentation Specialist at the North Cypress Medical Center in Cypress, TX.

“Personally, I love the challenge of this job,” says Shelia Bullock, RN, BSN, MBA, CCM,
Manager of Clinical Documentation Services, at the University of Mississippi Medical Center in Jackson.

Bullock enjoys the “big picture” potential of communicating the impact of appropriate documentation to the various healthcare stakeholders throughout her facility.

“It’s the interaction with different groups of people that I enjoy most,” she says. “Those moments when you see that the person you’re speaking with really understands where you’re coming from. Those ‘Ah-Ha’ moments. It’s so great to see them realize the impact of appropriate documentation.”

“I love how the clinical depictions intertwine with the whole patient picture,” says Colleen Stukenberg MSN, RN, CMSRN, Clinical Documentation Management Professional at FHN Memorial Hospital, in Freeport, IL. “Then you see how that picture translates into the revenue cycle. You [the CDI specialist] take the clinical aspect from the physician and bring it into this other world. It’s really fantastic.”

What do you love most about your CDI role? Let us know. Happy Valentine’s Day.

2008 salary survey shows modest means for most

moneyMost CDI specialists make between $60-$70,000 a year, according to the ACDIS 2008 salary survey. Whether you feel your current salary’s suffient for your workload or not consider this: When I first started my career as a reporter at hometown newspaper the argument of the day revolved around the superintendent-of-schools annual salary increase. That year (if I remember correctly) they raised his salary to $120,000. At the time, the mayor the city made $60,000 annually.

Now, the average 2007 salary of WellPoint, Inc. board of directors member was $350,000, according to a report from Atlantic Information Systems, Inc. Not to make a target of WellPoint. . . but. . . we all know how insane the corporate salary intakes seems in this day and age, from our local officials to our sports heros to our healthcare administrators.

What’s the solution to these spiraling salaries? Who knows.  Some say transparency’s the key. I’d guess that might induce additional feelings of jealousy and greed—i.e., if that guy gets so much money why shouldn’t I?

We have a few salary outliers in our own industry—less than 5% of those surveyed last year reported earning more than $90,000—but for the most part CDI specialists are just working folks.

Need proof? Check out last year’s salary survey and keep an eye out for your invitation to particpate in the 2009 version.

Perhaps we have to wonder at our collective ideologies when a bank president thinks its fine to spend millions on office decor.

Still inflamed by sepsis documentation? Listen in!

Bacteremia vs. septicemia; urosepsis vs. sepsis—who hasn’t experienced this documentation nightmare? Proper reporting of sepsis dramatically affects final MS-DRG assignment and hospital quality profiling. CDI specialists understand this. But what are the clinical indicators and how can we submit acceptable queries for these conditions.

If you missed the ACDIS February 5 audio conference  Sepsis Documentation and Coding: Clinical Indications, ICD-9 Guidelines, and Queries for Clarity Sample Sepsis Query featuring, James S. Kennedy, MD, CCS, from FTI Healthcare Brentwood, TN, and Jennifer Avery, CCS, CPC-I, CPC-H, a senior regulatory specialist from HCPro, Marblehead, MA, you can still order an audio-on-demand version of the show. 

Here’s a tip taken from the presentation: 

“If the physician only states ‘septicemia’ or ‘bacteremia,’ then query for clarification to determine if additional code assignment is appropriate for sepsis or SIRS. . . The coder should never assume that the presence of SIRS criteria on admission allows the coder to code 038.x as principal without corroborating physician documentation that sepsis was present on admission. This is especially important with Recovery Audit Contractors finding over $300 million in potential revenue their first year in existence.”

Download the free Sample Sepsis Query form courtesy of Wendy Dougherty, of Mercy Medical Center in Nampa, ID. ACDIS members have access to dozens of sample forms and useful tools in the Forms and Tools Library on the Web site. 

Visit our customer service department to become an ACDIS member.

Tips to help CDIs celebrate Lincoln’s 200th

He looks good for 200!

He looks good for 200!

You have enough to do. I know it. The last thing you really need to worry about is how to celebrate the 200th anniversary of the birth of Abraham Lincoln. (It’s Charles Darwin’s birthday, too, by the way. Yes, they were actually born on the same day-February 12, 1809.) You’re so busy the whole thing must have slipped your mind. Don’t worry, I’ve come up with a few suggestions to help you mark the day before the the last query is filed.

  1. Communicate with coders and physicians. Lincoln was known (thanks to Doris Kearns Goodwin and President Barack Obama) for assembling “a team of rivals.” CDI specialists can do this, too. Just reach out to the people “across the aisle” in order to obtain the most complete documentation possible.
  2. Write another query. “I shall try to correct errors when shown . . .errors,” Lincoln wrote in a letter to the New York Tribune on August 22, 1862. Of course he referred to the official state of the Union, that should a misguided notion of his own thought be uncovered Lincoln would seek to alter his opinion. Nevertheless, we can apply the sentiment to CDI (if only in honor of Lincoln’s birthday). CDI professionals should query any supposed error or omission to the patient medical record. It’s the CDI specialists’ role.
  3. Offer documentation tips to your favorite physician. Lincoln was the great orator. Use your own interpersonal skills; the ones you honed through your years communicating with physicians and patients on the floor to now communicate your facility’s documentation needs.

Okay, that’s all I could come up with and it was a stretch, I know. I suppose you could aim for 200 closed queries by the end of the month but how realistic would that be? Anything for a little bit of celebration on such an auspicious occasion. Cheers!

Free CDI white paper for download: Culture of quality

Hi ACDIS members, I hope you’re all doing well. I wanted to let you know about a new white paper that is now available for free download in the Helpful Resources section of our Web site. It’s called “Instill a culture of quality to ensure CDI success,” and you download it by clicking here.

We plan to continue to provide you with additional CDI-related white papers in the coming year. These are intended to provide an in-depth look at various issues in the world of clinical documentation improvement. We’ll also be using them to provide you with opinions of differnet thought-leaders in the field. Not all the opinions expressed in these white papers are necessarily shared by ACDIS, but we hope you find the information beneficial, useful, and thought-provoking.

If you enjoyed this white paper, or have some questions and/or would like to discuss what you read, please post it right here on CDI Blog.

If you’d like to make a suggestion for a future white paper topic, please e-mail me at

Take care,


CCDS tests in your neighborhood

Vegas is beautiful in May. (I’m not personally aware of this fact. I’m just saying Vegas is probably beautiful any time of the year.) But some of you may not be able to make it to the ACDIS conference. Rest assured we’re developing additional ways to share conference information with our members including possible audio CDs and downloadable presentations.

Perhaps the most common questions we’ve recieved so far about the conference is the request for additional information about the Certified Clinical Documentation Specialist (CCDS) credential and its corresponding exam. Later this month, ACDIS Director Brian Murphy plans to post a CCDS examination handbook as a free download for ACDIS members on our Web site. This will contain a detailed content outline of what to expect on the test, as well as a few sample questions. It will certainly help your study efforts. In the future, ACDIS members can expect a more formal study guide.

papermache_neighborhoodOur special advisory team developed the test questions based on standard CDI experiences and common requirements. This talented bunch spent nearly a year working with Applied Measurement Professionals, Inc. (AMP) to develop the most targeted exam questions possible. AMP’s also helping facilitate remote CCDS testing sites around the country  for those who can’t join us in Vegas. 

As ever, if you have any questions or concerns don’t hesitate to contact us.

In defense of Lumbergh’s TPS report

In one scene from the movie Office Space, the boss (Lumbergh) has to remind his staff members to put a cover sheet on the TPS reports. Company management even writes a memo about it.

 To some, documentation queries may seem like that Office Space scene. Who cares about the cover sheet? Unlike that fictitious account of office hijinks however, the nuances of capturing every bit of clinical evidence in patient care documentation is much more important than a cover sheet.

Lack of complete, specific documentation means the potential loss of reimbursement dollars for a facility. It also misrepresents patient needs, facility expenditures, population data, and more-all of which will soon become paramount as payers aggregate data and focus their attention on quality of care.

Physicians will use this data, too. They’ll drill into documentation to spot trends, identify diseases, and develop new treatments for our top health concerns.

That’s why CDI programs can’t be compartmentalized strictly into a DRG capture service or a severity of illness analysis tool, nor a revenue generating program, says ACDIS board member Shelia Bullock, RN, BSN, MBA, CCM, manager of Clinical Documentation Services, at the University of Mississippi Medical Center, in Jackson.

“CDI is very important not just for physician documentation but for the total hospital process. Everyone needs to understand how this little piece affects the global picture of how things work,” Bullock says.

The most appropriate adjective to describe a patient’s condition may seem insignificant. A physician might think everyone knows the differenct between an acute and systolic CHF.

Did I push the Office Space movie metaphor too far? Ah, well. It’s a good movie at any rate. Take it as my suggestion for your next Netflix pick.

ACDIS welcomes new advisory board members

Hi ACDIS members! I’d like to take a moment to introduce our four new advisory board members. These are the folks we depend on to provide leadership and share their expertise with you, the ACDIS membership.  They participate on our quarterly confernece calls to help foster discussion, serve as sources for articles, and are an invaluable  sounding board for all the decisions we make within the association.

So please take a moment to welcome them on board with a comment.

As a note, we received over 20 applicants for four available slots and the voting was difficult. If you applied for the board but were not selected, I encourge you to re-submit your application next year. Our plan is to add four new members each year, who will serve up to a three-year term. This will ensure an influx of new perspectives and opinions to share with our members.

So without further ado, here are the new advisors:


Shelia Bullock, RN, BSN, MBA, CCM
University of Mississippi Medical Center
Manager of Clinical Documentation Services
Jackson, MS

In March 2007, Bullock had the exciting and challenging opportunity to implement and manage the Clinical Documentation Improvement Program at the University of MS Medical Center. UMMC is the only Level 1 Trauma Center, Transplant Center, and Medical School in MS.

Bullock’s nursing career spans over 30 years. She has worked as a staff nurse, in hospital nursing management, in commercial insurance as an auditor, implemented a case management and disease management program for a commercial insurance carrier, and managed a hospital utilization review department. One of the most interesting steps in her career was case management in the prison health system.

Bullock believes education is the key to success in a person’s career and everyday life. Whether formal or informal, learning something new each day helps a person grow and enjoy life. She is a charter member and on the board of the Mid-MS chapter of CMSA. She has presented educational programs to physicians, nurses, coders, and at the MS AHIMA state conference. Her hobbies include gardening and photography.


Garri L. Garrison, RN, CPC, CMC, CPUR
3M Health Information Systems Consulting Services
Director of Acute Care Services

As a Director in Acute Care Services for 3M™ Health Information Systems, Garrison is responsible for development and management of clinical documentation improvement services, RAC services, HAC services, coding validations, quality outcome services, data monitoring services, and compliance services. Her responsibilities include design of service offerings, content development for educational programs, and content development of software associated to support these services. This software includes data monitoring tools that provide comprehensive case mix index and profiling analysis to assist hospitals in improving quality outcomes, ensuring the accuracy of performance reports, and achieving appropriate reimbursement.

Garrison has more than 30 years experience in healthcare, including extensive experience in clinical documentation improvement initiatives, quality outcomes improvement services, process improvement, coding validations, compliance audits, and litigation support. She has been heavily involved in the development of new consulting service offerings, including services for MS-DRGs, 3M™ APR DRGs, and APCs, as well as physician profiling services to identify cost and length of stay reduction.

Previously, Garrison served as Vice President for HIOB Consulting, which 3M acquired in 1999. She is a registered nurse with a wide-ranging background in critical care, cardiology, cardiothoracic surgery, and emergency/trauma nursing. Her clinical experience includes the implementation of inpatient and outpatient quality assurance, observation programs, and productivity standards. She was also responsible for JCAHO preparation, product evaluation, disaster planning, resource management, and daily operations.

Garrison is a frequent speaker and published author on industry issues related to federal and state payment initiatives, quality outcomes, and clinical documentation improvement. She is a Registered Nurse (RN), credentialed Certified Professional Coder (CPC), a Certified Medical Coder (CMC), and a Certified Professional in Utilization Review (CPUR). She is also a certified Six Sigma Black Belt.


Robin R Holmes, RN, MSN
DCH Health System
Manager of Clinical Documentation Improvement
Tuscaloosa, AL

Holmes is CDI manager for DCH Health System in Tuscaloosa, AL. The Health System is made up of four facilities and serves West Alabama.

In 2003, DCH Regional Medical Center began a CDI program. As part of this team, Holmes provided oversight for the CDI program across a continuum. DCH’s program began with a focus on concurrent record review and has expanded to include review of records post discharge/pre-bill. Its CDI team also reviews records concurrently for core measures across all payers.

DCH’s goal is to portray accurate severity of illness and risk of mortality through quality data. Last year Holmes was part of a team that created and implemented a CDI tracking system within its Midas software. This system has allowed CDI staff to efficiently and accurately collect data. The new reporting capability has far exceeded DCH’s expectations.

Through its CDI and core measure interventions, DCH is in constant communication with its coding and performance improvement staff. The Midas tracking system stores all of its CDI and core measures interventions and allows the CDI department to successfully communicate with its remote coders and performance improvement staff.

In 1995, Holmes received her BSN from the University of Alabama’s Capstone College of Nursing and began her career in critical care nursing. She also worked with Alabama Organ Center as an organ facilitator. In 2002, Holmes received her MSN for the University of Alabama.


Colleen Stukenberg MSN, RN, CMSRN
FHN Memorial Hospital
Clinical Documentation Management Professional
Freeport, IL

Stukenberg has over 20 years of nursing experience in a variety of areas. She has worked as a nurse in medical, surgical, orthopedic, intensive care, and in a hospital-based skilled nursing facility as a MDS care coordinator. In this role, she served as resource in PPS (prospective payment system), RUGS, and long-term care regulations. Stukenberg was involved with QA and QI (quality assurance and quality improvement) in the SNF and the ICU settings.

Stukenberg’s roles have also included health management (as a case manager) and professional development as a (clinical development specialist, or CDS). In the case management role, Colleen worked with a physician-based model and case managed adult inpatients. In addition, she reviewed patient’s charts and care for pay-for-performance and quality indicators along with accurate documentation. As a CDS, Colleen assisted with developing orientation plans for new employees and new graduate nurses.

In 2007, Stukenberg piloted a Clinical Documentation Management Professional (CDMP) position at FHN Memorial Hospital. While the name is CDMP, it is based on accurate documentation as a clinical documentation specialist. As a CDMP, Stukenberg has presented educational sessions for physicians on accurate documentation, coding, POA (present on admission), and RAC (Recovery Audit Contractors).

Stukenberg’s educational background includes an Associate’s Degree in Applied Science in Nursing from Highland Community College in 1985, a second Associate’s Degree in 1987, a Bachelor of Science in Nursing from Northern Illinois University in 1991, and a Master of Science in Nursing, Specialization in Health Care Education, from the University of Phoenix in 2008.

Stukenberg is a certified medical surgical nurse and was inducted into Sigma Theta Tau International Honor Society of Nursing Beta Omega. She graduated from the University of Phoenix Summa Cum Laude and is a member of ACDIS. In addition, she attends the regional quarterly meetings for clinical documentation specialists in the Chicago area.