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CMS releases crosswalk for ICD-9 to ICD-10 translation

CMS released The General Equivalence Mappings – ICD-9-CM To and From ICD-10-CM and ICD-10-PCS Fact Sheet in March to assist in the conversion of ICD-9-CM to the anticipated October 1, 2013 implementation date for ICD-10-CM codes. The fact sheet explains how to translate 9 codes to 10 codes and vice versa.

CMS also release information from The General Equivalence Mappings information discussed in the fact sheet is also posted in the CMS Frequently Asked Questions database.

Coders deserve ‘superhero’ kudos

Hidden deep within the HIM office hides the coders’ universe. These hard working individuals put in long hours at small cubicles, staring at multiple computer screens. They are the unsung heroes of the hospital. This group of individuals would probably shun any fancy accolades, tell you they are simply doing their job, but this is an understatement.

Coders deserve a hero's recognition.

Coders deserve a hero's recognition.

The coder is a type of superhero, bestowed with powers beyond that of a mere mortal. Physicians frequently use abbreviations that boggle the mind. Web sites abound with dictionaries for approved abbreviations, but low and behold the physician will always come up with something new. GLM, for example, sometimes refers to a patients’ good looking mother. ARBF means awaiting return of bowel function. The list goes on and on, but curiously the coders know what the collection of symbols stand for.

Coders also decipher the worst handwriting in the universe and make sense out of the senseless. They memorize physician signatures and read words where others only see squiggles. Coders know the DRG number of most illnesses.

Hospital reimbursement would come to a standstill were it not for the coders, making them more powerful than a locomotive. The “super coder” can read through a chart faster than a speeding bullet. They may not be able to leap tall buildings, but they sure can find the principle diagnoses in a single bound.

The Clinical Documentation Improvement department is still fairly new to the hospital scene and the profession has gone through many changes even within that period of time. Coders have been an integral component throughout this transition and it is clear that these modest groups of individuals are SUPER!

Have a CDI position fill? Tell us about it.

In the past seven days more than 30 new clinical documentation improvement specialist job openings have been posted on the World Wide Web, according to a quick search on CDI keeps growing and growing.

ACDIS wants to help you and your facility as you search for new professionals to join your documentation improvement team. Soon, we’ll launch a Web page that allows members to log in and post up to four open positions per year. Anyone who is not a member but wishes to post open positions can contact our customer service department at 800-650-6787. Prior to the page’s “go-live” date, please e-mail ACDIS Associate Director Melissa Varnavas at with the following information:

Job Title:
Name of Facility/Hospital:
Location of Facility/Hospital:
Contact Person:
Contact Address: (e-mail address)
Content Phone Number:
Job Description (only one job description per posting please maximum 300 words):
Preferred start date:
Please indicate if position is full-time or part-time; permanent, contract, or consultant

Chemotherapy documentation challenges warrant CDI attention

Given the extremely high cost of chemotherapy services, it is likely that third-party payers, including Medicare, will scrutinize these services, says Glenn Krauss RHIA, CCS, CCS-P, C-CDIS, in an article for

Here is a breakdown of areas generally targeted by payers including Medicare and their related documentation difficulty:

  • Medical necessity for the supplied diagnosis: Often the clinician fails to provide the specific location of the cancer. A clinical documentation specialist can query the physician to ensure appropriate documentation.
  • Coverage exclusion for specific drugs based on clinical trial effectiveness:  Coders should reference local coverage determinations that generally spell out which diagnoses are considered covered benefits for common chemotherapeutic agents.
  • Proper charging and billing of drug units: Just documenting patients’ nausea and vomiting is not always sufficient to support payment of anti-emetic medicines.
  • Documentation to support IV administration units of service: Accurate coding for this requires clear start and stop times for IV chemotherapy administration. It is particularly problematic because clinicians do not always document the order of sequential therapy.

CDI programs might consider designating a team member specifically for the chemotherapy service line, Krauss says. A part-time specialist or member of the existing team may be enough depending on the monthly volume of patients in the chemotherapy department and the number of new patients who begin chemotherapy each month.

Focus initially on validating documentation and providing feedback to clinicians regarding documentation of IV therapy administration. The CDI specialist can help bridge the gap between customary medical record documentation and the level and detail of documentation necessary to properly and accurately capture all IV administration charges. subscribers can read the complete article online. 

Three tips to maximize the role of physician advisor

It’s been a year or so since you’ve started your CDI program. So far, so good. The administration thinks your team took miracle-worker training. So much so, they’ve agreed to let you add a physician advisor (PA) to the staff. And you’re all for it. You know a PA will add credibility to your documentation improvement efforts, act as a liason with difficult physicians, and help your staff memebers investigate documentation deterrents. Here’s how:

  1. Disseminate CDI program goals: CDI specialist’s struggle to strike just the right documentation chord to win physician support. Improved documentation equals better patient care, improved scores on the physician’s scorecard, improved hospital care, and of course the elephant in the room no one’s supposed to mention—better reimburment. While the primary goals of CDI programs are indeed the improved care of the patient, physicians sometime think the facility cares only about the bottom line. A PA who puts his support behind the CDI program explore the benefits in a concrete way that a CDI specialist with coding or nursing background cannot.
  2. Define communication issues and barriers: Maintain a consistent dialogue with your PA. Allow him or her to bring you constructive criticism from fellow physicians. Maybe cardiologists hate it when CDI specialists bug them at lunch time. Maybe the internists, however, think lunch time is the best time for documentation education. In this way the PA can provide invaluable tips for how to perform better.
  3. Update CDI team on relevant clinical issues: Ask your PA to review existing physician query forms and offer suggestions for how to improve them. Inaccurate, or clinically vague query forms cause physicians confusion. A PA who can head off these potential disputes can help put your CDI program ahead of the game. It’s a physician’s role to understand the latest clinical research. They can help your team understand it too.

Join Mark S. Michelman, MD, MBA, (Morton Plant Mease Health Care System) and Trey La Charité, MD (University of Tennessee Clinical Documentation Integrity Project) for the ACDIS audio conference “Physician Advisors in CDI: Take a Team Approach to Achieve Success and Credibility” on Tuesday, April 14, at 1 p.m. (Eastern).

On the program, the duo will discuss strategies to establish a successful CDI team structure, types of expectations and limitations you should place on your PA, as well as methods to quantitatively measure the progress of your PA and CDI team.

Spring ideas to woo physician support

Chocolate bunnies, marshmallow chicks, and jelly beans all bring to mind the magic of springtime. Fill a clear bag with fake grass and a few candies, tie it with a ribbon and attach your business card.

A little sweetness goes a long way.

A little sweetness goes a long way.

You now have a great little thank you gift for your physicians and allied health professionals. We are all just children at heart and even the most serious surgeon will crack a smile when he sees the festive little treats. It doesn’t take a big budget to let someone know they are appreciated. Include a few documentation items, such as pocket cards, and hospital pens and now you are getting two for one—appreciation and education. This practice of passing out goodies can also be repeated for fall and winter holidays, keeping documentation fresh on the minds of your medical staff.

Keep your creative side open to suggestions when dealing with difficult doctors. Share your ideas with others and together, everyone can reap the rewards.

Consider CDI time management techniques

“E-mail eats the day away.” Sounds like a play on the ‘ole “apple a day” routine, doesn’t it? It’s actually an PR piece touting a new software that sorts and prioritizes your e-mail. Imagine if  automatic e-mail management saved you hours every day. I’ve seen some pretty disorganized e-mail in my day. One co-worker had more than 600 messages in her inbox at one time. She wondered why her e-mail wouldn’t work.

That press release got me thinking about how clinical documentation improvement (CDI) specialists manage to juggle their responsibilities and how they can effectively make the case for CDI to physicians whose time management techniques are already being tested.

Physicians often say their biggest concern about providing high quality documentation in the patient record is the amount of additional time they think it will take, according to Ruthann Russo, PHd, JD, MPH, RHIT, partner in the law firm Russo and Russo, LLP, in Bethleham, PA.

Time flies so try to make the most of it.

Time flies so try to make the most of it.

In her handbook Time Management for Clinical Documentation, Russo pools a variety of sources to show how various stakeholders’ demands affect a physician’s time management capabilities. For example, insurance companys frequently assume that a primary care visit takes a physician a mere 16 minutes. When micro-management of that caliber can affect your fiscal well being, imagine the time management stress that must result.

“Supporting your physicians in the time management process can result in better clinical documentation practices,” Russo writes.

Here are some time management tips you can either share with your physicians or keep to use yourself:

  • Prioritize
  • Plan your day
  • Plan for breaks and take them
  • Handle each piece of paper (or e-mail) only once
  • Make decisions, don’t procrastinate
  • Block out specific time to respond to phone calls
  • If there’s a task you dread, do it right away and get it out of the way

Physician support for CDI programs suffers when they worry about how additional documentation requirements could encroach on their already limited available time, Russo says. So, be open and honest with physicians. Talk about their time concerns and be realistic about how much time your additional interactions may take. Initial physician training sessions are a perfect time to raise these concerns and share some of your own time management techniques.

Appropriate investment in CDI helps programs bloom

Changes in the IPPS (Inpatient Prospective Payment System) led hospitals to develop clinical documentation departments to assist with these changes. Some hospitals hire consultants to initiate their novice CDI staff. They provide generous budgets to facilitate education and growth.

In many cases, the documentation departments outgrow the consultant firms hired to teach them as its  staff members become more savvy about the ins and outs of their particular hospitals. As these departments expand, the hospital case mix index grows.

CDI programs need to be nurtured in order to bloom.

CDI programs need to be nurtured in order to bloom.

Some hospitals hire CDI staff members and provide only minimal education. They keep a tight budget and provide minimal flexibility. These programs grow with the help of available audio conferences and through networking. The staff struggle and grow slowly.

Other hospitals are reluctant to start clinical documentation programs. They hired one or two nurses or add new responsibilities onto their already busy coders. These hospitals provide little in the form of incentives or budget. The CDI staff members are simply told to go out and find MCC’s. These hospitals are often disappointed with the results.

Hospitals must realize that in every successful business, you get what you pay for. A successful clinical documentation improvement program can potentially bring in a great deal of otherwise lost revenue, as well as increase the case mix index.

While appropriate documentation for appropriate documentation’s sake is the clinical documentation improvment team’s mantra, hospitals must do more than plant a seed for documentation improvement results to grow. Similar to a garden, they must water and fertilize their programs in order to see them bloom.

CDI professionals of the year nominated

 I’m no spoiler, so I’m not going to tell you who has been nominated by whom for the 2009 CDI Professional of the Year award. . . 
Who'll win the big one this year?

Who'll win the big one this year?

yet. Here’s a sneak peek at what healthcare professionals say about their nominees:

  • “In the past 18 months I feel that we have had breakthrough in physician acceptance of documentation improvement, both in its importance to the organization and to their own practice.”
  • This CDI professional “skillfully extracts ‘real’ medical record entries, poses appropriate queries to small groups of physicians, and ultimately convinces the physicians that further specifying a patient’s diagnosis or better explaining a procedure best explains what has occurred with a patient.”
  •  This CDI professional “worked with our executive management staff to demonstrate a 5.1% opportunity to increase severity of illness and 32.4% opportunity to increase risk of mortality, and a 4.0% opportunity to increase the case mix index. “
  • “We all know improved documentation improves revenue, but now we are able to show hard evidence that documentation improves the length of stay, the severity of illness, the mortality ratings, and overall patient care quality. [This CDI speicalist’s] creative thinking has influenced many hospital changes and probably many more to come.”

If you know a CDI specialist in your organization worthy of being named “CDI Professional of the Year” fill out the form and e-mail ACDIS Director Brian Murphy at

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.