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The ICD-10 final rule is out!

Hi ACDIS members, today the HHS published a final rule to adopt ICD-10 as the new national coding standard. ICD-10 will take effect on Oct. 1, 2013.

This is obviously huge news for CDI specialists, physicians, and coding staff. Physicians will require additional education to ensure they are documenting to the level of specificity needed to support the new ICD-10 codes. Query forms and documentation templates will have to be reworked, presumably the CC/MCC list will be changing, and the list goes on and on.

To read an abbreviated ICD-10 fact sheet that contains a link to the final rule, click here.

Here at ACDIS we plan to provide educational articles, audioconferences, e-learning courses, and more to help with your transition to the new system. I also encourage you to offer your thoughts and impressions of ICD-10 right here by commenting on this post, or by posting to your colleagues on the CDI Talk group.

Take care everyone,


CCDS credential: Answers to your top three questions

Hi everyone, questions about the Certified Clinical Documentation Specialist (CCDS) exam have been coming fast and furious. I thought I would take a moment to answer a few of the most common types of questions I’ve received. So here goes:

Question 1: I cannot attend the conference in May, but I would like to take the certification exam. What are my options?

Answer: No need to worry. We will be offering the certification exam at approximately 170 H&R Block locations nationwide. Qualified candidates may schedule to take the exam at the most convenient location to their work or residence.

The May 16, 2009 Las Vegas administration of the CCDS exam is merely the first administration. Las Vegas test-takers will take a pencil-and-paper version of the exam. H&R Block test-takers will take it on a computer. Otherwise, the experience will be identical.


Q&A with the ACDIS advisory board: The problem of coders holding up charts

Q: We have a new CDI program with a huge learning curve. I am an RN in a CDI position. There are many things to ask, but the present issue is the re-querying done by the coders, which results in a large number of charts being held up. Has this been a familiar problem that others have had to deal with, and what have they done to cut down on the numbers? I appreciate any help you can offer.

Colleen Garry: I understand completely. When beginning a new program you have to be very clear and your staff needs to hold each other to consistent timelines pertaining to the query close out. Closing out a query is an art form. I suspect that the CDS nurses are not being efficient in their closeouts or are meeting significant resistance (this is normal with new programs) and the unanswered queries may be causing frustration for the coders (understandably). Query response and turnaround time is a must have to a successful program. One can educate and place queries all day long, but at the end of the day it’s all about impact.


A New Year wish

Shortly before New Year’s Day, I looked over my notes from the November 17th HealthLeaders Web cast “5 Ways to Hospital-Physician Quality: Goals, Incentives, Dialogue, Infrastructure, Data.” A statement on first slide of the presentation made pause. It read:


“Why? Fulfillment of personal and institutional mission: Do the right thing.”


Why, the presenter asked, did those listening to this audio chose a profession in healthcare.


CDI professionals, as you well know, follow varied career paths. Generally, they start out as nurses with a mission to care for the sick and help those in need. For some, the rigors of nights and long weekends interfere with family life and growing children. This leads to career diversification. Many see the inherent value of appropriate documentation as an extension of patient care, and this in turn, makes a move to CDI an appropriate professional match. As the presenters pointed out, the mission of healthcare regardless of professional role is consistent—“Do the right thing.”


I couldn’t help but wonder, however, if this statement represents a more fundamental shift in thought. Forgive me for being contemplative. We all know about the economic downturn. Daily we hear the roster of corporate layoffs and healthcare cutbacks. We are not blind. We recognize the warning signs. But what if we take these foretold tempests and turn them into positive winds of change? [more]

Holiday celebrations for CDI specialists

Hi ACDIS members, we’d like to wish you all a happy holiday. And to get in the spirit, we’ve included a timeless YouTube clip of “A Marshmallow World” sung by Frank Sinatra and Dean Martin. Check it out!


Hopefully you’ve also taken the opportunity to weigh in on our weekly poll question “What are your CDI coverage plans for Christmas Day?”


So far, 83% of respondents said everyone in the department will have the holiday off to sip eggnog and toast the season with family and friends. Perhaps more surprising was the 12% of CDI specialists who said their department not only has December 25th off but several other days as well. Lucky you!


Not everyone is enjoying the holiday cheer equally: 1% said they’re stuck working, 3% said a colleague’s covering the department, and a final 1% said they hadn’t had time to think it about it.


While I admit to being a last minute shopper (I only just settled on buying my husband a new warm wool hat. Don’t laugh, those things can be expensive!), the time to consider holiday coverage has come. So, to those who pluck up the professional fortitude to report to duty on the Great American Opening Day (the day of opening presents) a special cheer of well wishes to you! To the rest of our fortunate CDI colleagues and friends: Happy holidays whatever they might be.


Also, starting in early 2009 we plan to upgrade CDI Blog over to WordPress, a fancy new blogging software program. Expect more content and a better-looking format in the coming year!

How much do you know about ICD-9-CM coding?

Are you frequently at odds with your coding staff because the documentation you’ve worked so hard to get doesn’t end up as a code on the final claim? Do your working DRG assignments get shot down too often? Does Coding Clinic or the ICD-9-CM Official Guidelines make your head spin?

If these or other scenarios sound familiar, you might want to consider coming out to Las Vegas a day early on Tuesday, May 13, for a special one-day pre-conference event: ICD-9 Coding Essentials: What every CDI specialist needs to know.

This one-day seminar provides an in-depth session on ICD-9-CM inpatient coding, the MS-DRGs system, and the forthcoming switch to ICD-10-CM. Tailored for clinical documentation specialists, participants will walk away with a firm understanding on how to use the ICD-9-CM Manual, the fundamentals of principal diagnosis assignment, and will learn how to assign the correct MS-DRG to cases with an MCC/CC as well as non-MCC/CC cases. You’ll also get up to speed on the forthcoming ICD-10-CM system.

Participants will receive one free copy of the 2009 ICD-9-CM Manual (Volumes 1, 2, 3) with admission.

Contact Shannon!


Our conference brochure is almost done so please check the conference page for updates. But in the meantime, Shannon has offered up her e-mail address to take any questions you may have about this special pre-conference event. You can reach Shannon at

Every Day You Write the Book

Have you heard that Elvis Costelo song Every Day I Write the Book? It compares a couple’s love story with the imagined characters of a romance novel.

While the story of ACDIS hardly mirrors a sordid affair, we certainly have started to write the proverbial book of the association. Which brings me to the point of my pun, we need your “chapters” to fill our “pages”. By which I simply mean that we’re stepping up our search for those starting local CDI chapters.

But getting to the point. . .you might have noticed this emphasis in a few places around the ACDIS Web site-there’s been a bit of chatter on CDI Talk, in the next issue of the CDI Journal we’re featuring a photo of the New England chapter, and Director Brian Murphy blogged about meeting the New England members during that group’s inaugural get-together.

If you are currently a member of a local group of CDI professionals we’d love to hear from you. Personally, I’d like to know how your group came to be, how long you’ve been around, and what difficulties you’ve managed to overcome since banding together. If you are interested in creating a local group of CDI professionals or hosting a local meeting of your own, we’d love to hear from you, too. We’re in the process of compiling a list of interested ACDIS members and existing state and regional chapters to increase your ability to network and learn from each other.

Send me an e-mail at I look forward to meeting you.


Quarterly Newsletter Highlights

Get ready, CDI specialists, my first foray into the world of clinical documentation will soon be on its way. The quarterly CDI Journal is in currently in production and should be updated on the ACDIS Web site soon. Don’t worry, our illustrious director Brian Murphy helped get me up to speed, so you can expect the same great line-up of information as always. Here’s a taste of what’s coming in the next edition.


More questions from the mailbox

Hi everyone, a few members of the ACDIS advisory board weighed in on some questions sent in by our membership. I’m finally getting around to posting these here in CDI Blog. Keep checking back for updates!


Q: We have been educated by our coding staff not to use the residents’ notes except as a guideline. They have said that they can only code the record from the actual attending documentation. We try to get physicians to co-sign the resident notes, and sometimes they do and sometimes they don’t. Are other institutions coding right from residents’ notes, or are they also required to have the note cosigned?


Recap of fifth quarterly conference call

The fifth ACDIS quarterly conference call took place Thursday, November 20. That’s right, folks, it was our fifth! That means we’ve just passed our one year anniversary. Thanks to all of you who’ve helped to grow this organization and make it the success it’s been so far. We certainly look forward to more successful programs and events as we move quickly through the holidays and on to the New Year!

Speaking of successes, we had a lively discussion regarding AHIMA’s September release of its brief on how to conduct appropriate physician queries. As ACDIS Director Brian Murphy pointed out during the call, ACDIS submitted comments to AHIMA regarding the brief prior to its final publication. Many ACDIS members offered their opinions and helped to guide the final version.

The brief provides a framework description of what CDI specialists do in the field and also expresses the simple fact of the growth of physician queries as a process in today’s healthcare world, said Lynne Spryszak, RN, coordinator of Clinical Documentation Management Program at Alexian Brothers Medical Center, Elk Grove Village, IL. The brief “is still what I’d consider more or less incomplete but it is an improvement over the original” drafts of the document, she said.

It’s important to remember that the AHIMA brief primarily targets HIM professionals, said Robert S. Gold, MD, CEO, DCBA, Inc., in Atlanta. Although all panel members agreed there was much to be gleaned from the content of the final brief for CDI/CDM programs.