Happy Friday the 13th

Don't be scare of ICD-10 codes for phobia.

Editor’s Note: Sure, most CDI professionals won’t be submitting queries to physicians about what scares their patients most. Nevertheless, this post from our friends over at the ICD-10 Trainer Blog raised the hairs on the back of our necks, so we thought you might enjoy a little Friday the 13th, ICD-10 coding fright, too.

Do you suffer from triskaidekaphobia, paraskevidekatriaphobia or friggatriskaidekaphobia? In other words are you afraid of the number 13 or Friday the 13^th? More importantly, can you code for those fears?

Surprisingly, ICD-10-CM does not have a specific code for the fear of the number 13 (triskaidekaphobia) or fear of Friday the 13^th (paraskevidekatriaphobia or friggatriskaidekaphobia). If your physician documents any of these phobias, you would report ICD-10-CM code F40.298 (other specified phobia). So even though the code doesn’t specify the phobia, the documentation does.

If the physician documents a generic phobia, but doesn’t say what the patient is specifically afraid of, you would have to default to the unspecified code F40.9 (phobic anxiety disorder, unspecified). Of course before you do that, you should query the physician. Maybe you’ll find out your patient is really afraid of injections and transfusions (F40.231), small spaces (F40.240), or spiders (F40.210).

So don’t break any mirrors or walk under any ladders today and absolutely, positively avoid black cats. If you believe in that bad luck stuff that is.

The April edition of the CDI Journal is available for download

The April edition of the CDI Journal has been posted and is available for download. This quarter’s edition includes:

CDI input helps EHR implementation succeed, 1
CDI staff and EHR experts explain how.

Director’s note, 4
Can CDI/coding staff survive computer-assisted coding efforts?

Earn CCDS CE credits locally

In order to maintain your CCDS credential you must maintain ongoing CE credits.

Educational programs offer more than just the training you need to stay current or enhance your skill set. They are a great source of the continuing education (CE) credits  you need to maintain your certification.

Many ACDIS local chapters offer CCDS CE credits for their programs (and the credits are free for local chapters). If you have a local chapter, take advantage of these learning and earning opportunities. If your local chapter doesn’t offer CCDS CE credit, ask your chapter leadership to apply. Better yet, volunteer to handle the application process. It’s quick and simple. Click here to download the application.

If you plan to attend a training that doesn’t specifically state it offers CCDS credits, ask the program sponsor to apply for CCDS CE units from ACDIS. The cost is minimal. Click here to download the application.

The entity that provides the training should give you a certificate or other notice that your participation earned you a specific number of CCDS credits. It is up to you to keep track of which programs you attend and to maintain a file of your certificates.

ACIDS audits a percent of recertification applications each month and you may be required to submit proof you attended training sessions. If you mail your recertification application, attach copies of your certificates—it saves time if you are audited.

More than a dozen opportunities to learn locally this spring

Texas: The state-wide TX ACDIS group holds its annual meeting Friday, April 6, 9 a.m. to 3:30 p.m., at KPMG Building in Dallas. The agenda includes:

• Registration and networking
• Chapter Business Meeting
• The Importance of Capturing Shock in the ICU Setting, Cindy Pritchett
• Lunch
• IPPS and ICD 10: What the future holds, Beverly Cunningham
• Value Based Purchasing, Scott Robins, MD
• Networking, Q&A

For information, contact Joanne Dukes at 972/566-5526 or email joanne.dukes@hcahealthcare.com.

New Orleans: The NOLA ACDIS Chapter holds its next meeting on April 11, 4-6 p.m., at Semolina’s restaurant in Metairie, LA. For information, email Melissa Mayer melissamayer@ejgh.org.

Indiana: The Central Indiana Chapter is gearing up for its next meeting Wednesday, April 11, 10 a.m. to noon, with featured speaker Nancy Ignatowicz presenting “CDI Success:  How Do You Measure It?”  For information, contact Susan Bradford at 317/776-7285 or by email at sbradford@riverview.org.

PHIMA: The Pennsylvania AHIMA group holds a CDI-related education session on Friday, April 13, 9 a.m. to 3 p.m., at the Wesley Village Conference Area, in Pittston. The agenda includes:

• Continental Breakfast
• Physician Buy In for your CDI Program, David McCann, director, Berkeley Research Group, LLC
• Physician Leadership and CDI Initiatives, Herbert Weinman, MD, president, BCE Technology
• CDI Programs: Why you Need One, Make it Successful, and Justify It, Mario A. Perez, III, RHIA, CCS, CCS-P director, clinical consulting, J.A. Thomas & Associates
• Lunch
• Roundtable Discussion: CDI Programs Implementation and Use, AHIMA CDI Tool Kit
• Review of Documentation Requirements for Optimal Reimbursement, Caroline Rader Znaniec, manager, Health Care Advisory Services, Grant Thornton, LLP

For information, email Eve Ellen Mandler at Eve-Ellen.Mandler@stclair.org.

Nevada: The next Southern Nevada ACDIS meeting will be on Wednesday, April 18, at 5:30 p.m. Guest speaker Karen Zaninovich Parker, RHIT, 3M Health Information Services consulting, will discuss how CDI specialists can begin ICD-10 documentation improvement now. She is making a special trip from Utah to join the Nevada ACDIS Chapter group. Attendees are invited to bring a brown-bag dinner. Admission is free. RSVP to Ailsa Kompare by April 16 at 702/343-7232 or email ailsa.kompare@kindredhealthcare.com.

Tennessee: The TN ACDIS and the THIMA host a joint session Friday, April 20, 8:30 a.m. to 3 p.m., focused on ICD-10 and the CDI program development. The agenda includes:

• ICD-10 and Beyond: The changing world of classification systems, Kathy Hallock, RHIA
• CDI from a Physician’s Perspective, Drew Rothschild, MD
• Best Practices for CDI Programs: Practical advice for improving or creating a successful program, Kyra Brown, RHIA, CCS
• What you should be doing now to prepare for ICD-10: How you can help your physicians improve documentation practices now, James Kennedy, MD, CCS
• Working lunch: HCA’s Approach to CDI.
• Group work: groups will choose a diagnosis or procedure where documentation must drastically change to support ICD-10 coding. The groups will discuss ways to improve documentation practices relative to those situations. In the second half of the group work session participants will discuss how to propose and justify a CDI program to hospital administrations.
• Reports from group work and open forum

Registration is $120. Online registration closes at the end of the business day on Tuesday, April 17th.
Click here to register. For information contact, Wanda M. Johnson executive director, TN Health Information Management Association, Nashville, at 615/242-7275 or email wanda@thima.org.

Michigan: The MACDIS Chapter will hold its quarterly telephone conference call on Thursday, April 19, noon to 1 p.m. The guest speaker is ACDIS Advisory Board member Fran Jurcak, RN, MSN, CCDS, director of CDI Practice for Huron Healthcare in Chicago. She will discuss ICD-10, goals/objectives of a CDI program, CDI staff productivity standards, leading queries,and the benefits of the CCDS certification.

The July MACDIS conference call is in its planning stages. The October quarterly meeting will be a joint regional meeting in collaboration with the Michigan, Wisconsin, Minnesota, and Northern Illinois, ACDIS associations.

For more information, contact Janet Gentle at 231/487-7509 or email jgentle@northernhealth.org.

New York: The next Albany, NY-regional ACDIS meeting will be held Wednesday, April 25, 2-4 p.m., at the Krause Center at Samaritan Hospital in Troy. For information, contact Lois Rubin at 518/525-1081 or email LRubin@sphcs.org.

Illinois: The next Northern Illinois ACDIS meeting will be held on Friday, April 27, 12:45 p.m., at Centegra Hospital, in McHenry. For information, contact Colleen Stukenberg at 815/599-6820, or email CStukenberg@fhn.org.

Maryland: The MDHIMA hosts its meeting 1-5 p.m., Thursday, May 3, at the Convention Center in Baltimore. The agenda features ACDIS Advisory Board member Robert S. Gold, MD, and discussion of CDI-related efforts including:

• Getting Medical Staff Interested in ICD-10”
• Metrics of CDI
• Writing Effective Queries

For information, visit http://www.mdhima.org/ContactUs.html.

West Virginia: The newly formed West Virginia ACDIS Chapter holds its first meeting Monday, May 14, at 1 p.m., at CAMC Hospital in Charleston. For information, contact Sheila Harrison at 304/389-0689 or email Sheila.Harrison@camc.org.

Kentucky/Illinois: The next session of the Kentucky/Illinois ACDIS Chapter will be Thursday, May 24, 1-4 p.m., at St. Mary’s and Elizabeth Hospital in Louisville, KY. For information, contact Rita Fields at or email rita.fields@BHSI.COM.

Georgia: The next meeting of the Southeast Chapter of the Association of Clinical Documentation Specialists will be Friday, June 15, 10 a.m. to 2 p.m., at Wellstar Kennestone Hospital in Marietta, GA. For information, contact Bonnie I. Epps at 404/712-4550 or email Bonnie.Epps@emoryhealthcare.org.  Visit the Southeast Regional ACDIS Chapter Facebook page for announcements and other information.

Introducing new CDI Education Director

Hello everyone,

I’d like to take a moment to introduce Cheryl Ericson to the ACDIS membership as our new CDI Education Director.

Cheryl Ericson

Cheryl is an MS, RN, and CDIP (and soon to be CCDS). She is a former CDI manager and oversaw utilization review and CMS quality measures at The Medical University of South Carolina (MUSC), a large academic medical center. She has an extensive background that includes adult education, data analysis, knowledge of the healthcare revenue cycle and CMS guidelines, as well as certification as an InterQual instructor. She also has experience with RAC audits and denials.

Cheryl is a member of the ACDIS advisory board and has served on many ACDIS work groups. She served on the American Health Information Management Association (AHIMA) ICD-10 work group and was a contributor to the new AHIMA exam for CDI. She also contributed to the development of the CDI toolkit and coauthored the 2010 AHIMA CDI practice brief.

As our new CDI Education Director, Cheryl will be responsible for teaching our four-day CDI Boot Camp and our upcoming two-day ICD-10 for CDI Boot Camp in addition to answering your CDI questions and helping us improve our association overall. Her broad range of experiences makes Cheryl an invaluable asset to our ACDIS team and we look forward to sharing her vast knowledge and experience with you in the future.  Contact her at cericson@hcpro.com. Please feel free to leave her a welcome message in the comments section below.

Thanks,

Brian

Cutoff nears for May 12 San Diego CCDS Exam

Are you planning to take the CCDS Exam at the ACDIS Conference in San Diego on Saturday May 12?

You must register for the San Diego location no later than April 11, as we have to submit the list of names to the exam company three weeks in advance. You will not be admitted to the exam room if your name isn’t on the list.

Click this link for exam particulars and to register. Email Penny Richards with questions.

Good luck!

Q&A: Code or query for clinical significance

Q:I am wondering about whether coders can use information the physician takes from test results and includes in the

We love to respond to your questions. Post yours in the comment section below.

history and physical (H&P). We recently had a situation where the H&P indicated under the studies section that “chest x-ray showed atelectasis,” or “EKG showed right bundle branch block (RBBB) with anterior fascicular block” etc.

Some of us believe that it’s okay to code the diagnosis, i.e., atelectasis, if the provider states that the testing “showed” the diagnosis. Others believe we cannot code the diagnosis as this is a lab/testing result and the provider could just be reading the results onto their H&P dictation.

However, I argued that since the provider is using this information to make decisions about care/testing/procedures and indicates the testing results in the H&P body, that makes it okay to code from this information.  I realize you cannot go to the testing result itself and code from it directly. What are your thoughts?

A: Most of the time these kinds of findings are “incidental,” in other words, they may have no clinical significance. I think it’s important to investigate whether these “new” findings lead to additional interventions, medications, more workup, etc.  If not, then I don’t feel they meet criteria for coding/reporting. Just because something is mentioned does not mean we should code it.  If I review the record and don’t see a direct correlation between a documented diagnosis and orders for care, I query for the clinical significance of the diagnosis.

We are seeing more and more copying and pasting of diagnostic findings from diagnostic reports into physician notes with no further documentation of clinical significance, treatment plan, etc. So you must be very cautious on coding these or not. Be sure to query the physician to either confirm or rule out the findings.

Editor’s Note: This question was answered by Lynne Spryszak, RN, CPC, CCDS, and Sue Belley, M.Ed., RHIA, CPHQ, of the ACDIS Advisory Board following the February 16 ACDIS Quarterly Conference Call.

CDI staff play an important role in the transition to electronic health record

Don't let the transition to electronic records become speed bumps to your CDI program efforts.

As I was waiting in the security screening line in an airport recently, I overheard two women speaking together regarding the need to give up their cellphones to the x-ray machine.  One commented, “I can’t give up my phone.  It’s my life and I can’t imagine what would happen if I lost it or if its contents were erased.”

The conversation seemed like a classic illustration of our dependence on technology. Yet just a few years ago many of us proudly stated that we would “never become dependent” upon these devices.

I personally remember stating that I’d NEVER join the texting world and yet here I am not only texting my family, but colleagues, and clients as well.  I’ve witnessed many a nurse “text” a message to a physician.  These same physicians are now being asked to complete orders electronically and many are beginning required to document care via an electronic medical record (EMR).

So what are the effects of EMR’s on the world of clinical documentation improvement?  Well, it certainly hasn’t erased the need for clarification of documentation.  It may actually create more queries than it eliminates. Legibility may have improved but identification of conditions being monitored and treated is still often lacking in clinical documentation. The way physicians assess and treat patients haven’t changed, the only thing different is how their thoughts are captured in the medical record.

Physicians who have always provided a detail-less “story” of the admission will still need to be queried to identify the conditions they are caring for during the admission. Drop downs and templates designed to make documenting easier for physicians, often create confusion and misrepresentation of patient conditions so this too will result in the need for clarification.

CDI specialists continue to be a primary resource for physicians, providing education regarding appropriate and compliant documentation. This is particularly true when supporting documentation within an EMR.

Therefore, CDI specialists need to have a thorough working knowledge of the electronic program being used for physician documentation so they can provide support to physicians. Supporting appropriate use of possible drop down choices or checklists ensures that accurate documentation of the patients’ severity of illness is captured in the record. Often CDI specialists participate in the nursing portion of EMR training but it is equally important for them to understand the provider applications so they can help train and guide physicians through use of the program.

Electronic queries pose their own unique issues as well.  In 2009, Barbara Hinkle-Azzara, RHIA, VP of Operations for Meta Health, in New York City, identified 10 tips that support use of electronic queries to streamline the query process and provision of a direct link to the EMR.  She points out some key reasons that support the use of electronic queries but it is important to ensure that the proper education is made available to providers so they use the system correctly.

Monitoring physician response rates before and after transition to an electronic system will assist in identification of possible process issues including the possibility that physicians are not addressing queries because they don’t know where to find them in the EMR.

Clearly due to the need to move to the EMR, electronic queries will become the “new” method of clarifying documentation issues with physicians. CDI specialists should not fear the move to EMR’s as even the most sophisticated EMR is not likely to eliminate the need for the CDI specialist role in serving as a “documentation resource” to healthcare providers.

However, it is important that CDI specialists are prepared to serve as a resource to physicians and are adequately educated regarding the proper use of the EMR program and the electronic query process.

Update: Local Chapter meetings

There are few upcoming meetings I wanted to bring to your attention.

First, the FL ACDIS Chapter meets tomorrow, Saturday, March 17, 9:30 a.m. to 3:30 p.m. at Regional Medical Center, Bayonet Point, in Hudson. The agenda includes:

• Pastries and coffee, donated by Panera Bread, and registration/opening comments
• George Klimis discussion of “The Road to Outpatient CDI”
• Dr. Mark Michelman Q&A: “Ask a Physician: Clinical Questions from the Florida Chapter ACDIS Membership”
• Lunch, featuring homemade corned beef and cabbage and sandwiches from Publix (mint chocolate brownies and Irish crème cake for dessert)
• Sylvia Hoffman presentation titled “Keeping the Wolf at Bay: Query Compliance and Risk Reduction.”

There will be five raffle baskets themed:

• Quality Time with Your Pet
• Sweet Treats
• Time to Garden Gift
• Relaxing Over Spring Break
• Leprechaun’s Delight

One lucky raffle winner will earn money towards their ACDIS Conference attendance expenses.

The meeting’s game will be in a Family Feud format with limericks regarding predetermined diagnoses likely to represent those patients. The teams will try to guess the diagnoses and receive a shamrock coin for each correct guess. The team with the most shamrocks wins St. Patrick’s Day-themed prizes.

For more information about the Florida ACDIS Chapter, visit its website http://flacdis.org/.

Next, I wanted to share the following thoughts written by Judi Bates, RN, BSN, CCDS, CDI specialist at Our Lady of Lourdes Medical Center in Camden, NJ, who has teamed up with Debby Dallen, RN, clinical documentation coordinator at Albert Einstein Medical Center in Philadelphia, to host the first Philadelphia regional CDI networking meeting. Excited about the event which which will be held Thursday, March 22, 8-10:30 a.m., at Our Lady of Lourdes Medical Center, Bates writes:

“Nothing grows in a vacuum. With that thought in mind a new networking group will have their first meeting on Thursday, March 22. The ACDIS website is a great way to collaborate via e-mail/CDI Talk and the ACDIS Blog. For some, that little bit of networking is all they need. But I am excited about being able to go to an ACDIS local chapter meeting, where we can share and learn in a face-to-face venue. Whether our gathering proves to be big or small, I know this forum will be a catalyst to solving problems and working efficiently.

“The purpose of an organized meeting in the local area is to share; share the good, bad, and ugly of our profession. Actually I hope that when we do gather next week, our discussions will mostly be about the positive aspects of our jobs and that when we do discuss problem areas that  we may help one another through our CDI growing pains. I am looking forward to talking with like-minded people, people who won’t give me that quizzical look when I tell them my title is CDI specialist.

“When I started as a CDI specialist more than three years ago, it didn’t take long before I was curious to see how other people did this job. I also wanted to pick people’s brains about what didn’t work and what did at their facilities. Efficiency is the name of the game, after all. That was when I began chatting with many individuals via ACDIS, one of which is the co-chair of this group, Deb Dallen.

“Our paths have crossed a few times over the years but it wasn’t until ACDIS Associate Director Melissa Varnavas suggested we start this group that we got together. So we are hoping to have lots of CDI specialists join us next week. We hope you’ll come with great ideas and positive energy to spark the potential for improvements in world of CDI in this area.

“Membership to ACDIS is not mandatory, so if you know someone who doesn’t belong and is interested, bring them along. You can find all the information you need under the tab ‘Local Chapters’.”

Bates and Dallen say that the first meeting will be informal and informational in nature featuring a meet-and-greet and open networking discussion. RSPV to Judi Bates via e-mail at Batesj@lourdesnet.org, or by phone at 856/757-3161. Or contact, Debby Dallen at dallend@einstein.edu, or by phone at 215/456-8902.

As a reminder, the North Carolina, South Carolina, and Minnesota ACDIS Chapters all also meet in the coming weeks. Like Judi, we know how valuable these local networking events can be. Frequently, they present an inexpensive way to stay informed on important CDI-related topics, and to learn from others’ experiences.

You can find a list of meeting information in a previous ACDIS Blog post or by visiting the Chapter Meeting tab under the Local Meetings section of the ACDIS website.

CDI ‘Roadmap’ committee charts program priorities

Don't get lost on the road to success. The CDI Roadmap Committee will offer direction for new programs.

Although you might not have heard of it before, ACDIS has formed a group called the CDI Roadmap Committee to help develop and define some of the core structures that the CDI profession has been lacking. These include the broad goals and objectives of CDI, staffing and productivity considerations, setting new goals for mature programs, and a realistic structured outline to help map out the way.

The CDI Roadmap Committee has been meeting since September 2011. The committee currently consists of the following members:

• Glenn Krauss, RHIA, CCS, CCS-P, CPUR, FCS, PCS, CCDS, C-CDI, ACDIS Advisory Board Member, Independent Revenue Cycle Consultant in Madison, WI.
• Lynne Spryszak, RN, CCDS, CPC-A, ACDIS Advisory Board Member and independent HIM consultant in Roselle, IL.
• Donna D. Wilson, RHIA, CCS, CCDS, ACDIS Advisory Board Member and Senior Director of Compliance Concepts, Inc. in Wexford, PA.
• Cheryl Ericson, MS, RN, ACDIS Advisory Board Member and CDI manager for Medical University of South in Charleston, SC.
• Gail B. Marini, RN, MM, CCS, LNC, ACDIS Advisory Board Member and CDI manager for South Shore Hospital in Weymouth, MA.
• Beth Kennedy, RN, BS, CCS, CCDS, Associate Director, Documentation Improvement Program CMO, The Care Management Company, LLC., Montefiore Medical Center in Bronx, NY.

The majority of the group’s first meeting was spent discussing the purpose and intent of the group and defining both short and long-term objectives. The committee determined that its objective is to create a phased approach to CDI success. The team decided to develop a pre-implementation timeline/checklist, then took a deeper delve into the goals/objectives of a basic CDI program and requirements and expectations for staff.

At subsequent meetings members offered drafts of a pre- implementation checklist with items such as assembling a steering committee and an outline for developing a project plan. The group also discussed sample orientation checklists, collected job descriptions for physician advisors, CDI supervisors, and CDI specialists, and discussed potential CDI evaluation criteria and assessment of CDI staff coding and clinical skills.

The CDI Roadmap Committee will likely break after it completes the “pre-implementation” and “implementation” phases of the timeline, and continue work on “ongoing maintenance” and “advanced level CDI” phases at a later date.

The committee plans to send its work to the ACDIS advisory board for approval and compile its findings in a series of White Papers available as free resources to the ACDIS membership.

Editor’s Note: This article first appeared in the March 15 edition of CDI Strategies.