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Note from the Associate Director: Announcing a new outpatient version of the CDI Pocket Guide

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Associate Director Rebecca Hendren

By Rebecca Hendren

Outpatient CDI is a fast-growing area of the profession. So, I’m excited to announce a new resource that will be an incredibly useful tool for those expanding to the outpatient arena. Richard Pinson, MD, FACP, CCS, and Cynthia Tang, RHIA, CCS, authors of the CDI Pocket Guide, are currently finishing their work on a new version focused on Hierarchical Condition Categories (HCC): the 2018 Outpatient CDI Pocket Guide!

One of our guiding principles at ACDIS is to be at the forefront of changes in the industry. We want to provide our members with guidance, information, and resources they can turn to for education and clarification as they venture into new CDI focus areas. We’ve been publishing articles exploring the growing outpatient and ambulatory arena for several years now and will continue to do so as this segment of the profession grows and changes. We want to keep our fingers on the pulse of what’s going on and share that knowledge with our members.

We bring together leading thinkers in the profession who can share their expertise, whether through articles in the CDI Journal, innovative sessions at our annual conference or the new outpatient-focused ACDIS Symposium, or lively discussions in the ACDIS Forum.

I’m delighted that the trusted authors of the CDI Pocket Guide are equally forward thinking and partnered with us to develop a this new resource.

Please continue to let us know what information you need and what resources you would like ACDIS to offer. We really do listen to you and use your feedback to develop our editorial directions.

Editor’s note: Hendren is the associate director of membership and product development at ACDIS. Contact her at rhendren@acdis.org.

UnitedHealth Group, Inc. versus the United States of America: The case for CDI

Brian-Murphy

ACDIS Director Brian Murphy

By Brian Murphy

The work of a CDI professional can at times seem isolating and unimportant. Does it matter if a query gets answered? When we educate physicians and tell them what they document matters, are they listening?

Then a case comes along and demonstrates not just that the CDI profession does matter—but that it matters a lot.

That point was driven home to me while reading a May 16, 2017 court document, United States of America ex rel. Benjamin Poehling v. UnitedHealth Group, Inc., in which the Department of Justice (DOJ), alleges that UnitedHealth artificially increased Medicare Advantage (MA) reimbursement/Hierarchical Condition Category assignment by mining for non-supported diagnoses that were not documented/reported by the physician or through chart documentation.

The case is a qui tam—a lawsuit brought forward by a private individual. The plaintiff is Benjamin Poehling, the former Director of Finance for UnitedHealthcare Medicare & Retirement (and its predecessor Ovations), which was the group at United that managed its MA plans and its Medicare Part D prescription drug programs.

The lawsuit seeks to recover more than $1 billion under the False Claims Act. The total damages sought are unspecified but it’s a large case with a lot at stake.

This case has received quite a bit of coverage, too, from big newspapers like the New York Times and popular healthcare websites like Beckers Hospital Review and HealthLeaders Media.

There is a lot more to this case than this 103-page court document, though. In addition to Poehling’s case (filed in February 2017), another whistleblower, James Swoben, a former employee of Senior Care Action Network Health Plan and a consultant to the risk-adjustment industry, came forward with similar allegations in March.

In a very recent development, UnitedHealth Group’s lawyers are seeking to get the case dismissed, claiming that they are not required to validate the accuracy of diagnostic data submitted by healthcare providers.

I need to reiterate that, at this point, the claims asserted against UnitedHealth Group are only allegations and there have been no determinations of liability. It remains to be seen whether the case will even reach court.

However, the case ultimately resolves, it’s a very interesting, real-world, big-dollar example of the business of healthcare, raising the question of who is ultimately responsible for the accuracy of submitted diagnoses to Medicare (coders, CDI, administrative contractors, physicians?). It calls into question the oft-repeated adage that coders must code what the physician documents. It brings into even greater prominence the process of clinical validation, for which ACDIS recently released a new white paper.

Reading through these articles and the original court document, I thought to myself, if only UnitedHealth Group had a robust, compliant CDI process in place, this suit could have been prevented. More than anything, United States of America vs. UnitedHealth Group Inc. is confirmation that your work as a CDI professional matters, and that the broader CDI profession matters.

I plan to share my thoughts on this case in a series of blog posts here and I welcome your thoughts and commentary.

Editor’s note: To read the summary of the case, visit the DOJ website by clicking here. To read the court document in its entirety, click here. Brian Murphy is Director of the Association of Clinical Documentation Improvement Specialists (ACDIS). He can be reached at bmurphy@acdis.org.

 

 

Q&A: Coding chronic kidney disease, hypertension, and diabetes mellitus

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Laurie L. Prescott, RN, MSN, CCDS, CDIP, answered this question

Q: Let’s say a provider documented chronic kidney disease (CKD), 2/2 hypertension (HTN), and diabetes mellitus (DM), and the stage of CKD was not specified, but lab results show patient was in stage 2. Could I assign codes for CKD, stage unspecified, Hypertensive CKD w/ stage 1-4, and Type II DM. Do I need to assign a separate code for HTN?

A: Let’s break down the documentation.

CKD secondary to HTN and DM: With this documentation, we have two combination codes to assign—hypertensive CKD and diabetic CKD. We would also assign a code to reflect the stage of the CKD.

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Guest Post: Altered mental status remains a challenge in ICD-10-CM – part 1

James Kennedy, MD, CCS, CDIP

James Kennedy, MD, CCS, CDIP

By James Kennedy, MD, CCS, CDIP

In ICD-10-CM, defining, diagnosing, and documenting the various forms of altered mental status and their underlying causes remains an ongoing challenge for physicians and their facilities.

Even the esteemed New England Journal of Medicine states that, “‘Altered mental status,’ a nonspecific term that is frequently used to describe alterations in alertness, cognition, or behavior, is commonly encountered in the emergency setting.” If you have a subscription or access through your medical library, review the discussion at www.nejm.org/doi/full/10.1056/NEJMcps1603154. [more]

Symposium Speaker Highlight: Whitley shares story of ambulatory success

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The ACDIS Symposium: Outpatient CDI takes place Sept. 18-19

Editor’s note: There are only 45 more days left until the first ever ACDIS Symposium: Outpatient CDI, September 18-19, in Oak Brook, Illinois. Last week, we brought you a Q&A with Laurie L. Prescott, MSN, RN, CCDS, CDIP, CRC, in CDI Strategies, but she’s not the only Symposium speaker we got to know recently. Today, we spoke with Yvonne Whitley, RN, BSN, CRCC, CPC, CRC, the supervisor for Novant Health Medical Group’s Ambulatory CDI team, who will present “Novant Health ambulatory CDI—How we’ve grown!” at the event. Please note that this event is filling up fast with limited seats remaining.

Q: Can you explain why you use the term “ambulatory” rather than “outpatient?”

A: The simple answer is that “outpatient” refers more to facilities such as wound care, same day surgery, infusion centers, etc. “Ambulatory,” on the other hand, refers to the provider clinics. Currently we only focus on the ambulatory setting.

Q: What was the biggest challenge you encountered during the implementation of your ambulatory CDI program?

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Note from the Associate Editorial Director: A Little Local Chapter Love

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Associate Editorial Director Melissa Varnavas grabs a picture with a Local Chapter leader from Kentucky at the 2017 Conference!

By Melissa Varnavas

Next Friday, August 11, ACDIS Editor Linnea Archibald and I will head down to Newton, Massachusetts for the third-annual joint ACDIS/AHIMA New England CDI Symposium. The leaders of the MaHIMA, NYHIMA, and MA ACDIS have met for months to develop a comprehensive agenda to fit the educational needs of both coding and clinical documentation professionals.

The full-day event, sponsored by 3M, was originally the brainchild of then ACDIS Advisory Board member Walter Houlihan, director of HIM for Baystate Health in Springfield, Massachusetts. Houlihan, at the time, served as the president of the MaHIMA and, although his time in that role was ending, he had yet to see his vision for a multi-state event come to pass. After mentioning his hopes in a passing phone call, we decided to see if we could, in fact, bring this idea to fruition. The first year, more than 100 attendees arrived. The second held nearly 160. Baystate Health generously hosted those first two events.

This year, attendance has topped 200 and the registration has closed due to the constraints of the room size (although there is a wait list).

This is an amazing story about the importance of collaboration and the value of networking and education in our tiny slice of the healthcare industry we serve. And it’s a story that’s not just happening in New England but is playing out across the country. Every week in this email newsletter, we list local chapter upcoming events and offer a tip or tale about what’s happening at the local level. Recently, on ACDIS Radio, we remarked about the number of full-day events coming up.

In August, not only do we have the New England event but also North Carolina and Florida are holding full-day educational sessions. In September, both California and Alabama hold full-day events. The California event will be its third annual, and generally gathers more than 200 attendees. The leaders from each of the three Missouri ACDIS chapters have been meeting for more than a year to plan their big full day event coming up in October. Last year there were nearly 150 attendees and this year they expect to reach 200 attendees as well. South Carolina and Oregon also hold events in October and although it’s still in the planning stages, Texas hopes to have a full-day event in October too.

These volunteer leaders have done a tremendous job planning these events for the benefit of their communities. We cannot thank them enough for their efforts and hope that you, too, reach out to them, volunteer, attend, extend your own involvement in this, our ever growing, ACDIS community.

Editor’s Note: Varnavas is the Associate Editorial Director for ACDIS. To find out about what’s happening in your neighborhood visit the local chapter page. To learn more about starting a chapter or networking group, scroll down below the map to read our local chapter leadership resources. Contact her at mvarnavas@acdis.org.

 

Website Tips: How to register for ACDIS Radio and never miss an episode again

According to the 2017 ACDIS Membership Survey, 73.68% of members find ACDIS Radio a beneficial piece of their membership experience. The bi-weekly talk show hosted by ACDIS Director Brian Murphy covers a wide-range of CDI-related news and topics through conversations with industry leaders, ACDIS Advisory Board members, physicians, CDI specialists, and managers. The show airs every other Wednesday at 11:30 a.m. eastern.

But, how do you access this free resource? While you can head over to the ACDIS website and listen to all the past episodes as soon as a day after they originally air, registering for the program makes things even easier. Plus, when you listen live, you can weigh in on the weekly poll and participate in the Q&A segment.

Simply follow the two step process below and you’ll get a weekly reminder when the show will air and instructions on how to tune in.

1. First, go to the ACDIS main page and select “ACDIS Radio” under the “Network & Events” tab (it’s the third option).

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2. Then, click the “register” button underneath the ACDIS Radio logo. The registration page will automatically open in a new window.

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3. Fill in the necessary information on the registration page and click “register” at the bottom of the page.

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4. Once you’ve clicked “register,” you’ll see a confirmation page with an option to add the program directly to your Outlook email calendar. All the instructions for listening to the call will be in the reminder emails for each episode.

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Editor’s note: To listen back to previous episodes of ACDIS Radio, click here. To read a recent Radio Recap about a session at the ACDIS Symposium: Outpatient CDI, click here.

Website Tips: How to find out whether your activity qualifies for CCDS CEUs

A few weeks back, CDI Strategies included a column about earning CCDS continuing education credits (CEUs) through your ACDIS membership. But, how can you tell what activity outside of ACDIS qualifies for CEUs?

Outside of ACDIS and HCPro activities covered in last week’s column, here are a few ways to earn CEUs:

  • Complete college courses relevant to healthcare/healthcare management, CDI, or clinical coursework for credit or degrees
  • Present CDI-related topics at seminars/speaking engagements outside of regular work activities (please note that the program must be accredited through the appropriate professional organizations, include a timed agenda, and documentation of program objectives)
  • Submit activities from other organizations that provide education or training in CDI, ICD-10, clinical, coding, documentation improvement activities, or diagnosis/pathophysiology

For any single event from other agencies or organizations, ACDIS will accept up to 10 of the CEUs offered. If the program and certificate of completion specifying that the CEUs are specifically for the CCDS, then ACDIS will accept all the CEUs, even if there are more than 10 offered.

Editor’s note: To see a complete list of places to receive CEUs, click here. To read more about certification, click here.

 

Website Tips: How to favorite an article on the ACDIS website

Re-finding your favorite article can be a difficult task. It doesn’t have to feel like banging your head against a wall, though. If you’re logged into the ACDIS website, you can actually “favorite” articles and access them all from one spot when you want to return to them.

Simply follow the steps and you’ll never lose your favorite article again.

  1. After you find an article you love, locate the star to the left of the article title. Click on the star (it will turn blue when you’ve added it).

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  1. To access your favorited articles, click on the star next to your account icon (on the far left side of the menu bar) and select “My Content” from the dropdown menu.

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  1. Once you’ve followed through step two, you’ll see all your favorited articles in one place. To remove something from your favorites, you simply click on the star icon (the same way you added the article). A small box will pop up saying, “This page has been removed from your favorites.”

Website Tips: Join in on the discussion on ACDIS articles

ACDIS members can join in on the discussion with any articles on the website they find intriguing by using the Discus feature. Just like the ACDIS Forum, this feature allows members to connect, discuss interesting articles, and weigh in on the issues presented.

But, how do members do this? Simply follow the following step-by-step guide for joining the conversation below.

  1. Scroll to the end of the article you want to comment on, past the “More Like This” section, to the section titled “Discussion”

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  1. Write your comment in the chat pod where it says “start the discussion”

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  1. Enter in your name and email address, ensuring your comment is signed and you receive notifications when someone responds to the comment

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  1. Either create a Disqus account using the prompts, log in with Facebook, Twitter, or Google, or simply check the box that says “I’d rather post as a guest”

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  1. Click the gray arrow below the sign-in information to post your comment

After posting a comment, the commenter will receive an email when someone responds or posts a comment of their own on the same article.

If you have any questions regarding commenting on ACDIS articles or anything else, please contact ACDIS Editor Linnea Archibald at larchibald@acdis.org.