Birds of feather: ACDIS chapters start to soar

Let's get every state with the cardinal as its chosen mascot to start a CDI Chapter!

There’s been a number of additions to the roll of local ACDIS chapters. Most notably, we’ve received interest from Ohio and Virginia to meet with fellow members.

Imagine my surprise to find that both these states’ also call the cardinal their state bird. Look out North Carolina! As it turns out, seven states have the bright-hued aviator as the soaring emblem of their respective aviary prowess (and that’s not including state affinity for the bird associated with the names of sports teams St. Louis Cardinals nor the Arizona Cardinals).

Okay, so here’s a challenge. I put the call out to any clinical documentation improvement specialists from Indiana, Kentucky, and West Virginia (which all say the cardinal is their state bird, too) to start local ACDIS chapters in their neck of the woods. After all as the saying goes. . . birds of a feather. . . right?

Download this document for some tips for how to get a CDI chapter started including advice from state organizations which have been gathering for a few years now.

Click on this link to download a list of current local groups, meetings, and contact information.

CMS cheat sheet on IPPS basics available

Page three and four of CMS’ revised Acute Inpatient Prospective Payment System Fact Sheet (January 2009) contains a number of pastel looking charts outlining what seems to be mathematical equations. These graphical details show how IPPS payments are derived through a series of adjustments applied to separate operating and capital base payment rates.

Although I don’t recommend it for bedtime reading, the Medicare Learning Network Payment System Fact Sheet should be on your CDI required reading list.

Maybe you’ve read it before, maybe you’re already well-versed in the IPPS process and know all about how DRGs became MS-DRGs and how the wage-index fits into the final cost analysis, but maybe all this sounds like you need an accounting degree or a master’s in business healthcare administration. Either way, it’s always good to keep an eye on what CMS says about its own systems.

Maybe make it your lunch-time reading instead.

KISS method applies to CDI physician education too

One really great way to get the message about your clinical documentation improvement program out to the medical staff members is through the use of group presentations.

The presentation is a challenge in itself-trying to teach that proverbial old dogs new tricks-but, it turns out that organizing and scheduling those presentations can be just as challenging. Physicians have a small amount of time to get a great deal accomplished. Getting physician to give you five minutes of their time is fantastic but getting them to commit to half-an-hour or a whole hour is downright miraculous. That is, if you aren’t routed by way of the overprotective secretary.

The CDI specialist must not get disheartened. Persistence is the key (and a hearty supply of bribes, I hear they love chocolate). Once the presentation is finally set, remember to remain respectful of the physicians’ limited availability. They are used to moving fast and juggling multiple tasks at once.

Your presentation must be on the point and have enough visual interest to pack a punch. You must grasp their attention and hold it. Do not talk about DRG’s MCC’s and CMI’s. Keep it simple and let them know what is in it for them. In this world of increasing quality data reporting the physician needs to understand the impact of their documentation on their physician scores. Tell them what they need to know.

Oh, in the forms and tools library on the ACDIS Web site there’s a few sample presentations and physician education e-mails available for members to download.

Your name in lights! Where’s your ACDIS award nominations?

How to handle multiple reasons for admission

When the physician directs medical treatment toward one condition, or when one condition is the only reason for the inpatient admission to the hospital, select that condition as the principal diagnosis (PDX). The PDX is the condition that the physician determines to be the primary reason for admitting the patient to the hospital.

Okay, let’s say Mrs. Happy Hinklebottom (yes, I just made that up) comes to the hospital complaining of a urinary tract infection (UTI) and exacerbation of congestive heart failure (CHF). The physician orders all sorts of tests and treats both conditions. The coder/clinical documentation specialist still needs to determine which condition justifies the inpatient admission. It could be the UTI. It could be the CHF. It could be both.

If the answer is truly both, then select the optimal DRG, writes Colleen Garry, RN, BS, clinical documentation improvement specialist at the New York University Medical Center in NYC, in The Clinical Documentation Improvement Specialist’s Handbook. However, if you are unsure as to which condition is the PDX you’ll need to query the physician. In Mrs. Happy Hinklebottom’s case, the CDI specialist should query about the type of CHF to determine if it is acute, chronic, systolic, diastolic, or both systolic and diastolic.

Editor’s note:This excerpt was adapted from the book The Clinical Documentation Improvement Specialist’s Handbook.

Stilted superstitions: Early-bird conference specials extended

Better luck on the way.

It’s Friday the 13th. Today was the last day to get in on the early-bird registration for the 2nd annual ACDIS conference in Las Vegas. It was also the last day to book your Caesar’s Palace room at the early-bird, $199 rate.

If you’re superstitious you might be hiding under the bed waiting for Jason Voorhees to arrive in his blood covered hockey mask. The more triskaidekaphobic might surround themselves with counter curses. We’ve got a counter curse or two to help ease your worries.

With special thanks go to our ACDIS conference coordinators, we’ve negotiated with Cesear’s Palace to extend the early-bird hotel rate through April 13. That’s more than a month longer than initially planned. And we’ve arranged to extend the early-bird conference registration discount through April 17.

Hopefully, this information helps to turn some of those superstitions around. After all some people believe that Friday, 13th actually brings good luck. . . .

First ACDIS NJ meeting slated for March 20

New Brunswick, NJ, calls itself the “healthcare city.”  Its nickname stems from the concentration of medical facilities which surround the city—New Brunswick’s home to the University of Medicine and Dentistry of New Jersey (UMDNJ), Robert Wood Johnson University Hospital, and Saint Peter’s University Hospital, as well as several large pharmaceutical companies such as Johnson & Johnson, and Bristol-Myers Squibb, according to the trusted information on Wikipedia.

Come for sintillating CDI conversation, stay for the skyline sights.

A tiny skip down the street lies East Brunswick, litterally 10 minutes from Rutgers and Robert Wood. That’s where New Jersey’s clincial documentation improvement specialists will converge on Friday, March 20, from 3-5:30 p.m.

“I am excited about how many people showed immediate interest in coming to a New Jersey meeting,” says Deborah Gardner-Brown, RHIT, CCs, C-CDI, who graciously offered up the offices of Reimbursement Review Associates, Inc., Suite D, 385 W. Ferris St., for the meeting. So far, 20 other CDI specialists signed up and there’s plenty room for more, she says.

The first gathering will be an informal meeting of the minds. Bring your ideas, your pain points, your hot topics, and your best practices because meeting with your peers isn’t just a good way to generate community; as Deborah says, it’s an “opportunity to be part of what will certainly be a huge industry shift in how healthcare views documentation.”

Please let Deborah know if you plan to attend. E-mail her at DGardnerbr@aol.com or Deborah@rra-inc.com; or call 732-371-3834 or 732-238-4511.

Take a survey, win a seat. What a deal!

What luck!

“Diligence is the mother of good luck.”
—Benjamin Franklin

Somehow every summer my husband finds dozens of four-leaf clovers in our yard. I can look and look around the lawn right next to him and not catch a glimpse of anything more rare than a dandelion tuft or two. Maybe Cindi Cross, CCS, DRG specialist at the University of Colorado Hospital, has some similar hidden talent for tapping into the luck of the Irish since her name was randomly chosen from more than 300 others to receive a free spot at the ACDIS annual conference in Las Vegas, May 14-15.

About a month ago, ACDIS launched its Physician Query Benchmarking Survey asking clinical documentation improvement specialists to log in and answer 20 questions regarding their physican query policies and practices. The drawing Cindi won was a token of our gratitude for the overwhelming response we received on the survey.

In the next few weeks, the ACDIS advisory board plans to review the the survey and offer additional analysis about the results. Here’s a sample question from the survey:

We’ll release portions of the White Paper here, in the ACDIS Blog, and on the ACDIS Web site, www.cdiassociation.com, under the helpful resources button so members can access it once it is compiled.

Being a DRG specialist, Cindi’s looking forward to attending the following programs when she comes to Vegas:

• Identifying the clinical ‘hidden agenda’ in the medical record
• How and where to identify opportunities in a DRG-based CDI program
• Hospitals cannot live by DRGs alone
• What not to ask physicians

So, I guess it’s only fitting that the thing she likes best about her job “is that I am constantly learning and growing in my profession every day.”

Congratulations, Cindi! See you in May.

New information on CCDS certification, Code of Ethics posted

Hi everyone, we’ve recently added some new informational Web pages on the upcoming Certified Clinical Documentation Specialist (CCDS) credential. You can find them here: www.cdiassociation.com/certification. The links to the pages are located along the top of the screen. I hope you find them helpful.

I also wanted to let you know about a few new developments regarding the CCDS:

1. We’ve received a lot of questions about the location of the Assessment Centers. To find the test center nearest you, visit the Applied Measurement Professionals Web site and click on your state when the map comes up. You will be able to take the CCDS exam at these Assessment Centers starting in mid-late June (for details on how to schedule a test at an Assessment Center, please see our Program Handbook).  The Assessment Centers offer computerized testing and the results are instant.

2. We had to narrow down the “standard drug reference guide” that test-takers can bring into the exam to five specific titles. Please note that in addition to DRG Expert published by Ingenix, test-takers can bring one of the following five drug guides into the test with them:

• Mosby’s Nursing Drug Reference
•  Nurse’s Pocket Drug Guide
•  Physicians’ Desk Reference
•  PDR Nurse’s Drug Handbook
•  Nursing Drug Handbook /Lippincott’s

3. Finally, we are proud to note that we have launched an ACDIS Code of Ethics. This document is intended to serve as a guide for the professional behavior of ACDIS members and nonmembers who hold the CCDS credential. ACDIS is indebted to the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC), who allowed us to borrow from their organizations’ own Code of Ethics to help ACDIS construct its own.

You can read the ACDIS Code of Ethics here: http://www.hcpro.com/acdis/code_of_ethics.cfm.

Thanks, and as usual, your comments and questions are appreciated,

Brian

Effective communication equals a CDI nurses’ strength

Good communication is a key attribute of a successful clinical documentation improvement specialist (CDIS). The CDIS must be able to function in a variety of different settings. These include the CDIS office, the patient care unit, and presenting at rounds. All require flexibility, quick thinking, and a sound knowledge of clinical documentation policies.

Many hospitals have been reluctant to use nurses in the role of CDIS, adhering to the belief that nurses cannot be retrained to think like coders. Why would anyone want them to? Nurses bring their own qualities and strengths to the job.

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