The 2013 AHIMA conference is in full swing today, but it’s educational sessions have been focused on clinical documentation improvement efforts since the conference opened on Saturday with sessions by Andrew Rothschild, MD, MS, MPH, CCDS, FTI Consulting, Dianne Haas, PhD, RN, TrustHCS, Brigid Caffrey, CCS, OptumInsight, and ACDIS book author Marion G. Kruse, RN, MBA.
This morning there was a CDI networking breakfast and this afternoon sessions include:
- CDI with a Twist
- Mission (It’s) Possible: Bridging the Gap Between Clinical Criteria and Coding Guidelines for Documentation Integrity
- The Future of Clinical Documentation in a World of ACOs, MU2, and ICD-10
ACDIS Director Brian Murphy arrived at the Atlanta, Georgia conference center last night and will be attending sessions, shaking hands at the ACDIS booth #1143, and hobnobbing at after-hours events tonight. So be sure to try and spot him! If you see him, be sure to take your photo with him and either tweet it @ACDISDirector or @ACDIS. If you’re not on Twitter, email it to Melissa Varnavas to post! Throughout the conference we’ll be giving away a free Boot Camp seat, a year’s membership to ACDIS, and other great items.
Tomorrow sessions include:
- Beyond ICD-10: Best Practices for Continual Clinical Documentation Improvement
- CDI and Coding — Collaboration with Innovation for Now and the Future
Although I wish I could be there, I know conference attendees will be learning a lot from our AHIMA colleagues and are in good hands with the tremendous HCPro staff in attendance. I can’t wait to hear all about it!
By Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, FAHIMA
- In-depth knowledge of ICD-9-CM guidelines and conventions
- Access to and awareness of pertinent AHA Coding Clinic references
- Understanding of the MS-DRG reimbursement system, including relevant MCCs and CCs that affect the MS-DRG assignment
- Clinical Documentation Improvement Practitioner (CDIP)
- Clinical Documentation Specialist (CCDS)
- Registered Health Information Administrator (RHIA)
- Registered Health Information Technician (RHIT)
- Certified Coding Specialist (CCS)
The April edition of the CDI Journal is now available. It includes an analysis of the new physician query practice brief as well as the brief in its entirety. It also includes the following articles:
All this week ACDIS Director Brian Murphy has been milling around the McCormick Place Convention Center rubbing elbows with HIM professionals and industry experts at the 84th annual American Health Information Management Association (AHIMA).
We’re not jealous. Okay, maybe I am just a little bit. After all, it has been two years we held our own conference in the ‘Windy City,’ two years since we were able to enjoy Chicago pizza and that terrific Garrett Popcorn Chicago blend. More importantly, however, I am jealous of the hundreds of connections coders, HIM, and CDI professionals have the opportunity to make during this extraordinary week.
AHIMA planned many networking events and the educational sessions seem to provide additional focus on CDI efforts. AHIMA is also offering CCDS credits for many sessions which relate to CDI. Some of the sessions which caught my eye included:
- When Queries Alone Just Don’t Cut It: Complementing the Query Process
- Taking the Guesswork out of CDI
- Integrating CDI and CAC Initiatives
And then there was the “Querying for ICD-10″ presented by our own CDI Boot Camp instructor and ACDIS Advisory Board member Cheryl Ericson.
I’m sure the ACDIS team in attendance will bring back all sorts of educational goodies. If you happen to be at the conference stop by Booth # 1227 and say hello!
ACDIS invites you to join a work group to research industry needs and develop best practices for physician/provider queries. The work group deliverables will serve to educate members and the industry on ongoing physician and provider query questions, and will be conducted in conjunction with the American Health Information Management Association (AHIMA).
Work group activity will be conducted via weekly one-hour conference calls. No face-to-face meetings are planned. The weekly calls will begin in July. To volunteer, send a resume, a brief email statement of your qualifications, and a short description of your experience with physician queries to ACDIS Director Brian Murphy at firstname.lastname@example.org.
Please note that the deadline for response is the close of business on June 15th.
On February 14, CMS acting administrator Marilyn Tavenner told American Medical Association (AMA) meeting attendees that CMS would “reexamine” the timeline for ICD-10-CM/PCS implementation. Tavenner offered no details, just the vague possibility of potential reconsideration.
The healthcare industry jumped with the news.
American Health Information Management Association (AHIMA) immediately published a release urging healthcare professionals to move forward with their ICD-10 implementation and training plans, and downplayed the announcement, pointing its vague language.
“This is a promise from CMS to examine the timeline, not to change it,” said Dan Rode, MBA, CHPS, FHFMA, vice president for advocacy and policy at AHIMA, in the release. “But government officials are sending mixed signals that many in the healthcare community will interpret as a reason for delay.”
The AMA celebrated.
“The timing of the ICD-10 transition could not be worse for physicians as they are spending significant financial and administrative resources implementing electronic health records in their practices and trying to comply with multiple quality and health information technology programs that include penalties for noncompliance,” wrote Peter W. Carmel, MD, AMA president in a February 16 release. “Burdens on physician practices need to be reduced—not created—as the nation’s health care system undertakes significant payment and delivery reforms.”
The very next day, February 15, HHS Secretary Kathleen Sebelius said “the federal government will delay for an unspecified time the implementation date for the ICD-10 diagnostic and procedural coding system,” HealthLeaders Media reported.
Specifically, the HHS release stated that the agency “will initiate a process” to delay the ICD-10 implementation date for “certain health care entities.”
And that was pretty much it.
The rest of the release reiterates that the provider community feels burdened by the ICD-10 implementation, but also reiterates the importance of the move to ICD-10 because it will “provide more robust and specific data that will help improve patient care.”
Meanwhile, CMS confirmed to ACDIS’ parent company HCPro Inc., that the agency will use the rulemaking process when revisiting the ICD-10 implementation timeline; a process known to be lengthy, a process that does not always furnishes an expected result (meaning after the rulemaking CMS may just decide to keep the implementation date firm).
So multiple experts from ACDIS Advisory Board members to AHIMA directors repeated the refrain,; “Stay the course with ICD-10 implementation.”
I’m on their side.
In a phone conversation earlier this week, an ACDIS member told me that she was glad to hear CMS delayed ICD-10 by two years. Two years, she said.
Of course, I asked where she got her information and she cited some reputable sources which, on closer examination, actually said nothing of the sort.
All this commotion—all this maybe, possibly, definitely thinking about it—may ultimately cause serious difficulties for those in the midst of ICD-10 implementation plans. The possible delay could cause facility administrators to pull back the purse strings on training funds. Programs could decide to delay important technology purchases to save money since the implementation date isn’t imminent.
Meanwhile, we hear how far behind facilities actually are in their ICD-10 planning. CDI staff (according to a recent survey) say they do not even know if a ICD-10 implementation committee is meeting at their facility or what will be expected of them as the coming change draws near. Possibly postponing the actual “go-live” date only adds to facility procrastination on these issues.
The more advanced facilities have already evaluated their staffing needs in terms of CDI specialists’ concurrent record reviews and coding needs. These facilities have already budgeted for additional employees and charted a course for staff member training beginning with anatomy and physiology. Even more advance programs have already begun reviewing their top MS-DRGs for documentation improvement opportunities related to ICD-10.
History may prove me wrong (especially as rumors also abound about HHS opting to skip ICD-10 and jump directly to ICD-11!) but I remain convinced that ICD-10 implementation is inevitable and that the sooner facilities prepare themselves the better.
Lynne Thomas Gordon, MBA, RHIA, FACHE, took over as CEO of AHIMA on September 29, according to a recent AHIMA release. Thomas Gordon joins AHIMA after serving as associate vice president for hospital operations and director of the Children’s Hospital at Rush University Medical Center. She also is a member of the Rush University faculty in the graduate program in health systems management.
“The combination of Lynne’s executive skills and healthcare knowledge will help lead AHIMA and its members through complex issues and the healthcare industry’s transformation of managing and integrating HIM with a new generation of technology,” said AHIMA Board President Bonnie Cassidy in a release.
The 83rd AHIMA Convention and Exhibit begins Sunday and ACDIS is proud to support the efforts of the HIM professionals who work so diligently to ensure the accuracy and security of the medical record. A few former ACDIS Advisory Board members will be presenting during the conference. ACDIS Director Brian Murphy will be in attendance, so be sure to stop by booth 1207 and pay him a visit.
A savvy CDI steering committee looking to implement a new CDI program should seek the opinion of other facilities in their vicinity, perhaps even visiting other programs and shadowing CDI professionals on their rounds. Such engagement provides anecdotal first-hand experiences to help shape the roles and responsibilities of the CDI staff and it helps the steering committee gauge potential problems.
The group may also decide to enlist the assistance of professional associations; both the American Health Information Management Association (AHIMA) and the Association of Clinical Documentation Improvement Specialists (ACDIS) help foster local meetings in various states where members freely discuss program troubles and triumphs. Furthermore, ACDIS surveys its members annually regarding the structure, staffing, and focus of CDI programs.
For example, two studies, an April 2010 CDI Staffing Survey featuring responses from 85 CDI department directors and a July 2010 CDI Program Benchmarking Survey featuring 482 responses from a variety of CDI professionals, both indicated that a majority of CDI programs employ registered nurses as CDI specialists who report to the HIM director.
Whether a facility uses coders, nurses, or some combination of both, and regardless of to whom the CDI staff reports, the goal of capturing complete and accurate documentation should not be compromised in favor of other agendas. Without clearly defined responsibilities, a case manager who also performs some CDI work may push one set of responsibilities aside for another given the limitations of time, experience, and administrative expectation. Conversely, a coder might not pursue a query if tasked with concurrently coding a chart, meeting productivity standards, and maintaining discharged, not final billed (DNFB) goals.
Editor’s Note: This article is an excerpt from The Clinical Documentation Improvement Specialist’s Handbook, Second Edition written by Marion Kruse, MBA, RN and Heather Taillon, RHIA, CCDS.
The more I learn about ICD-10, the more worried I get. At this point my worries are more related to knowing enough to be dangerous but not knowing nearly enough to truly understand or feel confident about our CDI program’s preparation efforts. Two recent ACDIS polls touched on feelings about ICD-10 (What are your initial impressions of ICD-10? and What is your planned primary method/vehicle for ICD-10 training?).
The conversion to ICD-10 is going to happen on October 1, 2013. There seems to be two opposing trains of thought about this implementation deadline:
- We have plenty of time.
- We are directly on top of this deadline and had better get our plans together.
In one sense, education of CDI specialists during the first six months of 2013 would (or should) be enough to prepare for individuals to complete their daily jobs. If CDI staff receive training on ICD-10 codes too far in advance then they will require an intensive refresher shortly before the conversion. However, if we wait too long we take a risk that all of the best training resources are fully committed and are unable to meet our facility needs.
A number of other potential problems need to be considered also. Where will your facility find the additional funds for training its CDI staff, for example? You’d need to know when training budgets are proposed and align the various learning objectives to your training expectations. And, of course, you’ll have to get that ICD-10 training budget approved. If you ask for funds too early, you risk being denied by your CFO.
Consider whether or not you’ll use in-house expertise for additional staff training. If so, expect to extend your training schedule further. It will take additional time to train a single individual on the various important aspects of ICD-10 and still more time for that individual to focus their training to your facility and various staffing needs.
Planning for your CDI program’s ICD-10 training needs really does need to start now but don’t worry, there are a number of resources I’ve found that seem exceedingly helpful. These include the following:
- 3M. As a significant vendor of all things related to inpatient coding, 3M also offers a number of free ICD-10 preparation tools including:
- AHIMA. Of course one would expect that AHIMA would be a premiere resource for all things related to this important transformation. The Association offers an e-newsletter, a resources page, and it even offers suggested tasks for inpatient coders.
- AMA. The American Medical Association offers a crash course of basics that CDI professionals might look to for help with training their own physicians. This site contains a number of links to helpful information also.
- Becker’s Hospital Review. Offers an article on 10 steps to prepare for ICD-10.
- CDC. This is where you can find the most direct information regarding changes to the proposed ICD-10 coding guidelines and updates to the codes themselves.
- CMS. CMS offers its overview of ICD-10 including detailed information on the procedural coding system, otherwise known as PCS.
- HCPro’s ICD-10 Trainer Blog. This includes several posts by Christina Benjamin regarding low-cost resources for ICD-10 education and a roundup of additional ICD-10 resources.
- The Milestone Group. Offers a white paper “5 Steps for a successful transition.”
There are a number of additional training options which range from more formal classroom programs to individualized educational offerings from consulting services, but I wanted to highlight some starting points that are free and easily available.
Editor’s Note: This article first appeared in this week’s issue of CDI Strategies. Subscribe to the free e-newsletter. Butler earned the 2011 CDI Professional of the Year Award. He is the Clinical Documentation Improvement Manager at Pitt County Memorial Hospital, in Greenville, NC. Contact him at dbutler@PCMH.COM.
Members of the Association of Clinical Documentation Improvement Specialists (ACDIS) advisory board recently provided commentary on the Centers for Disease Control and Prevention (CDC) proposed changes to the fiscal year 2012 ICD-9-CM codes, as detailed in the March 9-10, 2011 Diagnosis Agenda of the ICD-9-CM Coordination and Maintenance Committee Meeting. The agenda of the meeting can be found on the CDC website, here: http://www.cdc.gov/nchs/data/icd9/TopicpacketforMarch2011_HA1.pdf.
You can view ACDIS’ comment here: http://www.hcpro.com/content/264297.pdf
All CDI specialists are encouraged to view the proposed changes and submit their comments to the CDC. But time is short: The deadline for commentary is this Friday, April 1, 2011. Comments should be submitted to the following CDC representatives: