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Note from the ACDIS Director: It’s time for outpatient CDI to step out on its own

ACDIS Director, Brian Murphy

ACDIS Director, Brian Murphy

By Brian Murphy

We knew it was going to happen.

Eventually, the ACDIS Conference was going to get so big that we couldn’t give every CDI topic justice or the full coverage it deserved. Outpatient CDI was one of those topics. There is so much going on between Medicare Advantage and Hierarchical Condition Categories (HCCs), the complexities of patients admitted versus treated in observation, to outpatient opportunities in the emergency department and in the physician office setting, that the time had come to give outpatient CDI its own event.

Enter the ACDIS Symposium: Outpatient CDI.

This all-new ACDIS event will be held September 18-19 at the Hilton Oak Brook Resort & Conference Center, located just outside of Chicago.

Back when inpatient CDI was still relatively new in 2007, we received large numbers of basic questions, and there was an overwhelming need for nuts and bolts “how to get started” ideas and education. Because we anticipate the same kinds of concerns at the ACDIS Symposium: Outpatient CDI we are accommodating with three specific ideas:

  1. Case studies of how programs have implemented successful outpatient CDI programs. Hear from Cooper University Health Care, Novant Health, Mount Carmel Health System, and others about how they got started, their challenges and their successes.
  2. A “Morning Ideas: Lightning Round” general session on Day 1. This innovative one-hour session combines four to five quick-hit, “here was a problem we had and a solution that worked/here is a process that worked for us and might work for you” ideas from your peers that have worked in the field. This will get your brain working overtime!
  3. A dedicated Q&A panel session to conclude the program. Ask your top questions at this session—and listen to your peers’ questions. Chances are you might have the same questions.

Just like the ACDIS Conference, the Symposium will feature plenty of networking opportunities and idea-sharing over our breakfasts and lunches (food, including breaks, is provided with registration) as well as in our exhibit hall. Come see the many innovative outpatient CDI solutions several vendors are offering in this space.

There is far more on the agenda than I could mention here—sessions on the nuts and bolts of evaluation and management coding (E/M) and how to improve physician E/M billing, a session on the key differences between inpatient and outpatient coding (as taught by our top coding instructor Shannon McCall, RHIA, CCS, CCS-P, COC, CPC-I, CEMC, CRC, CCDS), and much more.

In short, I hope you can make our inaugural ACDIS Symposium. To learn more or to register, please click here.

Editor’s note: If you have specific questions about the Symposium’s content, please send them to ACDIS Associate Director of Membership and Product Development Rebecca Hendren at rhendren@acdis.org. Murphy is the director of ACDIS. Contact him at bmurphy@acdis.org.

Q&A: Documenting excisions in dermatologic settings

ask ACDIS

Have CDI questions?

Q: I work in dermatology and need to know what documentation is required for excisions. We are struggling with getting paid.

A: In dermatology, you often find vague documentation like “lesion” and “mass.” So the physician needs to be much more graphic as far as whether the lesion is red, itchy, scratchy, burning, and/or abnormally sized. If you can get the actual size of a lesion or a mass that they are going to excise, they also need to document the size of the excision.

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Note from the ACDIS Editor: CDI Journal provides training tactics

LA-new headshot

ACDIS Editor Linnea Archibald

By Linnea Archibald

New hire training. Ongoing education. Physician education. Each area holds unique difficulties for the CDI professional in all stages of their careers. Keeping all the CDI staff and physicians on the same page can be a daunting and headache-inducing task. For that reason, the July/August edition of the CDI Journal seeks to outline a few strategies, tips, and tricks from seasoned veterans in the field for keeping your whole team engaged and up-to-date in their CDI education.

Within the pages of the newest edition of the CDI Journal, you’ll find valuable information from a variety of perspectives—from CDI specialists conducting daily reviews, to CDI educators, to the ACDIS Advisory Board members, to the ACDIS leadership team and staff. [more]

Guest Post: Expanding the CDI focus to the outpatient arena, part 1

Editor’s note: Crystal Stalter, CPC, CCS-P, CDIP, is the CDI manager for M*Modal in Pittsburgh. She has more than 30 years of experience in healthcare focused on coding, compliance, and physician documentation concerns. Contact her at crystal.stalter@mmodal.com. Opinions expressed are that of the author and do not represent HCPro or ACDIS. This article was previously published in Briefings on APCs and JustCoding. This is the first part of a two-part series. Please return to the blog next week to read the second part!

The focus for CDI specialists has historically been on the inpatient hospital stay. Reviews of the chart for conditions not fully documented and/or evidence of conditions not documented at all, has been standard practice.

However, with so many changes in the industry facing providers in their outpatient practices, the importance of CDI in places of service such as physician offices, ambulatory clinics, and urgent care clinics is even more vital.

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Symposium update: Early bird pricing ends today

outpatient early bird

Early bird pricing ends today!

Today is the last day to get the Early Bird price for the first ever ACDIS Symposium: Outpatient CDI. Reserve your seat today, July 17, to take full advantage of the discount. The conference takes place from September 18-19 at the Hilton Oak Brook Resort and Conference Center in Oak Brook, Illinois.

ACDIS members receive a $100 discount on their conference tickets, bringing the price down to $805. [more]

Summer Reading: Physician Education Discussion Scenarios

LauriePrescott_May 2017

Laurie L. Prescott, MSN, RN, CCDS, CDIP

by Laurie L. Prescott, MSN, RN, CCDS, CDIP

The following clinical scenarios illustrate where clarification would be indicated and include examples of differing communication methods.

Clinical example: The record states the patient was admitted for treatment of pneumonia and the patient was placed on IV antibiotics. A swallow evaluation indicates the patient is at risk for aspiration. The patient is placed on aspiration precautions and thickened liquids. For the coder to assign a code for aspiration pneumonia, the relationship between the pneumonia and aspiration needs to be documented in the record.

Approach #1 (verbal query): “Dr. Smith, I’m Jane from the documentation improvement team. Do you have a minute to work with me? This chart indicates the patient is at risk for aspiration and needs thickened liquids. Could you identify a probable etiology for her pneumonia? The physician responds, “It is probably due to aspiration.” The CDI specialist thanks the physicians and asks, “Could you please clarify that possible cause-and-effect relationship in the record?” She then reminds the physician that “Unlike outpatient coding, the use of possible or probable is permitted and can be coded for inpatient cases.” The physician immediately writes an addendum to his progress note: “Jane, thanks for your help.”  Jane should then document this verbal query and the results as part of the CDI notes for this account. [more]

TBT: 2017 Conference Committee member shares session insight

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Faisal Hussain, MD, CCDS, CDIP

By Faisal Hussain, MD, CCDS, CDIP

It was a real privilege to serve on the 2017 ACDIS Conference Committee, even though it involved a lot of hard work, and tough decisions regarding the selection of speakers and award winners.

One of the sessions that caught the interest of the entire committee concerned objectively measuring providers’ clinical engagement. What made this session even more special was the fact that the presenter, Nicole Draper, RN, BN, MHA, DH-C, was responsible for putting together one of the first CDI programs in Australia.

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Behind the scenes at ACDIS: E-learning producer brings back industry-leading tips

Editor’s note: From time to time, we like to take a moment to share a behind-the-scenes look at what the ACDIS and broader HCPro team has been working on. Today, we wanted to shed some light on one of our e-learning producers, Amanda Southworth. Amanda recently attended the Association of Talent Development International Conference and Exposition (ADT) in Atlanta and brought back a number of important lessons about education, training, and e-learning. To see the complete list of HCPro’s e-learning opportunities, click here.

I recently had the privilege of attending the ADT, a massive four-day educational and networking event that included 10,000 learning and development professionals from all over the world. While there, I learned about the latest trends in the training world as well as the specific struggles, challenges, and successes specifically related to providing continuing education to those working in the healthcare field.

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Symposium Speaker Highlight: McCall demystifies outpatient coding

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Shannon McCall, RHIA, CCS, CCS-P, CPC-I, CCDS

Editor’s note: As we did with the 10th annual ACDIS conference in May, we’ll take some time leading up to the ACDIS Symposium: Outpatient CDI to chat with a few of the speakers. The event takes place September 18-19 at the Hilton Oak Brook Resort & Conference Center in Oak Brook, Illinois. Today, we talked with Shannon McCall, RHIA, CCS, CCS-P, CPC-I, CCDS, the director of coding and HIM at HCPro in Middleton, Massachusetts. She manages the instructors of the Certified Coder Boot Camps and has extensive experience with coding for both physician and hospital services. She will be presenting “The Ins and Outs: Inpatient and Outpatient Coding” on Day 1 of the Symposium.

Q: There are so many differences between inpatient and outpatient coding! What would you say is the most difficult one(s) for those moving from the inpatient CDI world to wrap their minds around? (e.g., that words like probable, likely, suspected don’t count toward a diagnosis, that outpatient facilities not only use ICD-10 but also CP[SM] T, the different code sets each have their own set of guidelines and rules governing use?)

A: Documentation for outpatient encounters is much briefer than documentation for an inpatient admission so the application of the guidelines of only assigning codes for relevant diagnoses is important. Providers typically lack the documentation in their notes to clearly identify chronic conditions being clinically relevant in their decision making process. Since risk adjustment is based on diagnosis coding, the differences in procedure coding has no bearing.  [more]

Note from the Associate Editorial Director: Setting the outpatient CDI table

outpatient CDI table

Join us for the ACDIS Symposium: Outpatient CDI!

By Melissa Varnavas

The stew’s been simmering in the pot for a while now. All the separate ingredients are melding and the overwhelming aroma in the room is enticing. The stew is outpatient CDI. Its ingredients are multitudinous, varied.

  • Pinch of evaluation and management (E/M) coding
  • Few cups of hierarchical condition category (HCC) groupings
  • Sampling of risk adjustment methodology
  • An awareness of current procedural terminology (CPT) codes
  • Knowledge of ICD-10-CM/PCS Official Guidelines for Coding and Reporting
  • Several specks of physician practice business savvy

And that’s not a comprehensive list of ingredients by any stretch of the imagination. Each cook in this CDI kitchen (just as in the inpatient world) follows its own recipe—drawing from its unique set of programmatic goals and overarching system mission and focus.

Yet, we have a basic recipe to follow thanks to those taste-testing the mixture over the past few years and sharing their samplings with rest of the CDI community. Now all we need to do is set the table and invite others to join us.

The ACDIS Symposium: Outpatient CDI invites you to the feast. Hope to see you there.

Editor’s note: Varnavas is the Associate Editorial Director for ACDIS and has worked with its parent company for nearly 12 years. Contact her at mvarnavas@acdis.org.