The Minnesota ACDIS Chapter meets Wednesday, May 28, 1-2 p.m., at North Memorial Hospital
Hosted by North Memorial Hospital in Minneapolis. A dial-in number will be available for those unable to attend in person. The agenda includes:
- Focus on malnutrition with discussion of guidelines, physician education strategy, and denials and appeals
- Obesity hypoventilation query opportunities
- Laparoscopic vertical (sleeve) gastrectomy
For information, contact Tracy Boldt at Tracy.Boldt@hcmed.org.
The South Carolina ACDIS Chapter meets Friday, May 30, 8:30 a.m. to 5:30 p.m., at the Gazes Auditorium, Medical University of South Carolina (MUSC) in Charleston.
- “The Importance of Leadership,” by Barton Sachs, MD, MBA, PhD, Professor, Chair of Medical University Hospital Authority (MUHA) CDI Committee
- “CDI is more than Reimbursement: Partnering with quality and analytic to increase CMI, improve mortality risk scores, and review patient safety indicators,” by Priscilla Browder, RN , PCCN, CDI specialist, Jackie Robinson, RN, MSN, CDI specialist, Danielle Scheurer, MD, medical director of quality and safety, and Amy Wilson, PhD, director of enterprise analytics
- “Integration of the CDI Specialist into the Care Team: A process and outcome review,” by Eric Kimchi, MD, associate professor, department of surgery, Marsha Cisa, RN, CCDS, and Becky Green, RN, CCDS, MUHA CDI Committee
- “Lunch and Learn,” featuring Brian Miller, RHIA, MBA, client relationship executive, 3M Health Information Systems, Inc.
- “Obtaining Physician Buy in for CDI: A private hospital’s perspective,” by Johanne Brautigam, RN, BSN, CCDS, manager Roper St. Francis Hospital, Cynthia Flynn, RN, second level reviewer; Beth Wolf, MD, CDI physician champion
- “Before the Bill Drops: Retrospective reviews and query follow-up, are they worth the time and FTE?” Pam Parris, RN, BSN, CCDS, MUHA CDI Committee
- “The Role of CDI in ICD 10 Education,” Cindy Kicklighter, RN, MSN, PJ Floyd, RN, BSN, MBA, NE-BE, CCA, director of HIS/CDI MUHA
- “A Joint Strategy: Developing teamwork between CDI and Coding,” by Christine Lewis, MHA, RHIA, CCS, CCS-P, Manager, Health information Services, MUHA
Cost is $10 for chapter members and $25 for non-members. Registration is limited to 75. Call 843-792-8136 or email firstname.lastname@example.org. Staying overnight? Contact Guest Services at MUSC for discount hotel reservations (first come, first serve) at 843-876-8456. Identify yourself as a member of the MUSC ACDIS conference.
The Wisconsin ACDIS Chapter meets Saturday, May 31, 9 a.m. to 3:30 p.m., at the Wheaton Franciscan Wauwatosa Campus in Wauwatosa. The spring meeting’s theme is “Maintaining Relevance to the Practice of CDI,” featuring:
- “Thinking like a Clinician: Understanding the physician’s clinical thought processes and medical decision-making in developing an assessment and plan,” by Mitch Hulbert, MD, from Columbia St-Mary’s Hospital in Milwaukee.
- “Clinical Documentation for Medical Necessity,” by Glenn Krauss, Manager, Accretive Health, in Milwaukee.
- “Querying under ICD-10,” attendees will break into small groups to work on and develop query templates for common clinical scenarios taking into the clinical specificity required under ICD-10.
- “Updates from the National ACDIS Conference.”
Maine ACDIS Chapter meets Thursday, June 5, 12-4 p.m., at the Alfond Center for Health in Augusta. For information, call 207-248-5093 or email email@example.com.
The Massachusetts ACDIS Chapter will meet on Tuesday, June 10, 1-3 p.m., at Rhode Island Hospital in Providence, R.I. For information, contact Sarah Eby at firstname.lastname@example.org, email@example.com or visit www.masscdis.weebly.com.
The Philadelphia/Southern NJ Chapter ACDIS meets Tuesday, June 17, 8-10 a.m. Our Lady of Lourdes Hospital in Camden, N.J.. For information, contact Mary Ellen Moakes at firstname.lastname@example.org.
The Evergreen Washington ACDIS Chapter meets Wednesday, June 18, 10 a.m. to 2 p.m., at Capital Medical Center in Olympia. For information, contact Susan Browne at email@example.com.
The MD ACDIS Chapter meets Friday, June 20, 1:30-3:30 P.M., at the Maryland Hospital Association in Elkridge. For information, email Andrea Norris at ANorris@uchs.org.
The Phoenix Arizona ACDIS Chapter meets Wednesday, July 16, 5:30-8 p.m., at Autumn Court (Chinese food restaurant), on East Indian School Road in Phoenix. For information, contact Carlena Forsha firstname.lastname@example.org.
Q: We continue to struggle with documentation regarding respiratory failure post surgery. Is there any new information or ideas about how to navigate this topic with the physicians?
A: I think the prevailing attitude in the CDI world is that delayed extubation after surgery is not respiratory failure. American Hospital Association (AHA) Coding Clinic for ICD-9-CM, third quarter, 2010, addresses the coding of mechanical ventilation stating that the threshold after surgery is generally 48 hours, but I do not believe that there is the same guidance regarding respiratory failure after surgery.
The provider can document the diagnosis of acute respiratory failure if the patient remains intubated following surgery, but, perhaps, CDI should not be querying until they remain intubated for 48 hours (based on Coding Clinic) or remains intubated longer than typical for the surgical pathway without being scheduled for additional surgery as patients are often left intubated when having multi-staged procedures.
Post-op respiratory insufficiency is coded 518.52 but be very wary of applying this code since it applies to both trauma and surgery and is a potential Recovery Auditor target due to its being an MCC.
The alphabetic index directs to 997.39 for postoperative respiratory complication, not elsewhere classified (NEC). Also documentation must clearly establish a cause-and-effect relationship between the condition and the surgery as well as refer to it as a complication. Remember, that the Official Guidelines for Coding and Reporting (Section I.B.18) directs code assignment based on “documentation of the relationship between the condition and the care or procedure.”
The guideline extends to any complications of care, regardless of the chapter the code is located in. Not all conditions that occur during or following medical care or surgery are classified as “complications,” however. There must be a cause-and-effect relationship between the care provided and the condition, and an indication in the documentation that it is a complication.
CDI professionals should query the provider for clarification, if the complication is not clearly documented.
Respiratory failure, on the other hand, can be acute, but if it was directly caused by the surgery, then likely will be a potentially preventable condition (PPC) problem according to the Maryland specific HSCRC guidelines (www.hscrc.state.md.us). Documentation by the physician can be made clear, in many cases, if it states that there likely was a cause other than surgery, but surgery is obviously a contributing factor. Also, acute respiratory failure is easier to code after surgery if the patient already had chronic respiratory failure and an exacerbation documented as caused by many factors including acute pulmonary edema that may or may not be caused by the surgery.
I like the idea of working toward an agreed upon criteria between physicians and CDI/coders/quality staff member. Education on this topic for all is necessary.
Editor’s Note: This question and response were exchanged by the Maryland CDI Workgroup and answered by ACDIS member Mark Dominesey, RN, BSN, MBA, CCDS, CDIP, senior CDI specialist at Sibley Memorial Hospital in Washington, DC. Contact him at email@example.com.
The Association of Clinical Documentation Improvement Specialists (ACDIS) currently has chapters in some of the hardest hit areas and members throughout the affected regions. We join the entire nation in expressing its sincere concern for the victims of the hurricane and understand that assistance is desperately needed now and will continue to be needed in the weeks of clean-up to come.
Over the coming days, ACDIS will continue to reach out to its local chapter leadership in support and solidarity. If you currently work or live in one of these areas please feel free to share how this storm has affected you by leaving a comment below. Additionally, those who wish to leave their comments of support may also do so.
The Maryland CDS Workgroup meets Friday, Aug. 17, 1:30-3 p.m., at the Maryland Hospital Association office in Elkridge. The agenda includes:
- Introduction of new members
- Christine Mobley – Future of the Maryland Workgroup
- Sallie Tyner – Topics related to CDI at the MdHIMA annual meeting
- Denise Otto – Observation cases
- MHACs and PPC
- Andrea Norris – ICD-10 training for CDI and physicians
- Wanda Myers – Anyone working with a PPC software application
- Lori E. Amonett-Wilson – The role of physician liaison and the CDI programs
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
- 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 firstname.lastname@example.org.
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 email@example.com.
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 firstname.lastname@example.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
- 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 email@example.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 firstname.lastname@example.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 email@example.com.
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.
The next meeting of the Minnesota group will be a 3M sponsored event Friday, Dec. 16, 8 a.m. to 3:30 p.m., at the 3M Innovation Center in Maplewood. For information, contact Mark LeBlanc at Mark.LeBlanc@ParkNicollet.com.
The next meeting of the Northern Ohio ACDIS Chapter takes place Thursday, Dec. 8, at Mercy Medical Center in Canton. Steven Robinson, MS, PA-O, RN, CPUR, senior director of CDI for Maxim Health Information Services will discuss the following CMS mandates and concurrent review opportunities:
- CMS current and upcoming mandates
- The importance of documentation in the medical record
- The typical CDI program
- MS-DRG IPPS (CC/MCC lists)
- POA coding
- JCAHO quality core measures
For information, contact Kristine Cilona, RN, at Kristine.Cilona@cantonmercy.org.
- SECACDIS Chapter meeting
- ICD-10 coding for orthopedics
- E/M coding
- Lunch and networking
- IPPS Final Rule updates applicable to CDI
The deadline for leadership nominations are due Friday, Dec. 9. Please take the opportunity to nominate a colleague via e-mail to Carla Payne at firstname.lastname@example.org. Candidate biographies/forms are due Dec. 12 and membership voting will take place from Dec. 19 through Jan. 9, 2012. There are currently 68 members in the chapter directory. Please take the time to participate by submitting your nominations today and make this a meaningful election of our chapter leadership.
The next Central Indiana ACDIS Chapter meeting takes place Wednesday, Jan. 11, 2012. For information, contact Susan Bradford, RN, BSN, by phone at 317/776-7285 or by e-mail at email@example.com.
The next Maryland Hospital Association Clinical Documentation Improvement Workgroup meets Friday, Dec. 16, from 12:30-1:30 p.m., for a holiday pot-luck lunch followed by its regular meeting from 1:30-3 p.m., at the Maryland Hospital Association Headquarters in Elkridge. For information, Contact Christine Mobley, RN, director of clinical documentation at Prince George’s Hospital Center, at christine.Mobley@dimensionshealth.org, or James Nagel at firstname.lastname@example.org.
The next Northern Illinois CDI meeting is tentatively scheduled for Thursday, Jan. 12, 2012. For information, contact Nancy R. Ignatowicz, at 815/806-2322 or by e-mail email@example.com. Or contact Colleen Stukenberg at 815/599-6820 or CStukenberg@fhn.org.
The Maine ACDIS Local Chapter will meet at Midcoast Hospital on Tuesday, Jan. 17, 2012. For information, contact Theresa Davis at 207/735-8340 or firstname.lastname@example.org.
The Southern Nevada Association of Clinical Documentation Specialists holds its next meeting Wednesday, Jan. 18, 2012. Guest speaker former ACDIS Advisory Board member Wendy DeVreugd will discuss “How to measure the success of your CDI program.” RSVP to Ailsa Kompare by Jan. 11, 2012 at 702/343-7232 or email@example.com.
The next California ACDIS webinar featuring a presentation regarding the role of CDI in RAC reviews and audit prevention will be held on Wednesday, Jan. 25, 9-10 a.m., PST. For information, contact Dexter D’Costa, MBBS, MHA, at Dexter.G.Dcosta@kp.org.
Other chapter news
The North Carolina ACDIS chapter now has a web site. Visit http://ncacdis.org/ to see photos from its November meeting and to learn more about recent events and initiatives. For information, contact Leah Taylor at 704/878-7436, or e-mail Leah.Taylor@iredellmemorial.org.
Editor’s Note: If you are interested in joining an existing local chapter please visit the Local Chapter page on the ACDIS web site. If you do not see a group listed for your area please e-mail ACDIS Associate Director Melissa Varnavas at firstname.lastname@example.org