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Local Chapter Events: Maryland, Georgia meet Dec. 5

mdThe Maryland ACDIS Chapter has been meeting for more than five years. Although previously under the auspicious of the Maryland Hospital Association (MHA) (which still graciously houses the group’s monthly meetings), the group became an “official” ACDIS chapter back in 2013.

On Friday, December 5, 12:30- 3 p.m., at the MHA headquarters in Elkridge, the group once again hosts its annual holiday pot luck event. In addition to inviting attendees to bring a tasty tidbit of food to share, the group also collects donations for Toys for Tots Foundation.

In fact, many local chapters have incorporated charitable giving into their meeting agendas. The North Carolina and Virginia ACDIS Chapters often ask the host facility to identify a charity in their area and a donation suggestion. Often hosts choose nearby food pantries, collect canned goods, and deliver the items following the event.

Such charitable efforts go above and beyond expectations as leaders, hosts, and even attendees often come to local meetings on their own time and on their own dime taking personal time off to attend and working after hours to ensure the event’s success.

Kudos to all who not only ensure the sharing of CDI wealth but who share their good fortune with those less fortunate in their vicinity. For information about the upcoming Maryland event email Andrea Norris at

Additional meetings coming up include:

The Georgia ACDIS Chapter holds its winter meeting Friday, December 5, 8:30 a.m. to 2:30 p.m., at Lanier Technical College in Oakwood. Dorothy Sneed will present “The Clinical Documentation Role in Preventing Healthcare Fraud.” For information, email

The Maine ACDIS Chapter meets Friday, December 12, noon to 4 p.m., at Maine General Medical Center in Augusta. For information email Cheryl McInnis,, or Cathy Seluke

New Jersey
The New Jersey ACDIS Chapter partnered with the Delaware AHIMA Chapter for a 21-part webinar series on ICD-10-CM/PCS titled, “Sharpening the Focus for Accurate Data and DRG Assignment,” which begins in November and continues through June 2015. For information, visit


New York
Suffolk County ACDIS Chapter meets Friday, January 9, 10 a.m., at Stony Brook University Hospital. For information, email Bernadette Slovensky at

Indiana ACDIS plans its first quarterly meeting Wednesday, Janaury 14. For information, email Angie Green,

South Carolina
South Carolina ACDIS Chapter meets at Baptist Hospital in Easley on January 16. For information, email PJ Floyd,

Editor’s Note: For additional information about ACDIS networking and state and local events, visit the Local Chapter page of the ACDIS website or visit the ACDIS Blog and click on the Local Chapters category.

Local Events: May and June meetings offered

Don't get lost on the road to success. The CDI Roadmap Committee will offer direction for new programs.

Where will your local chapter education take you?


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

South Carolina

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.

Agenda includes:

  • “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 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.”

For information, contact Diane Draize at, or Glenn Krauss


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


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, or visit


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


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


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


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

Q&A: Post surgery respiratory failure

Submit your inpatient coding and CDI questions reply to this post .

Submit your inpatient coding and CDI questions reply to this post .

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 ( 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


Sandy affects CDI professionals, ACDIS members

As news reports continue to illustrate the extensive damage caused by hurricane Sandy our thoughts and prayers go out to those who live and work in the affected communities.

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.

Maryland CDI meeting agenda set

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

More than a dozen opportunities to learn locally this spring

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
  • Lunch
  • 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

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

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

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
  • Lunch
  • 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

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

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

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

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

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

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

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

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  Visit the Southeast Regional ACDIS Chapter Facebook page for announcements and other information.