All Entries Tagged With: "query"
Chicago CDI Boot Camp sold out
That’s the good news and the bad news, I’m afraid.
On the good news side of the scale we place the fact that 32 people—that’s right, 32 people—registered for the four-day CDI Boot Camp being held at the Marriott Courtyard in Chicago/Schaumburg September 28 through October 1. The number of registrants speaks to the intensity of the educational needs of the profession as well as to the dedication of CDI professionals.
Of course, on the bad news side of the scale we place the fact that the Chicago program is, in fact, sold out. So anyone in the area who had hoped to register but was perhaps waiting for last minute approval from their director or other supervisor missed out, I’m afraid. We hope that if you’re in Chicago and did get shut out of the Boot Camp, you’ll be able to take some solace in the fact that the 2010 ACDIS conference will be held in the Windy City June 3rd and 4th, with the pre-conference coding essentials program and post-conference CCDS exam.
Just one more item to tip the scale to the positive. (I like to leave things primarily on a positive note, if possible.) Just because the Chicago program is closed doesn’t mean there won’t be other learning opportunities. The Atlanta, GA, program taking place at Hyatt Place October 12-15, still has multiple open slots. Just a note on that, the early bird hotel room rate ends on September 18, so if you are interested you might want to mention that to the powers that be. And the Boot Camp taking place at the Hilton Phoenix Metro Center in November from the 2nd to the 5th also has multiple slots open.
We are in the planning stages for the 2010 Boot Camp schedules now so if you want a session to come to your neighborhood, give us a shout. We hope everyone who attends the Chicago intensive has a great time and learns a lot.
Chemotherapy documentation challenges warrant CDI attention
Given the extremely high cost of chemotherapy services, it is likely that third-party payers, including Medicare, will scrutinize these services, says Glenn Krauss RHIA, CCS, CCS-P, C-CDIS, in an article for JustCoding.com.
Here is a breakdown of areas generally targeted by payers including Medicare and their related documentation difficulty:
- Medical necessity for the supplied diagnosis: Often the clinician fails to provide the specific location of the cancer. A clinical documentation specialist can query the physician to ensure appropriate documentation.
- Coverage exclusion for specific drugs based on clinical trial effectiveness: Coders should reference local coverage determinations that generally spell out which diagnoses are considered covered benefits for common chemotherapeutic agents.
- Proper charging and billing of drug units: Just documenting patients’ nausea and vomiting is not always sufficient to support payment of anti-emetic medicines.
- Documentation to support IV administration units of service: Accurate coding for this requires clear start and stop times for IV chemotherapy administration. It is particularly problematic because clinicians do not always document the order of sequential therapy.
CDI programs might consider designating a team member specifically for the chemotherapy service line, Krauss says. A part-time specialist or member of the existing team may be enough depending on the monthly volume of patients in the chemotherapy department and the number of new patients who begin chemotherapy each month.
Focus initially on validating documentation and providing feedback to clinicians regarding documentation of IV therapy administration. The CDI specialist can help bridge the gap between customary medical record documentation and the level and detail of documentation necessary to properly and accurately capture all IV administration charges.
JustCoding.com subscribers can read the complete article online.
Still inflamed by sepsis documentation? Listen in!
Bacteremia vs. septicemia; urosepsis vs. sepsis—who hasn’t experienced this documentation nightmare? Proper reporting of sepsis dramatically affects final MS-DRG assignment and hospital quality profiling. CDI specialists understand this. But what are the clinical indicators and how can we submit acceptable queries for these conditions.
If you missed the ACDIS February 5 audio conference Sepsis Documentation and Coding: Clinical Indications, ICD-9 Guidelines, and Queries for Clarity Sample Sepsis Query featuring, James S. Kennedy, MD, CCS, from FTI Healthcare Brentwood, TN, and Jennifer Avery, CCS, CPC-I, CPC-H, a senior regulatory specialist from HCPro, Marblehead, MA, you can still order an audio-on-demand version of the show.
Here’s a tip taken from the presentation:
“If the physician only states ’septicemia’ or ‘bacteremia,’ then query for clarification to determine if additional code assignment is appropriate for sepsis or SIRS. . . The coder should never assume that the presence of SIRS criteria on admission allows the coder to code 038.x as principal without corroborating physician documentation that sepsis was present on admission. This is especially important with Recovery Audit Contractors finding over $300 million in potential revenue their first year in existence.”
Download the free Sample Sepsis Query form courtesy of Wendy Dougherty, of Mercy Medical Center in Nampa, ID. ACDIS members have access to dozens of sample forms and useful tools in the Forms and Tools Library on the Web site.
Visit our customer service department to become an ACDIS member.
Tips to help CDIs celebrate Lincoln’s 200th
He looks good for 200!
You have enough to do. I know it. The last thing you really need to worry about is how to celebrate the 200th anniversary of the birth of Abraham Lincoln. (It’s Charles Darwin’s birthday, too, by the way. Yes, they were actually born on the same day-February 12, 1809.) You’re so busy the whole thing must have slipped your mind. Don’t worry, I’ve come up with a few suggestions to help you mark the day before the the last query is filed.
- Communicate with coders and physicians. Lincoln was known (thanks to Doris Kearns Goodwin and President Barack Obama) for assembling “a team of rivals.” CDI specialists can do this, too. Just reach out to the people “across the aisle” in order to obtain the most complete documentation possible.
- Write another query. “I shall try to correct errors when shown . . .errors,” Lincoln wrote in a letter to the New York Tribune on August 22, 1862. Of course he referred to the official state of the Union, that should a misguided notion of his own thought be uncovered Lincoln would seek to alter his opinion. Nevertheless, we can apply the sentiment to CDI (if only in honor of Lincoln’s birthday). CDI professionals should query any supposed error or omission to the patient medical record. It’s the CDI specialists’ role.
- Offer documentation tips to your favorite physician. Lincoln was the great orator. Use your own interpersonal skills; the ones you honed through your years communicating with physicians and patients on the floor to now communicate your facility’s documentation needs.
Okay, that’s all I could come up with and it was a stretch, I know. I suppose you could aim for 200 closed queries by the end of the month but how realistic would that be? Anything for a little bit of celebration on such an auspicious occasion. Cheers!
Free CDI white paper for download: Culture of quality
Hi ACDIS members, I hope you’re all doing well. I wanted to let you know about a new white paper that is now available for free download in the Helpful Resources section of our Web site. It’s called “Instill a culture of quality to ensure CDI success,” and you download it by clicking here.
We plan to continue to provide you with additional CDI-related white papers in the coming year. These are intended to provide an in-depth look at various issues in the world of clinical documentation improvement. We’ll also be using them to provide you with opinions of differnet thought-leaders in the field. Not all the opinions expressed in these white papers are necessarily shared by ACDIS, but we hope you find the information beneficial, useful, and thought-provoking.
If you enjoyed this white paper, or have some questions and/or would like to discuss what you read, please post it right here on CDI Blog.
If you’d like to make a suggestion for a future white paper topic, please e-mail me at bmurphy@cdiassociation.com.
Take care,
Brian
Recap of fifth quarterly conference call
The fifth ACDIS quarterly conference call took place Thursday, November 20. That’s right, folks, it was our fifth! That means we’ve just passed our one year anniversary. Thanks to all of you who’ve helped to grow this organization and make it the success it’s been so far. We certainly look forward to more successful programs and events as we move quickly through the holidays and on to the New Year!
Speaking of successes, we had a lively discussion regarding AHIMA’s September release of its brief on how to conduct appropriate physician queries. As ACDIS Director Brian Murphy pointed out during the call, ACDIS submitted comments to AHIMA regarding the brief prior to its final publication. Many ACDIS members offered their opinions and helped to guide the final version.
The brief provides a framework description of what CDI specialists do in the field and also expresses the simple fact of the growth of physician queries as a process in today’s healthcare world, said Lynne Spryszak, RN, coordinator of Clinical Documentation Management Program at Alexian Brothers Medical Center, Elk Grove Village, IL. The brief “is still what I’d consider more or less incomplete but it is an improvement over the original” drafts of the document, she said.
It’s important to remember that the AHIMA brief primarily targets HIM professionals, said Robert S. Gold, MD, CEO, DCBA, Inc., in Atlanta. Although all panel members agreed there was much to be gleaned from the content of the final brief for CDI/CDM programs.
AHIMA Takes Second Look at Revised Physician Query Practice Brief
Brian Murphy, director of ACDIS, asked me to say something about AHIMA’s decision to revise the Physician Query Practice Brief and provide some commentary on the first draft. While I’m unable to provide the complete text here I’ll try and paraphrase the sections that, in my opinion, still need some clarification and I’ll give some examples of the sections that I agree with.
The revised brief is presented in two sections:
- the first addresses current legal, regulatory and ethical issues, documentation, the query process
- the second part provides direction concerning compliance; specifically, auditing and monitoring and reporting and performance metrics
What the brief does not do is answer the all-time burning question “what constitutes a leading query?” or acknowledge that there is a difference between a nurse asking a physician a question (clinician-to-clinician) and a coder querying the physician. I feel that the “guidance” provided in the first draft does anything but guide.