Health Information Management

Tip: Develop a structured audit plan for CDI staff

CDI Strategies, August 6, 2009

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It's important to develop a structured process of performing quality audits of your CDI staff, says Wendy DeVreugd, RN, BSN, PHN, FNP, CCDS, senior director of case management for Kindred Healthcare. If you are not currently monitoring your CDI staff performance, consider implementing the following process:
  1. Review a selection of charts in a chosen focused tiered DRG each month (with query sheet, responses, number of reviews, and DRG progression) for accuracy
  2. Monitor those cases with a DRG that changed after discharge (i.e., assigned provisionally by the CDI specialist and changed during final coding), and assign these cases one of the following letter codes:
    1. Physician changed with new information available since last CDI specialist review
    2. Missed surgical procedure 
    3. Educational opportunity/Coding Clinic rule application
    4. Other: Case requires follow up (i.e., education to CDI specialist or concurrent coder) due to failure to sequence correctly or apply coding rule. “We brought these cases for discussion in a bi-monthly meeting between the coder and the CDI specialist team,” DeVreugd says.
Monitor the percentage of these changed DRG cases against the total reviewed number of cases and against your facility's set acceptable threshold of error.
DeVreugd’s department averaged approximately a 1.5% average “error rate” (or educational opportunity), which was acceptable, she says. “In the beginning of the CDI program, however, the percentage identified for educational opportunity was higher (5%) and education was done in a product line (such as oncology) where the CDI specialist or concurrent coder may not have had a lot of experience. After education, the ‘educational opportunity’ rates improved,” she says.
DeVreugd also offers the additional helpful hints:
  • A program to monitor productivity, queries, and DRG progression is very helpful, but requires clerical staff for input of data to develop the final reports. “In lieu of a formal purchased tracking database, one may take DRGs that change after discharge,” she says. “You should always examine why the change occurred.”
  • Review mortality cases for APR-DRG severity of illness and risk of mortality categories 1 and 2, and examine the documentation for missed opportunities/documentation. Complete appropriate physician queries before dropping the final coding and bill. “Complete your QI mortality review at the same time,” she suggests.

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