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CDI Strategies

CDI Strategies is a free bi-weekly e-mail resource for CDI specialists and Association of Clinical Documentation Improvement Specialists (ACDIS) members. CDI Strategies offers biweekly news on the latest coding changes and regulatory updates as well as tips for day to day program improvement and problem-solving.

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Issue 26, December 24, 2009

• News: Compliances breaches point to CDI importance

  $3.75 million. That’s the amount California HMO Kaiser Permanente plans to pay the government...

• News: Value Based Purchasing offers glimpse into the future of CDI

  A recent article published by the Healthcare Financial Management Association (HFMA) should get...

• Tip: Determine roles and goals of CDI prior to hiring staff members

  There are many schools of thought regarding which department should be in charge of a CDI...

• Tool: Novant Health shares CDI 101 training video

  CDI administrators are constantly seeking simple solutions to educate fellow healthcare providers...

• Q&A: Defining differences in DRG systems

  Q: What are the differences between the MS-DRG and the APR-DRG systems?  A:Garri L...

Issue 25, December 10, 2009

• News: RACs begin complex DRG reviews

  Facilities in 10 states could soon see medical record documentation requests for complex audits...

• News: CERT report of Part B billing/coding errors a good training tool for CDI specialists

  A recently-released Comprehensive Error Rate Testing (CERT) report detailing coding/billing errors...

• Tip: Conduct chart reviews for ulcer documentation opportunities

  Since physicians don’t always document pressure ulcers, carefully conduct investigations of...

• Tools and tips: Refresh awareness of altered mental state documentation

  In an informal ACDIS poll earlier this year CDI specialists answered the question: How well do your...

Issue 24, November 26, 2009

• News: Senate bill to increase RAC scope

  The Senate Healthcare Reform Bill includes a proposal for expanding the RAC program. Specifically...

• Tool: Send physician documentation kudos straight to the top

  At St. Mary’s Hospital in Passaic, NJ, Melanie Halpern, RN-BC, MBA, CCDS, clinical...

• News: ACDIS launches 2009 CDI specialist salary survey

  Nearly 300 people have already responded to the 2009 ACDIS annual CDI salary survey. In the...

• Q&A: Two query alternatives for acute on chronic renal insufficiency

  Q: How I should query a physician when he documents: “Acute on chronic renal insufficiency...

• Tip: Use 3rd Quarter Coding Clinic to help resolve surgery complication questions

  The American Hospital Association’s Coding Clinic for ICD-9-CM contains official advice from...

Issue 23, November 12, 2009

• News: Four states start ZPIC reviews, others begin soon

  Health Integrity LLC, the zone four (Colorado, New Mexico, Oklahoma, and Texas) Zone Program...

• Strategy: Position your CDI role to meet the evolving world of healthcare reform

  With so much attention on healthcare reform and CMS’ shift toward paying for quality, CDI...

• News: ICD-9 to ICD-10 code conversion conference call slated for Nov. 19

  Implementation of ICD-10-CM/PCS remains three years away. But it is not too soon to find out more...

• News: Three local CDI groups set to meet Friday, November 13

  CDI professionals across the country understand the benefit of informal, informational networking...

• Q&A: Queries under RAC scrutiny

  Q: We recently heard from our process management company that after several clients have had the...

• On the ACDIS Web site

  Editor’s note:The following items have been updated on the ACDIS Web site...

• On the ACDIS Blog

  Editor’s note: The ACDIS Blog contains important association information as well as tips and...

Issue 22, October 29, 2009

• Tip: Take the time to review the H&P and progress notes

  CDI specialists often underestimate the importance of the dictated history and physical (H&P...

• News: Simple mistakes cause profound costs

  Sometimes documentation mistakes caught by CDI professionals are the simple ones. Like an incorrect...

• Q&A: Maintaining CDI productivity under the SOI/ROM system

  Q: How has switching to a severity of illness (SOI)/ risk of mortality (ROM) system affected your...

• Tip: Take time for a sepsis refresher

  Sepsis. Severe sepsis. SIRS. Septicemia. Unfortunately, this isn’t a case of “tomato...

• On the ACDIS Web site

  Editor’s note:The following items have been updated on the ACDIS Web site...

• On the ACDIS Blog

  Editor’s note: The ACDIS Blog contains important association information as well as tips and...

Issue 21, October 15, 2009

• Tip: Pay attention to MACs, not just RACs

  With all the attention these days squarely on Recovery Audit Contractors (RAC), CDI specialists...

• Tip: Take 2010 IPPS as temporary initiative to spur CDI initiatives

  Many hospitals feared a 1.9% reduction in payment for 2010, but they’ll actually see a 2.1...

• Survey: Are queries a permanent part of the medical record?

  An HCPro Inc. poll survey posted this week asked healthcare compliance professionals if their CDI...

• On the ACDIS Web site

  Editor’s note: The following items have been updated on the ACDIS Web site...

• On the ACDIS Blog

  Editor’s note: The ACDIS Blog contains important association information as well as tips and...

Issue 20, October 1, 2009

• Tip: Stay up to date with quarterly Coding Clinic releases

  The most recent Coding Clinic, third quarter 2009, contains an entry on glioblastoma with vasogenic...

• News: Healthcare workers still face disruptive behavior

  CDI specialists appreciate this issue well. Understanding some of the reasons for inappropriate...

• News: Electronic records, query systems on their way

  Many CDI programs use Excel-spreadsheets to track and organize their query processes. More and...

• On the ACDIS Web site

  Editor’s note: The following items have been updated on the ACDIS Web site...

• On the ACDIS Blog

  Editor’s note: The ACDIS Blog contains important association information as well as tips and...

Issue 19, September 17, 2009

• News: CMS releases IPPS Fact Sheet

  While it may be familiar information for those working in the hospital payment world for years, CDI...

• News: Medicare's HAC policy may not save much money

  For a program that spends $400 billion annually saving one or two million dollars seems like a...

• Tip: Prepare for new MCCs effective October 1

  As a reminder, several new codes have been designated as complications/comorbidities (CCs) and...

• Tip: Examine emergency documentation to ensure compliant coding for ARF

  The sequencing of respiratory failure depends on the reason for admission. When respiratory failure...

• On the ACDIS Web site

  Editor’s note: The following items have been updated on the ACDIS Web site...

• On the ACDIS Blog

  Editor’s note: The ACDIS Blog contains important association information as well as tips and...

Issue 18, September 3, 2009

• News: Trailblazer outlines inpatient vs. observation status documentation pitfalls

  Following a targeted review of 250 claims with DRG 247, TrailBlazer, the Medicare Administrative...

• TIP: Couch your query when clarifying unstable angina

  Editor’s Note: The following tip was excerpted from the article “Tips for problematic...

• Clarification: Anemia documentation and coding presents communication hazards

  Editor’s note: The following Q&A first appeared in the August 20, 2009, edition of CDI...

• On the ACDIS Web site

  Editor’s note: The following items have been updated on the ACDIS Web site...

• On the ACDIS Blog

  Editor’s note: The ACDIS Blog contains important association information as well as tips and...

Issue 17, August 20, 2009

• News: CMS solicits comments on cardiac quality measures

  The Centers for Medicare & Medicaid Services (CMS) may add two cardiac outcomes measurements to...

• Tip: Track basic data to prove CDI program value

  Once your facility has its clinical documentation improvement program's structure in...

• On the ACDIS Web site

  Editor’s note: The following items have been updated on the ACDIS Web site...

• On the ACDIS Blog

  Editor’s note: The ACDIS Blog contains important association information as well as tips and...

Issue 16, August 6, 2009

• News: IPPS final rule reverses reimbursement rate cut

  Concern regarding CMS’ 2010 Inpatient Prospective Payment System (IPPS) proposed rule...

• Tool: CDI Program Structure benchmarking survey

  When creating a CDI program, you first have to determine its organizational structure. Will it live...

• Tip: Develop a structured audit plan for CDI staff

  It's important to develop a structured process of performing quality audits of your CDI staff, says...

• On the ACDIS Web site

  Editor’s note: The following items have been updated on the ACDIS Web site...

• On the ACDIS Blog

  Editor’s note: The ACDIS Blog contains important association information as well as tips and...

Issue 15, July 23, 2009

• News: Hospital Compare releases readmission data for heart attack, heart failure and pneumonia

  One in five Medicare beneficiaries who leave the hospital today will re-enter the hospital within a...

• Tip: Know what does, and does not, qualify as critical care

  (Editor’s note: CDI specialists may wish to provide the following tip to their physicians in...

• Q&A: Impact of SOI/ROM on DRG assignment

  Q: When coded, will the five ICD-9 diagnosis codes which turn off if the patient expires for use in...

• On the ACDIS Web site

  Editor’s note: The following items have been updated on the ACDIS Web site...

• On the ACDIS Blog

  Editor’s note: The ACDIS Blog contains important association information as well as tips and...

Issue 14, July 9, 2009

• News: AHIMA CDI Work Group busy researching best practices

  In April the American Health Information Management Association (AHIMA) asked for volunteers to...

• Q&A: ACDIS Advisory Board weighs in on physician query form retention

  Our facility is wondering how long to keep queries. In a previous institution in which I...

• On the ACDIS Web site

  Editor’s note: The following items have been updated on the ACDIS Web site...

• On the ACDIS Blog

  Editor’s note: The ACDIS Blog contains important association information as well as tips and...

Issue 13, June 25, 2009

• News: CCDS credential updates

  Those who took the Certified Clinical Documentation Specialist (CCDS) examination in Las Vegas can...

• News: AHA expresses IPPS proposed rule concerns

  While the American Hospital Association (AHA) says it agrees with some of the changes in the...

• Q&A: How should CDI programs track mortality information?

  Do established CDI programs typically track mortality rates concurrently or by trending historical...

• Tip: Provide clinical updates, resources to physicians as part of your CDI duties

  Along with their daily duties of chart review, CDI specialists should consider themselves as...

• On the ACDIS Web site

  On the ACDIS Web site

• On the ACDIS Web site

  On the ACDIS Web site

• On the ACDIS Blog

  On the ACDIS Blog

Issue 12, June 10, 2009

• News: Six cited for inadequate physician documentation

  Need to get your physicians onboard with your clinical documentation improvement program? Show them...

• Strategy: Multi-disciplinary documentation helps solve CHF problems

  When dealing with difficult documentation issues such congestive heart failure (CHF) consider...

• Q&A: Hospital Acquired Conditions and SOI/ROM levels

  Will a Hospital Acquired Condition (HAC), when coded, still affect severity of illness (SOI)/risk...

• Did you know: CMS states physician query position in 2001 brief

  Government payers previously believed that physician queries opened opportunities for the...

• On the ACDIS Web site

  Editor’s note: The following items have been updated on the ACDIS Web site...

• On the ACDIS Blog

  Editor’s note: The ACDIS Blog contains important association information as well as tips and...

Issue 11, May 28, 2009

• Sample query note: How to construct appropriate queries for bowel disease

  Sample query note: How to construct appropriate queries for bowel disease

• Tip: Put on your clinical hat first, coding shoes second

  CDI specialists who seek to alter code sequences in order to optimize CC/MCC capture and case mix...

• Q&A: Querying for type of heart failure

  Q: Last year a cardiologist provided an educational session for our coding auditor and the...

• On the ACDIS Web site

  On the ACDIS Web site

• On the ACDIS Blog

  Editor’s note: The ACDIS Blog contains important association information as well as tips and...

Issue 10, May 14, 2009

• From the Director's Desk: ACDIS live in Las Vegas

  Just a quick note to let everyone know that we’re enjoying the second annual ACDIS conference...

• Tip: Perform concurrent review of complication rates

  Many reported post-operative complications may not really be complications of care at all, says...

• Verbal queries: Let your policies and procedures do the talking

  Verbal queries remain a source of contention for hospitals simply because these queries are...

• On the ACDIS Web site

  Editor’s note: The following items have been updated on the ACDIS Web site...

• On the ACDIS Blog

  Editor’s note: The ACDIS Blog contains important association information as well as tips...

Issue 9, April 30, 2009

• Tip: Three Rs can improve diagnosis capture, medical necessity documentation

  CDI specialists should seek to promote the three “Rs” to improve their...

• Q & A: When is depression considered as a complication/co-morbidity?

  Q: If the patient has a history of depression continued on a maintenance dose of serotonin-specific...

• On the ACDIS Web site

  Editor’s note: The following items have been updated on the ACDIS Web site...

• On the ACDIS Blog

  Editor’s note: The ACDIS Blog contains important association information as well as tips and...

Issue 8, April 16, 2009

• Tip: Hire staff members based on expertise and professional passion

  Successful CDI programs begin with the selection of competent and cohesive teams. As CDI programs...

• Q&A: ACDIS Board weighs in on queries to the attending physician

  My facility’s policy requires us to address all queries to the attending physician...

• On the ACDIS Web site

  On the ACDIS Web site

• On the ACDIS Blog

  On the ACDIS Blog

Issue 7, April 2, 2009

• Tip: Elevate coder's role in concurrent reviews

  Many CDI programs use nurses as their primary concurrent reviewers, the argument being that a...

• Use kidney key-words to sooth your documentation troubles

  Many physicians fail to document conditions associated with acute kidney injury (AKI) and chronic...

• Tip: Consider a dedicated review of death charts

  It used to take up to three months to review medical records of expired patients in order to track...

• Q&A: Educating physicians on need to document chronic respiratory failure

  Other than explaining to the physician that we code chronic respiratory failure separately from the...

• On the ACDIS Web site

  ACDIS released its quarterly journal on Tuesday, April 1.The deadline to submit nominations for the...

• On the ACDIS Blog

  Editor’s Note: The ACDIS Blog allows us to post important association information as well as...

Issue 6, March 19, 2009

• CDI Tip: Look for documentation opportunities in DNR patients

  Many physicians fail to document acute respiratory failure, acute renal failure, or other...

• Q&A: Tracking physicians' responses to queries

  Q: How should our program track physician responses?

• On the ACDIS Web site

  Here's a review of newly updated items available for ACDIS members on the CDI...

• On the ACDIS Blog

  The following articles appeared on the ACDIS Blog at http://blogs.hcpro.com/acdis/ from Thursday...

Issue 5, March 5, 2009

• Stress synergy and collaboration to make your CDI program work

  Stress synergy and collaboration to make your CDI program work

• Use comparative data to justify CDI implementation

  Use comparative data to justify CDI implementation

• Ten reasons for adopting an electronic query process in your CDI program

  Consider 10 reasons for adopting an electronic query process in your CDI program

• ACDIS Blog: Keep up-to-date on what's going on in the association

  ACDIS Blog: Keep up-to-date on what's going on in the association

Issue 3, February 5, 2009

• News: White paper offers tour through AHIMA physician query brief

  This excerpt highlights information from the white paper, “Master physician queries...

• News: EHR part of economic stimulus package

  Many CDI specialists struggle with the impact of electronic health records (EHR) on their query and...

• News: Cigna says E/M documentation vital

  A bulletin from CMS carrier Cigna released in December 2008, should add a little extra impetus for...

• News: CMS announces full RAC expansion schedule

  CMS revised its Recovery Audit Contractor (RAC) expansion schedule with the first phase to start...

• Q&A: Improve hospital HealthGrades with CDI

  Note: ACDIS appreciates receiving questions from our readers. We cannot promise to answer every...

• CDI tip: Educating physicians as simple as hitting send

  The thought of e-mailing documentation tips to physicians may seem ludicrous—like lecturing...

• ACDIS events: Vital networking tools available to CDI professionals

  Editor’s note: ACDIS members have access to tools and forms and a number of educational...

• Local chapters: Meeting updates, search for starter members

  Editor’s Note: Below is an alphabetical state listing of specialists who are interested in or...

• ACDIS Blog: Keep up-to-date on what's going on in the association

  Headlines from the past two week’s worth of ACDIS Blog entries include biographies of new...

Issue 2, January 22, 2009

• Tip: Involve compliance officers/auditors in CDI program development

  From veteran programs to new CDI initiatives, CDI department managers should seek their...

• Tip: Seeking a physician champion? Advertise the position

  Avoid falling into the trap of choosing physician champions who have excellent documentation habits...

• Q&A: Tools to measure MCC/CC capture rate

  You can run a comparison for all MS-DRGs dependent on the presence or absence of a CC or...

• News: ICD-10 Final Rule pushes implementation to 2013

  HHS released its ICD-10 implementation Final Rule in the Federal Register on January 16. The rule...

Issue 1, January 8, 2009

• Q&A: Querying for CHF using prior documentation

  Question: Part of our clinical support for determining the presence of congestive heart failure...

• Strategy: Try these tips to engage physicians in your CDI program

  Consider the following techniques to improve physician education and awareness of your CDI program.

• Q&A: How to find the right physician champion

  What’s the basic role and purpose of a physician champion/advisor in a CDI program? Do you...

• Reminder: Dedicated member relations specialist added to ACDIS

  As a reminder, ACDIS has now added Susan Calabro as a full-time member relations specialist. If you...