HCPro.com - CDI Strategies

Director’s Note: ACDIS members elect four new ACDIS Advisory Board members

Thu, 02 Feb 2012 13:29:00 GMT

ACDIS would like to welcome four new members to the advisory board. These new board members are the first to be elected to the position through the work of a nominating committee and a vote of the ACDIS membership, in a new process begun this year. Thanks to everyone who voted! Please welcome:

Susan Belley, M. Ed., RHIA, CPHQ, iproject manager with 3M Health Information Systems Division, Consulting Services. Belley was the manager of coding at the University Hospitals of Cleveland (UHC) Ohio from 1993 until 1999, helping to implement its CDI program in 1996. She moved from UHC to take a position at the Cleveland Clinic, and in 2001 implemented a CDI program there; finally joining the Consulting Division of 3M HIS, in 2011. “I think we are at an important juncture in the CDI world – sort of the brewing of a perfect storm,” wrote Belley in her application statement. “I think it would be an interesting and exciting time to serve on the ACDIS board as the board helps its members navigate through the storm.”
Timothy Brundage, MD, physician champion and medical director of case management and continuing documentation improvement at Brundage Medical Group, LLC., in St. Petersburg, FL. Brundage served as medical director for case management at Kindred Hospital Central Tampa since 2004, and in 2008, became the champion for its north and central Florida districts. “The education I have in clinical documentation improvement has enhanced both my own practice as a clinician and also in the education of my resident physicians,” Brundage wrote. “Serving on the Advisory Board will allow me to impart my experience and expertise and serve as a voice to guide the growing community of clinical documentation improvement specialists.”
Fran Jurcak, RN, MSN, CCDS, director, Huron Consulting. As a healthcare consultant program manager for the past five years, Jurcak has helped implement a number of CDI programs and guided facilities in their ongoing assessment of their CDI efforts. She is the author of the CCDS Exam Study Guide and a member of CCDS Certification Board. “I believe that the main objective of the [CDI] role needs to continue to be education of physicians regarding accurate documentation,” Jurcak wrote. “And the goal of ACDIS needs to support that objective through educational opportunities, white papers, and establishing best practice standards that can be utilized and set into place by CDI specialists within their healthcare facilities.”
Dee Schad, RN, BSN, CCDS, director of care coordination and CDI at Clark Memorial Hospital in Jeffersonville, IN. She has 17 years of nursing experience, 12 specializing in CDI, and is the founder/current president of the Kentucky/Southern Indiana ACDIS Chapter. “I feel fortunate to have found an area in healthcare that I can truly say I love,” wrote Schad. “This specialty area allows you to be a patient advocate, physician advocate and facility advocate all at the same time. I do not know of any [other] healthcare position that can fulfill each of these roles at the same time. I see the opportunity to serve on the ACDIS Advisory Board as yet another way for me to give back to our profession.”

To learn more about the expectations of the position and the nomination process visit the following links:

Membership Update: New content added to ACDIS site; reminders for members

Thu, 02 Feb 2012 13:26:00 GMT

Professional of the year nominee deadline
Click here to download the 2012 award nomination form. It is in ‘word’ format; you can type into the form and return it as instructed. The deadline for nominations is this Friday, February 3. For additional information, e-mail ACDIS Director Brian Murphy at bmurphy@cdiassociation.com.

Conference Call

The ACDIS quarterly conference call is scheduled for Thursday, February 16, from 1-2 p.m. ET. ACDIS members will receive dial-in instructions via e-mail. If you have suggestions for discussion for the upcoming call, e-mail ACDIS Director Brian Murphy at bmurphy@cdiassociation.com. Recordings of all quarterly conference calls are posted as digital downloads on the ACDIS website.

Local Chapters

The Local Chapter page on the ACDIS website has been updated. It now includes an interactive map, meeting calendar, information regarding how to start a local chapter in your area, and updated information regarding local chapter leaders. http://www.hcpro.com/acdis/local-chapters.cfm.

Twitter

ACDIS Associate Director Melissa Varnavas is now on Twitter. Posts to this social media site will include association updates, snip-its from audio conferences, local chapter meetings, shared news, and other events. Follow her @mvarnavas.

Forms & Tools Library updates

Rebecca "Ali" Williams, RN, BSN, CCDS, manager of Documentation Integrity at Spartanburg (SC) Regional Medical Center & Village Hospital, donated a sample progress note regarding congestive heart failure. http://www.hcpro.com/acdis/forms_tools_group.cfm?topic=WS_ACD_LIB_QFM.

The ICD-10 Training Toolkit from HCPro Inc., shared some sample flashcards related to ICD-10-PCS and obstetrics, and Fran Toleno, RHIT, CCS, CDI coordinator and coding reimbursement specialist in the HIM department at Winthrop University Hospital in Mineola, NY, donated a sample ICD-10 myocardial infarction query and sample ICD-10 cerebral artery infarction progress note. http://www.hcpro.com/acdis/forms_tools_group.cfm?topic=WS_ACD_LIB_PEQ.

Featured article

A new featured article of the month has been posted to the ACDIS homepage. The article “Survey shows physician advisor role requires development,” was taken from the January edition of the CDI Journal. In it, three physician advisors to CDI discuss survey results and advocate the benefits of their roles.

Featured product

A new ACDIS featured product, the “JustCoding ICD-10 Virtual Summit,” was added to the ACDIS homepage. The summit, which takes place February 29 through March 2, features two tracks for HIM Directors and Coding Supervisors and Inpatient and Outpatient Coders over three days. Each session will be a one-hour and 15 minute webcast with a presentation and a question and answer segment with faculty. Each day will include a 30 minute break for participants to network with peers and visit the virtual exhibit hall, in which ACDIS will be represented.

News: Poll, survey indicates CDI salary range

Thu, 02 Feb 2012 13:23:00 GMT

Of 165 respondents who took part in a recent website poll, 50 (30%) indicated they earn more than $100,000 as CDI program managers/directors, followed by 34 (21%) who earn in the $70,000 range, according to a recent ACDIS Weekly Poll. In order to gain additional information ACDIS recently released its annual CDI Professionals ‘Salary Survey.

The survey is an important tool to assess national trends in the growth and compensation for the efforts of CDI specialists, program managers, and others working in the field. (To participate, visit http://www.zoomerang.com/Survey/WEB22EJ2VBYLVQ.)

When the survey was first conducted in 2008, 132 individuals completed it. In 2009, responses doubled to roughly 300. In December of 2010, nearly 900 people responded.

To date, nearly 700 CDI professionals have already responded. Of these, the majority (27%) indicate they earn $60,000-$69,000; a salary range consistent with that of previous years’ responses. And while 61% of survey takers reported feeling fairly compensated for their efforts in 2009, that number fell to 53% in 2010, and dropped again to 51% of respondents thus far.

The 2012 salary survey will close on Friday, February 3 at 5 p.m. Results will be shared in a special report on the ACDIS website later this month.

News: Vendor survey indicates physician documentation top priority for ICD-10 preparation

Thu, 02 Feb 2012 13:20:00 GMT

More than 65% of respondents listed improving physician documentation as “the most important revenue cycle-related business process” needed to “prepare for the transition to ICD-10,” according to a recent release from Waltham, MA-based vendor PatientKeeper, which provides physician healthcare information systems to facilities and physician practices.

Of the 173 responses, 94% indicated that implementing electronic physician documentation was “critical” or “important” to ICD-10 preparation, although only half indicated their facility currently uses a fully electronic charge capture system, according to the release.

“This survey shows that there’s a significant gap between what provider organizations know they will need to successfully implement ICD-10, and what’s in place today, in terms of the revenue cycle infrastructure at hospitals and practice groups,” said PatientKeeper CEO Paul Brient. “Over the next 21 months, we expect to see considerable activity in the market for physician charge capture and documentation software solutions, driven by the impending ICD-10 mandate.”

News: Study finds physicians need more help with electronic records

Thu, 02 Feb 2012 13:18:00 GMT

Transitioning to electronic health records (EHR) is no longer a question of “if” but “when.” Nevertheless, physician workflow and documentation habits continue to stymie EHR effectiveness, according to the findings of a new report published in the Journal of the American Medical Informatics Association.

The study authors conducted a retrospective audit of more than 4,000 charts from 57 New York City-based physician practices. Authors looked for specific quality measure improvements but discovered “that EHR-derived measures” actually “can undercount practice performance, with a disproportionately negative impact on the number of patients captured as receiving a clinical preventive service or meeting a recommended treatment goal.”

News: Nurses spending more time on indirect patient care

Thu, 02 Feb 2012 13:11:00 GMT

Three hours a day. That’s how much time, out of a 12-hour shift, nurses say they spend on indirect patient care tasks such as documenting orders and coordinating care with other departments, according to a new study from Jackson Healthcare and Care Logistics. The survey collected information from more than 400 nursing professionals whose most time consuming non-clinical care tasks included:

Documenting information in multiple locations
Completing logs, checklists and collecting data
Documenting for regulatory purposes
Traveling to equipment, supply and dirty utility rooms
Entering and reviewing orders

Q&A: Coming to terms with the clinical/coding language disconnect

Thu, 02 Feb 2012 13:05:00 GMT

Q: I am fairly new to CDI and I have a nursing background. I’m trying to understand how the coding and DRG systems work. But when I look up a diagnosis in the DRG Expert in the alphabetic index to diseases it is not listed as I would expect it to be.

Take for example, bradycardia. It is not listed under that term or arrhythmia. Yet, it is listed under cardiac arrhythmia. How about anorexia, as another example? The only listing is anorexia nervosa—not unspecified.

I also find it ironic that I cannot infer what a physician is stating (it has to be documented precisely) but when I have to look up a term I have to guess its meaning. Do you have any advice for me?

A: Your frustration is very common among new CDI specialists. The publishers of the DRG Expert did not include the same type of Index to Diseases that you would find in Volume I of an ICD-9 code book—probably to save space. The Index to Diseases alone in my code book is more than 380 pages.

This is one reason that when I teach the CDI BootCamp I mention so many diagnoses during the class’ review of Medicare Severity Diagnosis-related groups (MS-DRGs) in a major diagnostic category (MDC) and either have participants highlight certain terms or write them in. Believe it or not, I too had exactly the same issues you are having.

Every CDI team should also have a coding book in their department to use as a reference (ask your facility HIM department if they have an old one you can have), especially if you do not have access to an encoder (coding and reimbursement software), which would let you look up whatever you wanted—however, even that has limitations, because search terms often use “coding language” rather than the everyday language of clinicians.

As far as your comment regarding the irony of the situation, all I can say is it is the reason CDI specialist profession exists. We are the “translators” or “interpreters” to ensure that the clinical language matches the coding language. Regardless of whether you are an experienced coder or an experienced nurse, acquiring the skills to understand both of these languages, along with the ability to translate from one to the other, is what makes us, as CDI professionals, unique.

Since I have a nursing background, I just want to share that my very first DRG Expert was covered from end to end with handwritten notes, stickies, and slips of paper. I used this book for three years, copying my info into each new edition until I was granted encoder access. Every time I asked a coder where to find something I wrote it in the book—especially those diagnoses that had really strange “code” descriptions.

There can be a long learning curve to this position, so don’t worry. While some people catch on quickly, for most it may take up to six months before that proverbial light bulb finally goes on. Don’t get discouraged. Before you know it, you will find yourself sitting in traffic, converting license plate numbers into DRGs or diagnosis codes.

Editor’s Note: This question was answered by Lynne Spryszak, RN, CCDS, CPC-A, AHIMA-Approved ICD-10 CM/PCS Trainer, CDI Education Director for HCPro Inc., in Danvers, MA, answered this question. It originally published on the ACDIS Blog. Contact her at lspryszak@hcpro.com.

News: Advisory Board voting to begin next week

Thu, 19 Jan 2012 13:54:00 GMT

Look for special e-mail instructions in the coming week directing ACDIS members to an online voting page to determine the association’s four new advisory board members. The page will include the nominees’ background in CDI and information on why they are seeking election.

After careful review and secondary interviews of the applicants, the nomination committee has chosen nine individuals from which the entire ACDIS membership community will vote. Members must be logged into the site to select their choice for the four candidates they believe are the best fit for the association, and then cast their vote.

The results of the election will be announced in early February.

Previously, existing members of the Advisory Board selected the four incoming members of the board. Starting this year, the process of voting for new Advisory Board members includes a combination of a nomination committee and a vote of the ACDIS membership.

For information, contact ACDIS Director Brian Murphy at bmurphy@cdiassociation.com.

Director’s Note: First Quarterly Conference call of 2012 scheduled; your questions wanted

Thu, 19 Jan 2012 13:52:00 GMT

Mark your calendars: The first ACDIS quarterly conference call of 2012 has been scheduled for Thursday, February 16, from 1-2 p.m. ET. ACDIS members will receive dial-in instructions via e-mail. Note that due to heavy call volume, we recommend that you dial in 10 minutes early.

These calls are offered as a means for ACDIS members to network with one another and to discuss any CDI related issues. We will have a few ACDIS Advisory Board members on the call as well. We encourage your comments, thoughts, and questions during the call.

If you have a question to ask in advance that you’d like to see appear on the agenda, or suggestions for discussion for the upcoming call, please e-mail ACDIS Director Brian Murphy at bmurphy@cdiassociation.com. These calls are a great way to ask a question, air concerns, or gather input on CDI policies or procedures in your facility. While we cannot guarantee your question or discussion point will be addressed on the call, we will try to address as many as possible.

As a reminder, recordings of all quarterly conference calls are posted as digital downloads on the ACDIS website.

Membership Update: New Local Chapter page published

Thu, 19 Jan 2012 13:50:00 GMT

ACDIS recently updated its website Local Chapter networking page. To connect with Local Chapter leaders networking in your area, click on the orange and gray map on the landing page. When your state turns purple, the text below the map will provide a list of local networking groups and the leaders' contact information. If you do not see your area listed, contact ACDIS Associate Director Melissa Varnavas at 781/639-1872, Ext. 3711, or e-mail mvarnavas@cdiassociation.com.

If you are searching for a specific event, click on the navigation button at the top of the page which states "Chapter Meetings." A calendar will appear which lists events taking place this month across the country. Chapter leaders looking to post information regarding an upcoming event should login to ACDIS, click on the "Add a Chapter Meeting" button also located in the top navigation bar and fill out the form as indicated.

You may also search for regular local chapter meeting updates on the ACDIS Blog. Visit the Blog and type the name of the state where your meeting is expected to be held. Any posts which mention that state will show up in the search results. You can also click on the "Local Chapters-Networking Groups" tab under categories.

Those interested in starting a local ACDIS chapter should review the materials collected under the "Getting Started" tab and contact ACDIS Associate Director Melissa Varnavas by e-mail at mvarnavas@cdiassociation.com.

Note, you do not need to be an ACDIS member to become a member of an ACDIS Local Chapter at this time. However, members of official ACDIS Local Chapters do receive a discount off ACDIS National membership dues. Contact your Local Chapter leader(s) to learn more.

Conference Update: 2012 CDI Professional of the Year nominations, poster session submission period open; additional discount hotel rooms acquired

Thu, 19 Jan 2012 13:46:00 GMT

Professional of the Year nominations
It’s time to submit your nominations for the 2012 CDI Professional of the Year award. Each year the ACDIS annual conference committee selects one CDI Professional of the Year Award winner and two winners of Recognition of CDI Professional Achievement to be recognized at the annual conference. The fifth annual ACDIS Conference will be held May 10-11 in San Diego.

The winner of the Professional of the Year award receives free admission to the ACDIS annual conference. All three winners are recognized before their peers at the conference’s networking and awards luncheon.

Nominees should be ACDIS members who have a passion for the CDI profession and adhere to the ACDIS Code of Ethics. Consider nominating those who may have made a difference to your hospital’s CDI program or someone who positively influenced your CDI team. We also encourage you to nominate individuals who have made an impact on the broader CDI profession, outside of their own programs.

Click here to download the 2012 award nomination form. It is in ‘word’ format; you can type into the form and return it as instructed in the form. The deadline for nominations is February 3. For additional information, e-mail ACDIS Director Brian Murphy at bmurphy@cdiassociation.com.

Poster Session submissions sought

The 2012 ACDIS Conference will again include a poster session as part of its conference offerings. It’s an informal way for hospitals to share their CDI-related successes with each other, network, and exchange ideas and information.

If you would like to present your poster at this year’s conference, please download our poster application form, complete it, and e-mail it to ACDIS Director Brian Murphy at bmurphy@cdiassociation.com. Accepted poster presenters will receive a 50% discount off the price of conference admission.

Any and all ideas are welcome. View a complete listing of last year’s poster presenters on the ACDIS blog or download the 2011 ACDIS Conference Special Section. All final decisions on posters will be made by the 2012 ACDIS Conference Committee. The deadline to submit your poster is Friday, February 24.

Additional conference hotel rooms secured

ACDIS has secured an additional 300 hotel rooms at the Manchester Grand Hyatt, 1 Market Place, San Diego, for Friday, May 11.

The discounted room rate is $199 per night, a rate honored through April 16. However, ACDIS strongly recommends early registration as the first Friday evening room block already sold out.

For registration and additional hotel information, visit http://www.hcmarketplace.com/ev-9584/5th-Annual-ACDIS-Conference-San-Diego-CA.html.

News; CMS releases online list of DRGs for ICD-10

Thu, 19 Jan 2012 13:44:00 GMT

CMS recently published a draft ICD-10 MS-DRG definitions. According to the website, the definitions are displayed in 'grouper logic order,' meaning that the MS-DRGs are listed in the order in which the grouper recognizes them. “This enables users to see instances where grouper logic order differs from strict numerical order.”

Access this listing at: https://www.cms.gov/icd10manual/definitions_manual/p0001.html

Tip: MLN Matters article stresses importance of complete record review

Thu, 19 Jan 2012 13:42:00 GMT

MLN Matters article SE1121 emphasizes that coders must consider all documentation from licensed treating physicians and attending physicians when assigning a principal diagnosis. It states:

“The emergency room report, history and physical (H&P), and early progress notes may indicate the patient has one condition, but continuing workup and evaluation may determine something entirely different. By having access to the complete medical record, more accurate codes can be assigned.”

It also states that when “there is conflicting or contradictory information” in the record (e.g., sprained ankle and fracture), the attending physician should be queried for clarification.

The AHA’s Coding Clinic for ICD-9-CM, First Quarter 2004, pp. 18-19, encourages coders to assign codes based on attending physicians' documentation when a conflict exists and the CDI specialist or coder does not query the attending physician to resolve it. However, an attending physician's failure to mention a consultant's diagnosis does not mean there is a conflict, at least according to the MLN Matters article SE1121.

"A number of [audit] reviewers are taking the position that final diagnoses cannot be coded unless they're in the discharge summary," says James S. Kennedy, MD, CCS, managing director at FTI Consulting in Atlanta. "They're taking positions that unless the attending physician cites the consulting physician's diagnosis, the diagnosis cannot be coded. That is contrary to this advice."

Editor’s Note: The following tip is adapted from an article in the December 2011 Strategies for Health Care Compliance.

Q&A: Proper sequencing of heart failure with hypertensive heart/kidney disease

Thu, 19 Jan 2012 13:27:00 GMT

Q:I have a question regarding sequencing. I would usually have sequenced 428.21 (heart failure) as principal diagnosis, but I was advised by my inpatient coder that she would sequence 404.91 (Unspecified hypertensive heart and renal disease with heart failure) as the principal diagnosis in keeping with the Official ICD-9-CM Guidelines for Coding and Reporting.

Is this a compliant practice?

I’ve turned it over in my head, reasoning that acute heart failure is a manifestation of the chronic condition of hypertensive heart and chronic kidney disease, but that the heart failure was really mostly mediated by cardiomyopathy.

A: Report hypertensive heart disease as the principal diagnosis and acute congestive heart failure (CHF) as secondary. The Tabular ICD-9-CM Manual guidance trumps all other advice and the ‘code also’ notes include the acute forms of CHF. This note states to code all forms of CHF as secondary codes in conjunction with hypertensive heart disease.

If you should deal with this issue again in the future, you may wish to refer all to the entry in the Tabular list of ICD-9 clearly instructing one to: “Code first heart failure due to hypertension.” This is found at the tabular at the 3 digit category for 428 Heart Failure. This is a clear directive that the particular form of specific CHF is to be used as a secondary code.

Note that the sequencing has implications for MS-DRG assignment if ‘hypertensive heart failure’ is properly sequenced as the principal diagnosis. Sequencing the codes correctly, as follows:

404.91: Hypertensive Heart/Kidney Disease, not otherwise specified (NOS)
428.21: Acute Systolic Heart Failure
585.4: Chronic Kidney Disease, Stage IV (severe)

Results in a DRG assignment of 291 (Heart Failure with Shock with MCC) with a relative weight of 1.5010.

Sequencing 428.21 incorrectly as principal, as in the following example:

428.21: Acute Systolic Heart Failure
404.91: Hypertensive Heart/Kidney Disease NOS
585.4: Chronic Kidney Disease, Stage IV (severe)

Results in a DRG assignment of 292 (Heart Failure and Shock with CC) with a relative weight of 1.0214.

Related also is the following statement from the ICD-9-CM Official Guidelines for Coding and Reporting:

“These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-9-CM itself. The instructions and conventions of the classification take precedence over guidelines. These guidelines are based on the coding and sequencing instructions in Volumes I, II and III of ICD-9-CM, but provide additional instruction. Adherence to these guidelines when assigning ICD-9-CM diagnosis and procedure codes is required under the Health Insurance Portability and Accountability Act (HIPAA).”

The relationship between CRF, HTN, and CHF is complex and the coding rules are easily misunderstood, in my opinion.

Editor’s Note: This question was discussed on the August 2011 ACDIS Quarterly Conference Call. Thanks to ACDIS member Paul Evans, RHIA, CCS, CCS-P, Supervisor of Clinical Documentation Integrity and the Quality Department for the California Pacific Medical Center in San Francisco for providing the answer and related research.

News: CMS debuts web page for ICD-10 CC and MCC lists

Thu, 05 Jan 2012 17:06:00 GMT

CMS recently released ICD-10 CC and MCC lists on its web site. It lists the diagnosis by ICD-10 code, then indicates whether it qualifies as a CC/MCC, then it notes exclusions, and offers a description. If the CC or MCC is allowed with all principal diagnoses, then the phrase NoExcl follows the CC/MCC indicator. Otherwise, a link is given to a collection of diagnosis codes which, when used as the principal diagnosis, will cause the CC or MCC to be considered as only a non-CC.

Because the pages list all CC/MCC alphabetically by ICD-10 code, the list could be cumbersome if you don’t already know what ICD-10 code you’re looking for. To get around this difficulty somewhat, type “control F” for the “find on this page” function and type in the word/diagnosis you are looking for. This only helps when the diagnosis appears on a particular page, however. For example, if you type “infections” under the “A” page you’ll be able to find all the infection-related ICD-10 codes on this page but you’ll have continue to click through the rest of the alphabet if you don’t know where the code falls.

Editor’s Note: This information was provided courtesy of ACDIS Advisory Board member Lynne Spryszak, RN, CCDS, CPC-A, CDI education director for HCPro, Inc., in Danvers, MA.

News: MAC notice underscores importance of good documentation through the medical record

Thu, 05 Jan 2012 17:01:00 GMT

CDI specialists ideally should review medical records in their entirety and clarify non-specific documentation for reasons other than just principal diagnosis or CC/MCC capture. This recently-released article by Medicare Administrative Contractor Trailblazer provides a great overview of different types of clarification that should be obtained on all inpatient admissions.

According to the notice, the medical record should include:

Documentation of the patient’s condition
The patient’s need for services and prior failed interventions
A plan of care to address the patient’s specific healthcare needs
The results of laboratory tests, signed radiology reports and diagnostic tests ordered by the physician
The risk factors complicating the patient’s healthcare condition
The patient’s response to:
- Surgical procedures and medical interventions
- Therapies
Progress made in the patient’s condition and plan of care
Description of setbacks in patient progress
Any barriers to treatments, for example, complications that need to be addressed before other treatments may be initiated
History and physical information and risk factors which influence physician treatment decisions that present risk and/or that reduces the improvement of the patient’s condition

The article also includes an informative “chart of tips” for the CDI specialist to review.

Editor’s Note: This information was provided courtesy of ACDIS Advisory Board member Glenn Krauss, RHIA, CCS, CCS-P, CPUR, FCS, PCS, CCDS, C-CDI, independent revenue cycle consultant from Madison, WI. Contact him at glennkrauss@earthlink.net.

News: Important change impacts all CDI programs that review mortality charts

Thu, 05 Jan 2012 16:57:00 GMT

CDI specialists that incorporate quality measures review in their duties take note: The Joint Commission on Dec. 16 updated its Specifications Manual for National Hospital Inpatient Quality Measures. Effective for discharges July 1, 2012, patients documented as receiving “Palliative Care” and “Palliative Measures” will not be excluded from quality improvement measures.

Release Notes version 4.1 of the Specifications Manual states:

“Since palliative care is increasingly being offered as a care program provided with curative treatment, patients should not be excluded from quality improvement measures because they enter a palliative care program.”

Patients who receive palliative care are currently excluded from certain quality measures. CDI specialists should query for documentation of the term “comfort care,” when appropriate, to ensure that these types of patients are properly excluded.

Note that comfort care “includes attention to the psychological and spiritual needs of the patient and support for the dying patient and the patient's family. Comfort Measures Only are not equivalent to the following: Do Not Resuscitate (DNR), living will, no code, no heroic measure,” according to the Specifications Manual.

Visit the Joint Commission web site to download the latest Specifications Manual.

Editor’s Note: This information was provided courtesy of Cheryl Ericson, MS, RN, manager of Clinical Documentation Integrity and core measures abstraction for the Medical University of South Carolina and a member of the ACDIS Advisory Board.

Conference opportunity: Poster submissions open for 2012 ACDIS conference

Thu, 05 Jan 2012 16:38:00 GMT

The 5th annual ACDIS conference, to be held May 10-11, 2012 at the Manchester Grand Hyatt in San Diego, CA, will again include a poster session as part of its conference offerings. It’s an informal way for hospitals to share their CDI-related successes with each other, network, and exchange ideas and information.

If you would like to present your poster at this year's conference, please download our poster application form, complete it, and e-mail it to ACDIS Director Brian Murphy at bmurphy@cdiassociation.com. Accepted poster presenters receive a 50% discount off the price of conference admission.

Any and all ideas are welcome. Some poster topics to consider include the following:

An overview of your CDI program—staffing, processes, etc.
A successful new CDI-related initiative you launched
Methods of inter-departmental collaboration
Successful physician training/educational methods
CDI program data mining and reporting techniques
Query forms, physician newsletters, etc. that you’ve developed and would like to share

For more ideas, you can view a complete listing of last year's poster presenters on the ACDIS blog. All final decisions on posters will be made by the 2012 ACDIS Conference Committee.

Thanks, and we look forward to receiving your application!

Networking opportunities: Start CDI education by joining your local chapter

Thu, 05 Jan 2012 16:32:00 GMT

There's no better way to celebrate the New Year than with these educational opportunities. Make good on your CDI educational resolutions. Get involved.

New England

The next New England ACDIS regional meeting will be held on Monday, January 9, 8:30 a.m. to 5 p.m., at Good Samaritan Hospital in Brockton, MA. The day-long event features AHIMA certified ICD-10 Trainer Kelley Godin, CCS, who will present a discussion regarding ICD-10 for CDI.

Admission is $30. AHIMA and ACDIS CEU’s will be available. A light breakfast and lunch will be served. Space is limited. Send check or money order to: Kelley Sears, 480 School St, North Dighton, MA, 02764. Please include your email address as you will receive a confirmation email that you should bring with you to the program. Jeans will be allowed with a $5 donation for charity.

For information, contact sears.kelley@yahoo.com or kelley.sears@caritaschristi.org.

Central Indiana

An organizational meeting for the Central Indiana ACDIS Chapter will be held Wednesday, January 11, 10 a.m. to noon, via teleconference. Information regarding recent chapter elections, 2012 meeting agendas, survey results, and regional networking opportunities will be shared. For information, contact Susan Bradford at 317/776-7285 or by email at sbradford@riverview.org.

Southern Nevada

The next meeting of the Southern Nevada ACDIS Network will be held at Kindred Hospital Flamingo Campus, Las Vegas, Wednesday, January 18, at 6 p.m. 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 January 11, at 702/343-7232 or email ailsa.kompare@kindredhealthcare.com.

Northern Illinois

The next Northern IllinoisCDI meeting is tentatively scheduled for Thursday, January 12, 2012. For information, contact Nancy R. Ignatowicz, at 815/806-2322 or by email nancy.ignatowicz@provena.org. Or contact Colleen Stukenberg at 815/599-6820 or CStukenberg@fhn.org.

Connecticut

The Connecticut ACDIS Chapter meets Thursday, January 12, 12:30-2 p.m., at The Hospital of Central Connecticut, Bradley Memorial Campus, in Southington. For information, contact Alison Yazmer at 860/358-6224 or MaryAnn Shanley at 201/213-5287.

San Diego, CA

CDI specialists in the San Diego area are invited to start the New Year with a happy hour at Dave and Buster’s, on Friday, January 20, 5-8 p.m. RSVP to Eva Valles at envalles@rchsd.org by Monday, January 16.

In addition, California ACDIS Chapter members interested in volunteering to help with the 5^th annual ACDIS Conference networking luncheon on Friday, May 11, should contact Conference Committee member Eva Valles at envalles@rchsd.org or ACDIS Associate Director Melissa Varnavas at mvarnavas@cdiassociation.com. A planning meeting will be held on Friday, January 20, at 11 a.m. via teleconference.

Maine

The Maine ACDIS Local Chapter will meet at Midcoast Hospital on Tuesday, January 17, 2012. For information, contact Theresa Davis at 207/735-8340 or tdavis@emh.org.

Michigan

Michigan ACDIS chapter, M-ACDIS, is planning to meet via a telephone conference call on Thursday, January 19, noon to 1 p.m. For information, contact Janet Gentle, 231/487-7509 or email jgentle@northernhealth.org.

California

The next California ACDIS webinar featuring a presentation regarding the role of CDI in RAC reviews and audit prevention will be held on Wednesday, January 25, 9-10 a.m., PST. For information, contact Dexter D’Costa, MBBS, MHA, at Dexter.G.Dcosta@kp.org.

Wisconsin

The WI ACDIS chapter hosting its next teleconference Thursday, January 26, 1-2 p.m. Family practice physician Dr. Shailesh Virani will present case studies illustrating physician clinical thought processes and medical decision-making. For information, contact Glenn Krauss at glennkrauss@earthlink.net.

Virginia

The next Virginia ACDIS Chapter meeting will be held Saturday, February 11, 10 a.m. to 2 p.m., at 1222 Jefferson Park Ave., Charlottesville, VA. Each facility attending will present/discuss what works well in their facility and what needs improvements as we embark on 2012. RSVP by January 31. For information, contact Sequana Webb 434-760-4491, sck8u@virginia.edu.

Q&A: When is it appropriate to query for aspiration pneumonia?

Thu, 05 Jan 2012 14:45:00 GMT

Q:A physician admitted a patient with pneumonia, which was the first diagnosis. The second diagnosis was malnutrition secondary to feeding difficulties of the elderly. Two days later, the physician inserted a percutaneous gastrostomy tube. A day or two later, the physician documented only that the patient had aspirated.

Our clinical documentation analyst then queried the physician for aspiration pneumonia. I'm an inpatient coder, and we had a different viewpoint on this, and I wanted to get someone else’s insight on this topic.

A: This may be on the cusp of leading according to very conservative experts. I might suggest asking the physician, “Please clarify whether there is there a link between the patient’s pneumonia and the aspiration you described?”

A physician query would be credible only if the antibiotics the physician documented prescribing were appropriate for aspiration pneumonia. If the antibiotics the physician administered were ceftriaxone and azithromycin, then the physician is not treating aspiration pneumonia and it would be a leading query and inappropriate to pose this question.

Editor’s Note: Robert S. Gold, MD, CEO of DCBA, Inc. in Atlanta and a member of the ACDIS advisory board answered this question for JustCoding.com. Contact him at dcbainc@cs.com.