Health Information Management

News: AHIMA releases CDI program guidance

CDI Strategies, May 13, 2010

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Shortly after releasing its Clinical Documentation Improvement Toolkit in April, the American Health Information Management Association (AHIMA) released its Guidance for Clinical Documentation Improvement Programs in the May issue of the Journal of AHIMA.

Like the toolkit, the guidance provides an outline for how to structure a CDI program, samples of job descriptions, examples of leading and non-leading queries, and options for performing and tracking verbal and written queries.
Team effort
The toolkit and guidance grew from the year-long efforts of a larger committee of roughly 30 CDI-related professionals including physicians, HIM managers, and CDI specialists. The guidance itself came from the efforts of a six-member committee which included three members of the ACDIS Advisory Board (denoted by an asterisk*):
  • Gloryanne Bryant, RHIA, CCS, CCDS*
  • Cheryl Ericson, MS, RN
  • Gail Garrett, RHIA
  • William Haik, MD, FCCP*
  • Robin Holmes, MSN, RN, CCDS*
  • Eve-Ellen Mandler, MS, RHIA, CCS
When AHIMA first submitted a request for volunteers to work on its CDI Work Group Kathy DeVault, RHIA, CCS, CCS-P, manager of professional practice resources at AHIMA received more than a 150 applicants. Decisions as to who ultimately the association chose to participate were based on volunteers’ resumes, ACDIS’ recommendations, and input from the AHIMA staff.
“We wanted to be sure we had a diverse group and some fresh voices,” DeVault says.
Compendium of advice
AHIMA initially hoped to compile the volunteers’ research into a larger volume or book, but ultimately “settled on a number of different venues to disseminate the results of their year’s worth of collaboration,” DeVault says. “The energy of this group was just like a ball rolling downhill, they just kept gathering momentum. They were so enthusiastic.”
First, the volunteers felt strongly that the advice be provided openly and freely on the AHIMA Web site. Second, they wanted to deliver the information quickly—book projects can take up to a year or more to see to fruition. These two points led to the release of the toolkit and the guidance, DeVault says.
Third, the diversity of the group’s focus areas seemed to fit a variety of project-lines. For example, a CDI practice ethics proposal is on its way through AHIMA’s ranks and another proposal for an additional CDI credential has been submitted to AHIMA management.
Query consensus
Much of the guidance and toolkit contents echo commonly held CDI best practices regarding program structure, staffing and query policies, and compliments AHIMA’s previous query guidance Managing an Effective Query Process released in October 2008.
Specifically, the guidance released last week in the Journal acknowledges that programs are frequently housed under either the HIM or case management umbrella and generally report up through the finance department. It also acknowledges that CDI specialists are commonly nurses but reiterates the fact that anyone with appropriate clinical, coding, and regulatory knowledge may excel in the role.
Furthermore the guidance takes up the issues of leading and non-leading queries, offers a checklist for conducting compliant written and verbal queries, and acknowledges the importance of the verbal query process.
“I still struggle with the verbal queries process myself,” DeVault says. “CDI programs need to know how to measure and manage the verbal process, and that’s somewhat ambiguous.”
Nevertheless the guidance suggests that “organizations should outline the following procedures for verbal queries:
  • When verbal queries are appropriate
  • An initial and ongoing training process that includes mentoring and testing trainees and a process for ongoing compliance monitoring
  • A process for documenting the verbal queries
  • A QA process of verbal queries, including:
    • Who will monitor the verbal queries
    • How many queries will be reviewed for compliance and how often
    • The feedback and corrective action needed
    • Reporting documents for CDI QA processes”
“The advantage of a verbal query is the [CDI specialist’s] ability to interact with the provider to facilitate understanding of the issues that need to be addressed,” the guidance says. “However, caution must be used to ensure that the provider is allowed to make his or her own conclusions regarding the appropriateness of a particular diagnosis or service.”
DeVault’s particularly proud of the committee’s work on leading and non-leading queries and the examples the guidance provides to help illustrate each.
“It is easy to cross that line into potentially leading the physician to a particular diagnosis when you are in the hallway having a conversation. So, I’m really happy for the leading and non-leading query examples. We worked really hard on those to make sure we offered clinically valid presentations of both,” she says.
Volunteers “felt strongly about creating facility-wide policies for CDI practices including policies regarding how and when to query physicians,” DeVault says. “They felt that everyone should follow the same rules regardless of whether they are a coder or a physician or a nurse performing the CDI role. Everyone said—a query is a query is a query.”
Guidance implications
As one of the four cooperating parties with the American Hospital Association, National Center for Health Statistics, and the Centers for Medicare and Medicaid Services (CMS) that work together to clarify ICD-9-CM medical coding guidelines, some may feel that AHIMA’s recent guidance possesses additional regulatory weight.
It’s one reason “people take our releases pretty seriously,” DeVault says, “but this isn’t meant to be a standard like a release from Coding Clinic would. The importance of these releases is more about perception. A practice guidance is when there’s consensus in the industry. That’s why it was so important for us to pull together a diverse group to sit on this committee.”
And it’s why the guidance underwent a particularly thorough vetting process, she says, earning approval from the volunteer board that created it, the AHIMA leadership, and the AHIMA practice councils which include HIM volunteers.
“I was just amazed by how much work everyone put into this project,” she says.
Editor’s note: AHIMA CDI work group members and ACDIS Advisory Board Members Gloryanne Bryant, RHIA, CCS, CCDS, and William Haik, MD, will join ACDIS Director Brian Murphy for an audio conference regarding the various releases in July.
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