Reconciliation policy

mvarnavas@hcpro.commvarnavas@hcpro.com
in CDI Management
I'm working on an article about reconciliation policies and procedures (what does the team do when CDI/coding mismatch occurs). Does anyone have such a policy they'd be willing to share for the Forms & Tools Library or be interested in discussing their processes?

Comments

  • katysuegood@gmail.comkatysuegood@gmail.com

    Melissa,

    We don't have a 'policy' but I have a guideline and am happy to discuss our process with you and what we are seeing.


    Katy

  • jenniferan@mcmc.netjenniferan@mcmc.net
    I don't have a policy either but if I have a mismatch, I will review the record again including the coding guidelines incase I have missed something. If I am still coming to the same conclusion, I will send an email to the coders with my findings and what I think the Pdx should be. It then gives them an opportunity to re-evaluate. Sometimes they agree with me, other times they will come back with a coding clinic statement that I have not picked up on. If we are still in disagreement for the Pdx, it then goes out to a consulting firm for a definitive answer.
  • jackietouch@aol.comjackietouch@aol.com
    jenniferan@mcmc.net said:
    but if I have a mismatch, I will review the record again including the coding guidelines in case I have missed something. If I am still coming to the same conclusion, I will send an email to the coders with my findings and what I think the Pdx should be. It then gives them an opportunity to re-evaluate. Sometimes they agree with me, other times they will come back with a coding clinic statement that I have not picked up on. If we are still in disagreement for the Pdx, it then goes out to a consulting firm for a definitive answer.
    We follow a similar process at our institution, no written policy in place at this time. Our coders can access our CDI worksheets, so some will discuss with us during the coding process and we may determine together, through collaboration, the most appropriate PDx/DRG with combined review.

    Jackie Touch
  • vparent@emhs.orgvparent@emhs.org

    Within one of our CDI policies we have this:

    • If the MS-DRG selected by the coder differs from the MS-DRG option(s) offered by the CDI, the consultants and the CDI will discuss the difference on an as needed basis, at the request of the CDI staff. These charts will be used as educational topics in the interdepartmental meetings (see page 6) when unique situations or trends are identified.  Coders will comment the reason for the code selected.

    • CDI will run the CDIS-MS Working and Final DRGs by Concurrent Reviewer & Reason Code weekly to look at reason codes assigned.  CDI staff will review with the Lead CDI nurse and if further review/clarification is needed the CDI staff will communicate directly with the IP Coder involved.

    We reconcile all of our CDI charts with coder final billing.

    Valerie Parent

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