We do state what we think the DRG is. However, our coders are under no obligation to let us know if they do not agree or why. So there is minimal actual "reconciliation".
Katy Good, RN, BSN, CCDS, CCS Clinical Documentation Program Coordinator AHIMA Approved ICD-10CM/PCS Trainer Flagstaff Medical Center Kathryn.Good@nahealth.com Cell: 928.814.9404
When I am closing out our query log and I notice that something was not coded or coded incorrectly (yest had one we had queried for hyponatremia: na 120-132, treated w/IVF, and coder had coded hypernatremia), I contact the coding supervisor and report the account number and issue. Sometimes it gets followed up but many times it is just ignored. I requested a meeting with the HIM director and showed her all the missed and/or incorrect diagnoses that I had reported to the coding supervisor - I had printed out all the emails and attached them to the queries that had missing or incomplete coding. I was asked by the HIM director why I was even looking at the encoder and then had to explain the CDI query process and why/how we closed out the query log. She told me she was going to meet with the coding supervisor, but I can't tell that anything has been changed since I still get ignored when I report things.
Sharon Cole, RN, CCDS Providence Health Center Case Management Dept 254.751.4256 srcole@phn-waco.org
That is a tough one to answer ... our software requires a final coded DRG, which is automatically entered for us, we just need to close the case out. I, as the supervisor, do not use the agreed rate as a definitive measurement as there are to many variables with this number. Thank You, Susan Tiffany RN, CCDS Supervisor Clinical Documentation Program Guthrie Healthcare System
" You only live once, but if you do it right, once is enough!" Mae West
We do reconcile CDI DRGs with Coder DRGs. Our software compels coder to state reason why DRG does not match (subsequent procedure, documentation, CDI error, etc.) and if they cannot interpret why we differ they must notify CDI Manager and Coding Educator.
Jane Hoyt, BSN, RN, CCDS Manager, Clinical Documentation Integrity Health Information Management PAV A, 5th Floor, #505 Mail Code 1801 Denver Health and Hospital Authority 303.602.3830 Jane.hoyt@dhha.org Think with Ink☺
We still reconcile coder and cdi drg's. Our coder writes a note on the worksheet back to us as to why we don't match. Our ceder and cds have a fantastic working relationship and frequently discusss cases.
Tracy M Peyton RN, CCDS Bradford Regional Medical Center Upper Allegany Health Systems 116 Interstate Parkway Bradford, PA 16701 814-558-0406
Our software generates a list from the "final coded" DRGs which the CDS then reconciles to remove from the list.
If we have a question as to why the DRG changed or do not agree w/what is coded then it is reviewed by the Lead Coder. If she believes it should be changed she will contact the coder. If there is still a discrepancy it will be forwarded up to the Coding Supervisor for review. The Coding Supervisor has the last word. If at anytime the coder disagrees w/changing a code or adding a code, etc. Then the Lead Coder or Coding Supervisor will drop the chart so the coder's initials are not on that chart.
We are not held to any matching % - it is purely educational and we look at it as another set of eyes seeing the final coded chart.
Our program is similar to this as well. We do not have any target goals for Matching DRGs. It is a learning opportunity for both CDI and Coders. There are definitely times when the CDI DRG is the one that is dropped for billing. But again, not until all parties agree. We are lucky to have great working relationship with Coding.
We have the same process as below. The coder has final say but they will question CDS for clinical clarification of the CDS dxs if they are not seeing it or if they feel a different diagnosis is principle. We also have a "task force" 1 to 2 times a month where we meet as a group to discuss new coding clinics, education, education for the physicians, denials etc.
Karen McKaig, BSN, RN, CCM, CPUR, CCDS Case Manager Clinical Documentation Specialist Baxter Regional Medical Center Mountain Home, AR 72653 870-508-1499 kmckaig@baxterregional.org
I had a blog post awhile ago on this question -- we don't use as a direct metric whether the DRG's match. However, in an ideal situation, these cases represent some important learning opportunities for both the CDS & Professional Coder.
Coding professionals (with a single person in that shop -- manager) ought to have a final say, it is their core professional, coding is a complex and challenging learned skill & knowledge set. However, there is room for collaboration between coders & CDS's that will produce a real value for all involved.
I think we've done some good work improving our process and communication, and this is reflected specifically in the P&P that were recently posted to the Forms & Tools library.
Comments
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
Dorie Douthit, RHIT,CCS
Sharon Cole, RN, CCDS
Providence Health Center
Case Management Dept
254.751.4256
srcole@phn-waco.org
That is a tough one to answer ... our software requires a final coded DRG,
which is automatically entered for us, we just need to close the case out.
I, as the supervisor, do not use the agreed rate as a definitive
measurement as there are to many variables with this number.
Thank You,
Susan Tiffany RN, CCDS
Supervisor Clinical Documentation Program
Guthrie Healthcare System
" You only live once, but if you do it right, once is enough!" Mae West
Jane Hoyt, BSN, RN, CCDS
Manager, Clinical Documentation Integrity
Health Information Management
PAV A, 5th Floor, #505
Mail Code 1801
Denver Health and Hospital Authority
303.602.3830
Jane.hoyt@dhha.org
Think with Ink☺
Tracy M Peyton RN, CCDS
Bradford Regional Medical Center
Upper Allegany Health Systems
116 Interstate Parkway
Bradford, PA 16701
814-558-0406
Our software generates a list from the "final coded" DRGs which the CDS then
reconciles to remove from the list.
If we have a question as to why the DRG changed or do not agree w/what is
coded then it is reviewed by the Lead Coder. If she believes it should be
changed she will contact the coder. If there is still a discrepancy it will
be forwarded up to the Coding Supervisor for review. The Coding Supervisor
has the last word. If at anytime the coder disagrees w/changing a code or
adding a code, etc. Then the Lead Coder or Coding Supervisor will drop the
chart so the coder's initials are not on that chart.
We are not held to any matching % - it is purely educational and we look at
it as another set of eyes seeing the final coded chart.
NBrunson, RHIA, CDIP, CCDS
-Jane Hoyt
Karen McKaig, BSN, RN, CCM, CPUR, CCDS
Case Manager
Clinical Documentation Specialist
Baxter Regional Medical Center
Mountain Home, AR 72653
870-508-1499
kmckaig@baxterregional.org
Without repeating, I'd ask that folks do take a look at this blog post:
http://blogs.hcpro.com/acdis/2010/08/acdis-poll-illustrates-need-for-drg-reconciliation-process/
A lot of my discussion there is as relevant today as it was almost 2 years ago, which is sad.
Coding professionals (with a single person in that shop -- manager) ought to have a final say, it is their core professional, coding is a complex and challenging learned skill & knowledge set. However, there is room for collaboration between coders & CDS's that will produce a real value for all involved.
I think we've done some good work improving our process and communication, and this is reflected specifically in the P&P that were recently posted to the Forms & Tools library.
Don