Assigning a Working DRG

rhondawest619@hotmail.comrhondawest619@hotmail.com
in CDI Talk Archive
Happy Friday!!

I would first like to say I love the different discussions that occur in this forum. This is my first time posting a question.

At my facility CDI is under Administration and Case Management is suggesting CDS give them the working DRG for every patient. We do not use the same systems and this will change my department workflow.

Can someone please tell me your interactions with case management and assigning a working drg.


Thanks in advance!!


Regards,

Rhonda West-Haynes, MHA, BSN, RHIA, CCDS
Clinical Documentation Specialist-Manager
rhaynes@cchosp.com

Comments

  • lsipos@monument.healthlsipos@monument.health
    edited May 2016
    Rhonda

    Currently, we have little-to-no contact with Case Management. We are in-the-works to present them with a PowerPoint on what our role is-as we have so many new Case Managers, many of them do not know our role. We want the case managers to be able to see one of our queries in the chart and reinforce the question or be aware of what a PDX and DRG are! Other than that, we have no daily interaction with them.


    Juli Bovard RN CCDS
    Clinical Effectiveness/Clinical Quality
    Rapid City Regional Hospital
    719-4390 (work)
    786-2677 (cell)
    "No Limit to Better......"


    "The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens


  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Until last week, we were under CM (now under quality). We did not provide a working DRG, though we did offer. With our tracking software it would be easy for us to print off a patient list that included the working DRG for CM though. Our facility has morning "discharge rounds" that include the MD, CM, and charge RN for each unit and our CDI's attend these meetings most morning so questions can be answered then. However, our CM's have never seemed very interested.

    One thing I think it is important to clarify if they do want this information is that DRG's change quickly.if you are re-reviewing records every-other day, the list will not always be accurate. Just a thought.

    Good luck!

    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


  • lsipos@monument.healthlsipos@monument.health
    edited May 2016
    Katy

    Well said, after all, as we know...it's the "after study" issue with placing a working DRG...and many times the patient working DRG can change every day!


    Juli Bovard RN CCDS
    Certified Clinical Documentation Specialist
    Clinical Effectiveness/Clinical Quality
    Rapid City Regional Hospital
    719-4390 (work)
    786-2677 (cell)
    "No Limit to Better......"


    "The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens


  • rhondawest619@hotmail.comrhondawest619@hotmail.com
    Currently I enter working and target drg into Clintrac and yes they change daily. Case Management was redesigned a few months ago and they are required to assign a working drg to determine the LOS. Now they have a new Director who doesn't want them to do this & would rather CDS do this task and tell CM.

    CDIP is a home grown program that I started a year ago. We had FTI do education in the Fall and I am in the process of hiring another CDS to assist me.


    Rhonda West-Haynes, MHA, BSN, RHIA, CCDS
    Clinical Documentation Specialist-Manager
    rhaynes@cchosp.com
  • sharon.colesharon.cole
    edited May 2016
    Our CDI program is actually IN Case Management. HIM didn't and still doesn't want us, said we weren't necessary, and that only coders should query - but I digress. We do assign working DRGs - it helps the Case Managers with DC planning and issuing the IM letter (Important Message from Medicare letter) that has to be given to patients prior to DC.

    Sharon Cole, RN, CCDS
    CDI Specialist
    Providence Health Center
    254.751.4256
    Sharon.cole@phn-waco.org

  • don.cdi.rn@gmail.comdon.cdi.rn@gmail.com
    edited May 2016
    We don't review all patients (staffing restriction).
    For those that we do review, we use the Morrisey software for an interactive worklist.
    In there, we do record (and update) a working DRG.
    CM is able to access the same software, and are able to see our working DRG.
    CM initiated a daily 'rapid round' process & was interested in the anticipated LOS (per CMS DRG) to help in identifying some ball park expectations for discharge planning -- of course modified with understanding of unique issues.

    Don

  • sharon.colesharon.cole
    edited May 2016
    I forgot to mention that CDI and CM document in the same program so they can see the DRG. This helps in case the DRG changes.

    Sharon Cole, RN, CCDS
    CDI Specialist
    Providence Health Center
    254.751.4256
    Sharon.cole@phn-waco.org


  • kmckaigkmckaig
    edited May 2016
    We are on the Case Management Dept and are all case managers. Until about 3 years ago the case management and CDI functions were integrated. We meet with the CM's every day and provide LOS information and diagnosis information if it is either pneumonia, COPD, AMI, CHF. We also provide and receive input into the dc planning options, treatment continuity , readmissions etc. For our group, giving them the DRG wouldn't be helpful as the current group of case managers have never worked CDI and the DRG number wouldn't mean anything to them. We don't use CM software.
    Having said all of this, I will mirror the comment that some of the case managers do not seem interested in the information we provide nor do they do anything with it. However, the "huddle" does keep us all in the loop and provides information to be used in the patient's continuum of care.

    Karen




    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


  • Unknown
    edited May 2016
    We reside in the Coding department and they love us! It makes their job
    easier. Often the queries are already sent and returned by the time the
    record is coded by them and the bill can go out the door! It's a win
    win!
    Thanks Jamie Dugan RN

  • Unknown
    edited May 2016
    We, currently, do not collaborate with CM. But, I want too!

    We do parallel duties and if we are not on the same page and understand each other's roles, I fear we may undo each others work. MDs get hit from both sides with CM and CDI needs, that in itself is an issue. For example, we see an inpatient with syncope dx (weak inpt admission-I call it a "never event"), we realize a different dx that warrants inpatient admission could fit (say severe dehydration with multiple co-morbid conditions with realization that patient will not turn around in 24 hours). So CDI beefs up documentation to support and then UM turns around and makes them Outpatient Obs because they are worried about medical necessity for inpatient. We have been hit by RACs hard for medical necessity so UM is running scared. It is one of my 2013 goals to bridge the knowledge gap at my institution and start working with UM(CM) this year.

    I am not sure you should take on that role of giving them the working DRG, though. I agree, it would hinder workflow. But, maybe you could do some education into each others roles, see where they overlap, and ultimately contribute to better flow in both work processes. This is what I plan.
    Just my 2 cents:)
    TGIF!!

    Jane
  • vanessa.falkoffvanessa.falkoff
    Hi,

    We started meeting with CM and their physician advisor several months
    ago. At first I was resistant, but actually found that it doesn't take
    that long to assign a working DRG to share with them (they meet 2 x week
    and discuss 3+ day stays only) and hearing their reports helps me to
    keep up to date on patients and sometimes alerts me to a possible query
    opportunity. Once they understand, the CMs can be very helpful in
    reinforcing to the physicians the need to reflect accurate severity!

    Best of Luck!

    Vanessa Falkoff RN
    Clinical Documentation Coordinator
    University Medical Center
    Las Vegas, NV
    vanessa.falkoff@umcsn.com
    office 702-383-7322
    cell 702-204-0054
  • rhondawest619@hotmail.comrhondawest619@hotmail.com
    Thanks everyone. I appreciate your feedback and will let you know the final outcome.




    Rhonda West-Haynes, MHA, BSN, RHIA, CCDS
    Clinical Documentation Specialist Manager
    rhaynes@cchosp.com
  • rhondawest619@hotmail.comrhondawest619@hotmail.com
    Case Management are trying to decrease LOS and they had training in working drg's. Another issue is that we do not have access to the same systems. They want me to enter info into more than on e place.
  • tpeytontpeyton
    edited May 2016
    I am the only CDS and work under case mgt. I use working DRG's and put DRG stickers on the chart to help with the LOS. As my DRG changes, I change the sticker. The docs and casemanagers are all aware that these are only working DRG's and the coder has the final say. Seems to work well for us.



    Tracy M Peyton RN, CCDS
    Bradford Regional Medical Center
    Upper Allegany Health Systems
    116 Interstate Parkway
    Bradford, PA 16701
    814-558-0406
  • fantinsfantins
    edited May 2016
    Hi again

    I put this together for Allison. Thought it may be helpful to you.

    Susan
  • tpeytontpeyton
    edited May 2016
    Thank you

    Tracy M Peyton RN, CCDS
    Bradford Regional Medical Center
    Upper Allegany Health Systems
    116 Interstate Parkway
    Bradford, PA 16701
    814-558-0406





Sign In or Register to comment.