Severity Of Illness

arsusott@msn.comarsusott@msn.com
in CDI Talk Archive
I was just wondering how many facilities out there have the coders hold the bill until a severity of illness query is answered. There are 2 of us reviewing charts for CDI and many times we place multiple queries that don't "move" the DRG but of course show severity of illness. We obviously hope to have the queries answered by d/c but in some instances they are not. Our coders take the queries off if they are not answered by d/c and don't send them to the doctors chart box for completion. I have 2 thoughts on the subject... 1. I understand that we don't want to hold up revenue... but 2. Isn't the purpose of a CDI program to improve documentation to reflect the patient's true severity of illness.
Any thoughts on this subject?

Thanks in advance,

Angela Susott

Comments

  • robert.hodges2robert.hodges2
    edited May 2016
    I share all my queries that may impact coding with the inpatient coder so she knows what to look for and what I was looking for. That doesn't mean that she holds the chart for coding, but on occasion she will initiate or follow up on my query with the provider to get the information we are looking for. I would say that holding it is an exception rather than a rule, but it does happen on occasion.

    We have had occasions where the chart was coded and then the provider responded and added an addendum to the chart to address the query and we have lost some opportunities there, but coding has a deadline to get a chart done and that is their driving force.

    The big thing here is she knows what I'm doing and we talk on a daily basis to keep that communication open.

    Robert

    Robert S. Hodges, BSN, MSN, RN
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
    Mail Code 136
    1500 Weiss Street
    Saginaw MI 48602
     
    P: 989-497-2500 x13101
    F: 989-321-4912
    E: Robert.Hodges2@va.gov
     
    "Anyone who has never made a mistake has never tried anything new." -Albert Einstein 


  • Unknown
    edited May 2016
    I have 48 hours post discharge to get my queries answered. If they are not answered in that time I review with coder and the coder has the ultimate decision to follow through. I am happy to say that 99.9% of the time they do complete it.

    Charlene


  • leanne.sterlingleanne.sterling
    edited May 2016
    We do hold our bills until the queries are answered. I would think that
    might be a compliance problem because you would be treating the money
    making queries differently.

    Leanne Sterling, RHIT
    Clinical Documentation Specialist
    CRMC
    Ext: 2508

  • stacy.vaughnstacy.vaughn
    edited May 2016

    At first, our coders were pulling the queries that did not impact the DRG.
    We then debated the point of having a "documentation Improvement"
    program. The coders are now keeping the queries, on a temporary basis to
    see how this affects bill holds with the revenue cycle. We will see!

    Stacy Vaughn, RHIT, CCS
    Data Support Specialist/DRG Assurance
    Aurora Baycare Medical Center
    2845 Greenbrier Rd
    Green Bay, WI 54311
    Phone: (920) 288-8655
    Fax: (920) 288-3052




  • sbeattysbeatty
    edited May 2016
    We developed criteria for when we would pursue a query post-DC.

    Sandy Beatty, RN, BSN, C-CDI
    Columbus Regional Hospital
    2400 E. 17th Str.
    Columbus, IN 47201
    (O) 812-376-5652 (M) 812-552-6997


    "Great leaders are almost always great simplifiers, who can cut through
    argument, debate, and doubt to offer a solution everybody can
    understand."

    General Colin Powell



  • dbutlerdbutler
    edited May 2016
    It is a hard balance -- would at least advocate for a case by case judgement. When there is a real impact on SOI/ROM, should be held. If it is for improved data specficity, harder to argue since wont help profiling.

    Don


  • dbutlerdbutler
    edited May 2016
    Nice approach. Certainly would help compliance issues another raised (and agree with that concern)
    Will need to keep that in mind and look at P&P development with that in mind.

    Don


  • sbeattysbeatty
    edited May 2016
    Our criteria are:
    Moves SOI to a 3 or 4
    >$1000 diff in $$
    POA, core measure, NSQUIP, HCAHPS driven clarification
    Conflicting documentation-usually leaving things out of the DC Summary

    Sandy Beatty, RN, BSN, C-CDI
    Columbus Regional Hospital
    2400 E. 17th Str.
    Columbus, IN 47201
    (O) 812-376-5652 (M) 812-552-6997


    "Great leaders are almost always great simplifiers, who can cut through
    argument, debate, and doubt to offer a solution everybody can
    understand."

    General Colin Powell



  • arobinsoarobinso
    edited May 2016
    We hold ours as well, much rather hold and have completed documentation, than billing and having to go back and add addendum with rebill.

    Mandi Robinson, BS, RN, CPC
    Clinical Documentation Specialist
    Trover Health System
    270-326-4982
    arobinso@trover.org
    "Excellent Care, Every Time"



  • NormaBNormaB
    edited May 2016
    We do not hold queries for SOI. Only for MCC/CC's. However, currently we
    do not have a way to measure SOI.

    For those of you who do hold for SOI - do you have software or method of
    measuring SOI?

    N. Brunson, RHIA, CCDS
    Bay Medical Center


  • arobinsoarobinso
    edited May 2016
    3m



    Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.
Sign In or Register to comment.