Benchmark for CDI/Coder DRG Match

agreen915@yahoo.com

I am looking for benchmarks for CDI/Coder DRG match.Does anyone have any information on this benchmark. Thank you

Angie Green RN
Manager Clinical Documentation Improvement
IU Health, Indianapolis, IN

m.leblanc

I am not seeing any response and so am going to put this out there again to see if anyone has a benchmark for CDI/Coder DRG Match? I also would like to ask how many programs have the coders utilize the CDI captured codes and finalize from their work or do the coders start from scratch and then compare their final DRG and codes to the CDI concurrent DRG and codes?

Thanks and Happy New Year!

Mark

angelisa.romanello

Happy New Year Mark.

We have an interesting program here.
Last November, we started a program where we scan our CDI worksheets into out McKesson system so the coders are able to see our work.
The coders final bill our cases.
The cases then present in our "reconciliation" bucket for us to review.
If we disagree or see something missing, we then send it back electronically for a review.
The jury is still out on whether or not the coders take the time to review our worksheets.
I believe the coders really do start from scratch.

There is a report sent out monthly with the CDI/Coder match however we do not use it at this time as a "metric" for evaluation for several reasons.
1. The CDIs very rarely see the discharge summary
2. We do not have adequate staffing patterns with CDI staff.
3. Due to the volume in our facilities, it is sometimes difficult to return back and complete secondary reviews.

I would enjoy seeing a more collaborate arrangement between coders and CDI however with the current model, this is not possible.
I hope this helps.
Lisa Romanello

deanne_wilk

Benchmark is difficult because there are numerous factors that contribute. If you were reviewing every day until discharge then I would say benchmark could be 100%. Since that usually does not happen we usually don’t benchmark but look at mismatches as educational opportunities and room for discussion and growth.

How I handle it is review the mismatch report and see why they didn’t match. CDI an coding meet monthly and have case discussion to discuss those cases that truly are a mismatch. Then we can discuss coding guidelines, coding clinic, clinical indicators, documentation etc.

Coders do review CDI coding and re-enter as needed. We currently use 360 and CAC so it allows them to cross over the system. I believe coding should review the work done by CDI as it is a secondary check on documentation and coding within the record and leads to improvements in both areas.


Deanne Wilk, BSN,RN,CCS
AHIMA approved ICD-10-CM/PCS Trainer

Clinical Documentation Improvement and Inpatient Coding Manager
HIMS Department
Good Samaritan Health System
4th & Walnut Sts
Lebanon, PA 17042
dwilk@gshleb.org

Phone: 717-270-4804
Cell: 717-679-7926

catladyrn

I do not have a CDI/coder DRG match metric in my program. While I do expect the CDI specialists to understand MS-DRG and produce a working DRG, and I believe fervently in the importance of reconciling the DRG so that the most accurate codes are reported, I don't actually care if the working DRG matches the final DRG. I do care that the CDS understands how the DRG is impacted by the documentation and how changes in the documentation may impact the DRG. I do care that the CDS and the coder come to an agreement that the final billed DRG is the correct representation of the documentation. But for me, evaluating a CDI specialist on their ability to see into the future leads to a lot of wasted effort on the coding process that should be spent on the documentation process, and generates a lot of competition between coding and CDI that should never exist in a collaborative environment.

Just my $0.02,
Renee

Linda Renee Brown, RN, MA, CCDS, CCS, CDIP
Director, Clinical Documentation, Core Measures and Outcomes
Tanner Health System

angelisa.romanello

Well said Renee !
Lisa


Lisa Romanello, RN,BSN,FNS,CCDS
Manager, Clinical Documentation Improvement
Quality and Compliance
CJW Medical Center
Office phone: 804-228-6527
Cell phone: 804-629-0396
AHIMA Approved ICD-10 CM/PCS Trainer
Angelisa.Romanello@HCAHealthcare.com

don.cdi.rn@gmail.com

You'll see some benchmarks from a couple of consultants that support this metric, but I am not certain of the specifics and would rather not suggest a specific benchmark value.
I echo many of the concerns others have voiced -- really need to be aware of how your review cycle, staffing, etc. as well as limitations in available documentation at time of CDI reviews impact the accuracy of a working DRG.
That being said, it is equally imperative (IMHO) that there be close collaboration and attention between CDI & Coding. Feedback and learning about both clinical and coding factors is a two way street, and results in stronger professionals all the way around.

For our facilities, the coders essentially code the record 'natively' before reviewing the CDI work.

Some additional thoughts in this old blog post: ACDIS poll illustrates need for DRG reconciliation process -
http://blogs.hcpro.com/acdis/2010/08/acdis-poll-illustrates-need-for-drg-reconciliation-process/

Don


Donald A. Butler, RN, BSN
Manager, Clinical Documentation Advisor Program
Vidant Health, Greenville NC
DButler@vidanthealth.com ( mailto:mDButler@vidanthealth.com )