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afeighnerafeighner
in CDI Talk Archive
Looking for some opinions/guidance on my current CDI situation....
I have currently held a CDI position for 3 years, finished my masters degree in nursing in May of 2013 and will sit for the CCDS this November. When census fluctuates and when I have finished my CDI responsibilities for the day I am being asked to code and finalize inpatient records.

Is this something that other CDIs are being asked to help with? Is this even appropriate? I have no coding background except my years of nursing anatomy and physiology knowledge.

Comments

  • cynthia.hudson@christushealth.orgcynthia.hudson@christushealth.org
    edited May 2016
    I am a Certified Case Manager and am asked frequently to assist the Case Management Dept by taking patients, processing charges, and filling in when they are out sick or on vacation. It was never like this before. CDI just did CDI. I guess it depends on your knowledge base. It seems that you are being asked to do something that you haven't been trained to do as far as coding guidelines. I would be concerned about future audits by RAC and ask that training be provided so that you feel that you confident in finalizing the chart. This is a lot of responsibility. CDI serves as one tier of review and coders do the final review. I learn so much from our coders and do not feel that I am prepared to do the final coding. You are right to have these concerns.

    Syndi Hudson, RN, CCM

    CDI Specialist

    Christus Santa Rosa New Braunfels

    600 North Union

    New Braunfels, Texas 78130

    cynthia.hudson@christushealth.org

    830-643-6116 (Office)

    830-643-5139 (Fax)



    "I press on toward the goal to win the prize for which God has called me." Philippians 3:14







  • jolene.filejolene.file
    edited May 2016
    In my opinion, if you were credential by AHIMA as a coder, it might be appropriate. However, if you are not certified, I would be concerned about doing the final coding. There are so many C.Clincs and pages of the Coding Guidelines that unless you have been referencing & coding all the time you would not be familiar with them. I do know that in years past, the hospitals did not require certification but I believe all hospitals do have credentialed inpatient coders for compliance now.


    Jolene File,RHIT,CCS,CPC-H,CCDS
    Documentation Improvement Specialist-Coder
    Hays Medical Center
    jolene.file@haysmed.com

    IMPORTANT: This communication contains information from Hays Medical Center which may be confidential and privileged. If it appears that the communication was addressed or sent to you in error, you may not use or copy this communication or any information contained therein, and you may not disclose this communication or the information contained therein to anyone else. In such circumstances, please notify me immediately by reply email or by telephone. Thank you.

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    I agree with Jolene. Many, but apparently not all?, sites require 'a' coding credential. Leaving the politics aside, some of the coding credentials are offered by different governing bodies.

    However, most hospitals in most larger cities do require a credential appropriate for review of complicated claims, expecting the person performing the final coding to have a baseline performance level.



    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.412.9421

    evanspx@sutterhealth.org

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Also, I forgot to say I have done both the 'production' coding of claims as well as the concurrent CDI chart reviews. The level of detail required of final coding is not something I relish after having worked as a CDI. You would be expected to abstract many, many details - some very mundane and repetitive - not 'easy', but very, very detailed and time-consuming functions.

    I personally do not think most of us now performing CDI work would be happy working as a coder - just my opinion, and I have done both for years.



    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.412.9421

    evanspx@sutterhealth.org

  • afeighnerafeighner
    edited May 2016
    I am also asked to perform some duties in the coding compliance realm such as being the "final check" for complications, sequencing of codes, and verifying single CCs and MCCs.

    I am told that I am overly qualified to be an inpatient coder based on my clinical experience and degrees obtained. Professionally I do not feel that I am equipped to be a coder nor have I been certified in anyway as one.

    Amber L. Feighner RN MSN
    Clinical Documentation Improvement Specialist
    Blanchard Valley Hospital
    1900 South Main Street
    Findlay, Ohio 45840
    419-425-5787

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    If they want you to perform as a coder, I would ask that they support you (education funding and time) in pursuing coding certification in order to support this role. I DO carry certification but have never worked as a coder and I feel like I would need additional training in order to effectively code. There is so much abstracting and such that the coders do that I am unfamiliar with. Also I tend not to be overly concerned with many of the E-codes and V-codes in my CDI role, I would really need to step up my game to be an effective coder. I do not think that the average (or even above average) CDI is prepared to code records.
    On the other hand, I see what Amber is talking about as potentially appropriate work for the right CDI with the right experience. I know there are other CDI's who verify complications, quality concerns, etc prior to them being dropped. I think verifying single CC/MCC's seems pretty appropriate for a CDI as well. I personally look at every death chart post coding but prior to the final bill to assure that coding is accurate as far as Pdx, complications, sequencing, SOI/ROM, etc.

    I think as CDI's we should be prepared to be flexible. Each hospital may have different needs depending on other hospital resources, problem areas, and focus. While we should stay true to our main purpose, when time is available we need to use that time to have the most benefit for the hospital. I would imagine this may be especially true for small facilities when census may be low and full FTE's may not be supported with strict CDI work alone. Otherwise, I think there is risk in these facilities that you may lose a program in its entirely or see positions move to less than FT positions. What we should NOT be flexible on is demanding proper education and training for the job we are being asked to do. This does not necessarily mean that they will fund coding courses (for example) but hopefully they would give you time to acquire any knowledge that you need to effectively do what is being asked. I also think that it is very beneficial to always have your eyes/ears open for where you think need may be so that you can anticipate this and be prepared. I know in my case, I quickly found that coding knowledge would be extremely beneficial in my role and took it upon myself to pursue that education independently. It was nothing I was asked to do or even discussed with me. However, my superiors were thrilled I did it and I honestly feel that this is what has made me extremely valuable to my employer and allowed me great flexibility within my role.

    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


  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Short response: Agree, CDI can confirm key conditions, when needed. That can be a great role for CDI.

    But, final and formal coding is complicated and training should be mandatory if one is asked to perform full coding duties. The coding classes in the B.S. (RHIA) program were 6 credits in my day (two semesters).


    So, that formal training represented quite a commitment far beyond casual classes or seminars where one 'learns to code in a week' - can't be done.


    As Katy stated, there is a huge world of conditions assigned by coding that go far, far beyond PDX, CC, MCC, etc.

    I'd be concerned if administration asked the CDI team to code as an additional duty. The commitment to do so properly is not understood by many.



    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.412.9421

    evanspx@sutterhealth.org

  • afeighnerafeighner
    edited May 2016
    Administration is probably not aware that I was asked to code charts. Before I was asked to do this I was also asked to analyze and index charts. The other option was go home on low census time. Worried about the support for the overall program and feel that they want me to "hang around" for the intense ICD-10 roll out and education in the spring. I feel that I will be severely unhappy by that time. I have worked at my hospital for going on 16 years and do not want to look elsewhere for employment. What choice do I have?

    Amber L. Feighner RN MSN
    Clinical Documentation Improvement Specialist
    Blanchard Valley Hospital
    1900 South Main Street
    Findlay, Ohio 45840
    419-425-5787


  • jrileyjriley
    edited May 2016
    How about expanding your role? Outpatient CDI is of growing interest to many hospitals. Or you could create educational materials- presentations, newsletters, etc. for ICD-10 documentation requirements. I would definitely have a discussion with whomever assigned you your "other duties" about your discomfort with finalizing codes and why it's not a good fit for you or your organization (think compliance and outside auditing) unless you obtain appropriate education. There is so much CDS's can do besides review charts and write queries.
    Good luck!

    Judy

    Judy Riley, RHIT, CCS
    Coding/CDI Mgr
    AHIMA-Approved ICD-10 trainer
    LRGHealthcare
    Laconia, NH 03246
    jriley@lrgh.org



  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Amber,
    Are you being asked to code complete records with your name listed as the coder? or verify key pieces? Pdx, CC/MCCs, quality indicators? I think those are two very different things.
    I think if I was in your shoes I would be looking for ways to increase your value to the facility? What department are you in? I would possibly start by going to your quality department and ask them what metrics the facility is falling behind on. How's your O:E ratio? Core measures? Complication rates? Many of these things easily fall into the CDI body of knowledge and showing that you can improve these metrics may help them better see your value.

    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


  • afeighnerafeighner
    edited May 2016
    Thank you for all the feedback.

    Amber L. Feighner RN MSN
    Clinical Documentation Improvement Specialist
    Blanchard Valley Hospital
    1900 South Main Street
    Findlay, Ohio 45840
    419-425-5787


  • afeighnerafeighner
    edited May 2016
    I am being asked to code and finalize under my name, which is printed out on the attestation sheet. I verify the other components as well for the coders such as CCs MCCs complications, sequencing , lab values, query help etc. I am currently a part of the Revenue Cycle in Health Information Services or Medical records.

    I have been working with Quality helping them on some projects such as SOI and ROM and Value Based purchasing, Bundling, Mortality reviews etc.....I am very active in that aspect and serve an a few committees related to such. Quality would like me to move to their department, however I doubt that will happen.

    I am also do monthly newsletters for physicians on CDI topics for improvement. I do a monthly education session for our Hospitalists that entails chart review documentation discussion and ICD-10 readiness. On top of doing CMEs for all providers regarding ICD-10 documentation.



    Amber L. Feighner RN MSN
    Clinical Documentation Improvement Specialist
    Blanchard Valley Hospital
    1900 South Main Street
    Findlay, Ohio 45840
    419-425-5787


  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Amber: I would also consider working for some of the consulting firms offering remote CDI reviews - you could work from home?



    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.412.9421

    evanspx@sutterhealth.org


  • afeighnerafeighner
    edited May 2016
    Do you have any reputable agencies that you would recommend? Thank Paul.

    Amber L. Feighner RN MSN
    Clinical Documentation Improvement Specialist
    Blanchard Valley Hospital
    1900 South Main Street
    Findlay, Ohio 45840
    419-425-5787


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