Establishing criteria for subjective diagnoses

Snook@fmchealth.orgSnook@fmchealth.org
in CDI Talk Archive
I almost have our organization's criteria approved for Acute Respiratory Failure. It is going to our Critical care committee in less than two weeks. I know that the reason we do this is because this diagnosis can be a subjective one. We did the research and I worked with our Pulmonologists to get their input and approval. It is important for physician participation for CDI. It can also be used for RAC and insurance audits. Can anyone give me any other reasons why it is important to do this for our organization that I can take to that Critical care committee meeting on February 6th? Be specific and to the point please. Physicians like it that way.

Mary L. Snook RN-BC
Clinical Documentation Improvement Specialist
Fairfield Medical Center
740-689-4443



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Comments

  • Loretta.Hoffmeister@mercy.netLoretta.Hoffmeister@mercy.net
    edited April 2016
    I don't have an additional reason for you, but I am curious if you would be willing to share the "criteria" you will be presenting to them. This is a subject that I am currently getting involved with as well.
    Thanks,
    Loretta


  • Unknown
    edited April 2016
    On reason I can think of is for audits and reviews from outside payers. When you have 'standard' definitions approved by your physicians auditors will have a harder time removing these diagnoses.


    Charlene

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Monday, January 26, 2015 12:09 PM
    To: Thiry Charlene
    Subject: RE:[cdi_talk] Establishing criteria for subjective diagnoses

    I don't have an additional reason for you, but I am curious if you would be willing to share the "criteria" you will be presenting to them. This is a subject that I am currently getting involved with as well.
    Thanks,
    Loretta


    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Monday, January 26, 2015 12:04 PM
    To: Hoffmeister, Loretta
    Subject: [cdi_talk] Establishing criteria for subjective diagnoses

    I almost have our organization's criteria approved for Acute Respiratory Failure. It is going to our Critical care committee in less than two weeks. I know that the reason we do this is because this diagnosis can be a subjective one. We did the research and I worked with our Pulmonologists to get their input and approval. It is important for physician participation for CDI. It can also be used for RAC and insurance audits. Can anyone give me any other reasons why it is important to do this for our organization that I can take to that Critical care committee meeting on February 6th? Be specific and to the point please. Physicians like it that way.

    Mary L. Snook RN-BC
    Clinical Documentation Improvement Specialist
    Fairfield Medical Center
    740-689-4443





  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited April 2016
    Have you seen the criteria that Dr. Pinson presented at the most recent ACDIS convention? Very helpful and the material is on the share point for ACDIS.

    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

  • Loretta.Hoffmeister@mercy.netLoretta.Hoffmeister@mercy.net
    edited April 2016
    Thank you! I'll take a look there.

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Monday, January 26, 2015 12:12 PM
    To: Hoffmeister, Loretta
    Subject: RE:[cdi_talk] Establishing criteria for subjective diagnoses

    Have you seen the criteria that Dr. Pinson presented at the most recent ACDIS convention? Very helpful and the material is on the share point for ACDIS.

    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 April 2016
    Brief, concise and clean. I like the way the diagnostic criteria is listed, as well as the cited intervention.

    Paul

    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

  • annnd2009@gmail.comannnd2009@gmail.com
    edited April 2016
    Playing devil’s advocate, not sure it would matter…would it be helpful in the top section to say something like- meets at least 2 or 3 (what ever you have determined), so as not to illicit denial because all are not met???

    I think I have seen coders take issue when not ALL the coding clinic advice fits, might strengthen it a little…just a thought.

    Looks good!

    Ann Donnelly,RN,BSN,CCDS
    Annnd2009@gmail.com

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