concurrent coding in the CDI role

jmontyjmonty
in CDI Talk Archive
Good morning. I am new to ACDIS and CDI talk. I have been a CDIS for the past 4 years in a hosptial in upstate NY. Currently there are 2 CDI's at my hospital and we are in the process of hiring a 3rd. In November the CDI staff started concurrent coding with the assistance from the coders. We received a few hours of training from a coder and now as part of our work flow we review the record, query when needed, and start the coding to get a working DRG with the final coding being completed by the coder. Are there any other facilities out there that are doing this also? If so, has it drastically decreased your porductivity? For us this has cut our productivity down to where we are having a difficult time getting to re-reviews, let alone getting all of our new cases open. I am sure once we are fully staffed again this will help tremendously. Any thoughts or input would be greatly appreciated.

Julie Monty, RN CDS
University of Vermont Health Network
Champlain Valley Physicians Hospital
Plattsburgh, NY

Comments

  • Snook@fmchealth.orgSnook@fmchealth.org
    edited April 2016
    Yes we do the initial coding but we did from the start. We use 3M for the coding but I do not know how one could be an effective CDI without this process. You read and code-then you are critically thinking at the same time. I do 30-45 cases daily that includes 31 critical care beds and do re-reviews daily. It is busy but I like it that way. I come from a critical care background and so I am used to hitting the floor running anyway. It has made a huge financial impact.

    Mary Snook RN-BC
    Clinical Documentation Improvement Specialist
    Fairfield Medical Center
    Lancaster, Ohio 43130
    740-689-4443 snook@fmchealth.org


  • jrileyjriley
    edited April 2016
    We have 2 CDI nurses at our small 100-bed facility. Part of their work routine has always been to assign a working DRG to all their reviewed cases. They are able to do their admission reviews as well as re-reviews without any problem. They were trained in using the 3M grouper by my inpatient coders and continue to work closely with them for all coding questions. We compare initial vs final DRGs to show where we found CC/MCC's that would not have been documented without CDI query and follow-up so that initial DRG assignment is important for us as a metric that shows our financial and CMI impact.

    Judy

    Judy Riley, RHIT, CCS, CPC
    Coding/CDI Mgr
    LRGHealthcare


  • jmontyjmonty
    We have always assigned a working DRG through our software provided by our consultant company. However, using the 3M grouper is new to us. 2 CDI currently covering 25-30 patients per unit, and covering 3 units a piece. We are used to being able to accomplish more in a given day but are improving daily as we get used to the 3M grouper. I cannot see reviewing 30-45 cases a day though and doing a good job. Mary, are you just putting the bare bones in for coding to get the correct DRG or are you also entering all the secondary codes, V codes etc. ?
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    I agree that there is a huge difference between comprehensively coding a record versus assigning a working DRG and/or significant dx/procedure codes. I personally think that the latter makes the most sense (if using the encoder as a concurrent coding tool at all). In general, I don’t think CDI's acting as concurrent coders makes sense from a time management position nor to I think that most CDI's are qualified for this role. We do not do any concurrent coding at our facility though we do use the encoder as a tool as needed.

    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


  • Snook@fmchealth.orgSnook@fmchealth.org
    edited April 2016
    It depends on how many new ones I have but I do assign all the secondary and V codes in addition unless my associate is on vacation. There are two of us and our hospital can hold up to 200 patients. But we only are assigned to a patient population of 55 and older-Inpatient only. We do not code OB-GYN or Psychiatric inpatients. When we began that population was chosen by the Six Sigma project coordinator. It seemed only beneficial to do CDI on that portion of the population. At present that is still what we do. My associate helps with appeals in addition-with the RAC coordinator.

  • Snook@fmchealth.orgSnook@fmchealth.org
    edited April 2016
    I agree.

    Mary Snook RN-BC
    Clinical Documentation Improvement Specialist
    Fairfield Medical Center
    Lancaster, Ohio 43130
    snook@fmchealth.org 740-689-4443

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