agree/disagree metric
How do you define agree/disagree for query response at your facility (or do you not??)? Do you any mark as 'agree' if the provider gives you a response you were looking for? For example:
1. You query for ABLA and the provider responds with 'dilutional'. Agree or disagree?
2. Dietary writes that the patient has severe PCM and you query with the info but the provider responds with moderate PCM. Agree or disagree?
Thanks!
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
1. You query for ABLA and the provider responds with 'dilutional'. Agree or disagree?
2. Dietary writes that the patient has severe PCM and you query with the info but the provider responds with moderate PCM. Agree or disagree?
Thanks!
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
Comments
A query for :
* A dx when dx not started-
o Agree=gave a dx but not necessarily the one you want
o Disagree=provider did not provide a dx but continued to provide a symptom or something that could not be assigne a code
* Specificity-
o Agree=gave a dx but not necessarily the one you want
o Disagree=any other response
* Principal Dx-
o Agree=changes the DRG
o Disagree=does not change the DRG
* POA-
o Agree=Y
o Disagree=N
o Disagree=W (provider unable to determine after query)
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, April 16, 2015 3:52 PM
Subject: [cdi_talk] agree/disagree metric
How do you define agree/disagree for query response at your facility (or do you not??)? Do you any mark as 'agree' if the provider gives you a response you were looking for? For example:
1. You query for ABLA and the provider responds with 'dilutional'. Agree or disagree?
2. Dietary writes that the patient has severe PCM and you query with the info but the provider responds with moderate PCM. Agree or disagree?
Thanks!
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
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Thank you.
I wondered why you give a disagree for a W on poa? I think It will still negate a HAC, though it may not be able to be PDX.
> On Apr 16, 2015, at 2:00 PM, CDI Talk wrote:
>
> It depends on what we query for. Here are definitions at our 3 facilities which derived from 3M consultation:
>
> A query for :
> · A dx when dx not started-
> o Agree=gave a dx but not necessarily the one you want
> o Disagree=provider did not provide a dx but continued to provide a symptom or something that could not be assigne a code
> · Specificity-
> o Agree=gave a dx but not necessarily the one you want
> o Disagree=any other response
> · Principal Dx-
> o Agree=changes the DRG
> o Disagree=does not change the DRG
> · POA-
> o Agree=Y
> o Disagree=N
> o Disagree=W (provider unable to determine after query)
>
>
>
>
>
> From: CDI Talk [mailto:cdi_talk@hcprotalk.com ]
> Sent: Thursday, April 16, 2015 3:52 PM
> Subject: [cdi_talk] agree/disagree metric
>
> How do you define agree/disagree for query response at your facility (or do you not??)? Do you any mark as ‘agree’ if the provider gives you a response you were looking for? For example:
> 1. You query for ABLA and the provider responds with ‘dilutional’. Agree or disagree?
> 2. Dietary writes that the patient has severe PCM and you query with the info but the provider responds with moderate PCM. Agree or disagree?
>
> Thanks!
>
> 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
>
>
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: dvitalone@comhs.org
> If you would like to be removed from CDI Talk, please send a blank email to
> leave-cdi_talk-12121342.2ffcc42f203494f36544e53ea82f91d7@hcprotalk.com
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> Copyright 2013
> HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
> This message and attachment(s), if any, is intended for the sole use of the individual and/or entity of which it is addressed, and may contain information that is privileged,confidential and prohibited from disclosure under applicable law. If you are not the addressee, or authorized to receive this on behalf of the addressee, you are hereby notified that you may not use, copy, disclose or distribute to anyone this message or any part thereof. If you have received this in error, please immediately advisethe sender by e-mail and delete this information and all attachments from your computer and network. Thank you.
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2. Disagree
Mary.
Sent from my Verizon Wireless 4G LTE smartphone
-------- Original message --------
From: CDI Talk
Date: 04/16/2015 4:51 PM (GMT-05:00)
To: rmhosler@charter.net
Subject: [cdi_talk] agree/disagree metric
How do you define agree/disagree for query response at your facility (or do you not??)? Do you any mark as ‘agree’ if the provider gives you a response you were looking for? For example:
1. You query for ABLA and the provider responds with ‘dilutional’. Agree or disagree?
2. Dietary writes that the patient has severe PCM and you query with the info but the provider responds with moderate PCM. Agree or disagree?
Thanks!
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
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2. IF there was no malnutrition in chart without query I think moderate would be agree. If we only get AGREE when the answer was for max reimbursment it seems like we are making a better case for those who think our queries are leading. Seems to indicate only a specific answer is warrented.
> On Apr 16, 2015, at 2:09 PM, CDI Talk wrote:
>
> 1. Disagree.
> 2. Disagree
>
> Mary.
>
>
> Sent from my Verizon Wireless 4G LTE smartphone
>
>
> -------- Original message --------
> From: CDI Talk
> Date: 04/16/2015 4:51 PM (GMT-05:00)
> To: rmhosler@charter.net
> Subject: [cdi_talk] agree/disagree metric
>
> How do you define agree/disagree for query response at your facility (or do you not??)? Do you any mark as ‘agree’ if the provider gives you a response you were looking for? For example:
>
> 1. You query for ABLA and the provider responds with ‘dilutional’. Agree or disagree?
>
> 2. Dietary writes that the patient has severe PCM and you query with the info but the provider responds with moderate PCM. Agree or disagree?
>
>
>
> Thanks!
>
>
>
> 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
>
>
>
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: rmhosler@charter.net
> If you would like to be removed from CDI Talk, please send a blank email to
> leave-cdi_talk-20295724.7e4b3ee20701dbf03c91c3ca2d39289d@hcprotalk.com
> ---
> Copyright 2013
> HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: annnd2009@gmail.com
> If you would like to be removed from CDI Talk, please send a blank email to
> leave-cdi_talk-13089320.38a6920d4dbebb3c0272be2f9e77119e@hcprotalk.com
> ---
> Copyright 2013
> HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
I appreciate all the responses ☺
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
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, April 16, 2015 3:13 PM
To: Kathryn Good
Subject: Re: [cdi_talk] agree/disagree metric
1. I can see both ways. MY GUT says disagree by consultants would be agree.
2. IF there was no malnutrition in chart without query I think moderate would be agree. If we only get AGREE when the answer was for max reimbursment it seems like we are making a better case for those who think our queries are leading. Seems to indicate only a specific answer is warrented.
On Apr 16, 2015, at 2:09 PM, CDI Talk wrote:
1. Disagree.
2. Disagree
Mary.
Sent from my Verizon Wireless 4G LTE smartphone
-------- Original message --------
From: CDI Talk
Date: 04/16/2015 4:51 PM (GMT-05:00)
To: rmhosler@charter.net
Subject: [cdi_talk] agree/disagree metric
How do you define agree/disagree for query response at your facility (or do you not??)? Do you any mark as ‘agree’ if the provider gives you a response you were looking for? For example:
1. You query for ABLA and the provider responds with ‘dilutional’. Agree or disagree?
2. Dietary writes that the patient has severe PCM and you query with the info but the provider responds with moderate PCM. Agree or disagree?
Thanks!
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
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Vanessa Falkoff RN
Clinical Documentation Improvement Coordinator
University Medical Center of Southern Nevada
1800 W Charleston Blvd
Las Vegas, NV
vanessa.falkoff@umcsn.com
office 702-383-7322
Compassion * Accountability * Respect * Integrity
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, April 16, 2015 2:23 PM
To: Vanessa Falkoff
Subject: RE: [cdi_talk] agree/disagree metric
This has been my struggle too. On one hand, I think there are many scenarios where we do have a dx clearly in mind. However, it makes me slightly uncomfortable to say that any deviation from this is a ‘disagree’. It makes it very clear our agenda…. Additionally, I think there are many scenarios where we are simply looking for a response. So if I am querying for the specificity of degree of malnutrition and the dietician has stated it a ‘severe’, is there really anything wrong with the MD independently determining that it really was only moderate? My query was still justified. I still got a specific response which I wanted. And the provider is establishing their own diagnosis, which is perfectly appropriate, they are the diagnostician….
I appreciate all the responses ☺
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
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, April 16, 2015 3:13 PM
To: Kathryn Good
Subject: Re: [cdi_talk] agree/disagree metric
1. I can see both ways. MY GUT says disagree by consultants would be agree.
2. IF there was no malnutrition in chart without query I think moderate would be agree. If we only get AGREE when the answer was for max reimbursment it seems like we are making a better case for those who think our queries are leading. Seems to indicate only a specific answer is warrented.
On Apr 16, 2015, at 2:09 PM, CDI Talk wrote:
1. Disagree.
2. Disagree
Mary.
Sent from my Verizon Wireless 4G LTE smartphone
-------- Original message --------
From: CDI Talk
Date: 04/16/2015 4:51 PM (GMT-05:00)
To: rmhosler@charter.net
Subject: [cdi_talk] agree/disagree metric
How do you define agree/disagree for query response at your facility (or do you not??)? Do you any mark as ‘agree’ if the provider gives you a response you were looking for? For example:
1. You query for ABLA and the provider responds with ‘dilutional’. Agree or disagree?
2. Dietary writes that the patient has severe PCM and you query with the info but the provider responds with moderate PCM. Agree or disagree?
Thanks!
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
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CONFIDENTIALITY NOTICE: This communication and its attachments may contain confidential or privileged information intended solely for the use of the individual or entity to whom it is addressed. If you are not an intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it (or any portion of the contents) or the attachments is strictly prohibited. If you have received this communication in error, please contact the sender and immediately destroy all copies of the communication and attachments. Thank you.
Could you share the metrics you use? The agree disagree gets complicated and is up for interpretation. How does one ensure appropriate imact/credit is given to clinician? How does one ensure proper credit to physician?
Mary
Sent from my Verizon Wireless 4G LTE smartphone
-------- Original message --------
From: CDI Talk
Date: 04/16/2015 5:59 PM (GMT-05:00)
To: rmhosler@charter.net
Subject: RE: [cdi_talk] agree/disagree metric
We do not use this metric.
Vanessa Falkoff RN
Clinical Documentation Improvement Coordinator
University Medical Center of Southern Nevada
1800 W Charleston Blvd
Las Vegas, NV
vanessa.falkoff@umcsn.com
office 702-383-7322
Compassion * Accountability * Respect * Integrity
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, April 16, 2015 2:23 PM
To: Vanessa Falkoff
Subject: RE: [cdi_talk] agree/disagree metric
This has been my struggle too. On one hand, I think there are many scenarios where we do have a dx clearly in mind. However, it makes me slightly uncomfortable to say that any deviation from this is a ‘disagree’. It makes it very clear our agenda…. Additionally, I think there are many scenarios where we are simply looking for a response. So if I am querying for the specificity of degree of malnutrition and the dietician has stated it a ‘severe’, is there really anything wrong with the MD independently determining that it really was only moderate? My query was still justified. I still got a specific response which I wanted. And the provider is establishing their own diagnosis, which is perfectly appropriate, they are the diagnostician….
I appreciate all the responses J
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
ADDED CC
ADDED MCC
CHANGED DRG
ADDED CC N/A DRG
ADDED MCC N/A DRG
POA
PDX CLARIFICATION
EDUCATIONAL
N/A
Vanessa Falkoff RN
Clinical Documentation Improvement Coordinator
University Medical Center of Southern Nevada
1800 W Charleston Blvd
Las Vegas, NV
vanessa.falkoff@umcsn.com
office 702-383-7322
Compassion * Accountability * Respect * Integrity
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, April 16, 2015 3:20 PM
To: Vanessa Falkoff
Subject: RE: [cdi_talk] agree/disagree metric
Vanessa:
Could you share the metrics you use? The agree disagree gets complicated and is up for interpretation. How does one ensure appropriate imact/credit is given to clinician? How does one ensure proper credit to physician?
Mary
Sent from my Verizon Wireless 4G LTE smartphone
-------- Original message --------
From: CDI Talk
Date: 04/16/2015 5:59 PM (GMT-05:00)
To: rmhosler@charter.net
Subject: RE: [cdi_talk] agree/disagree metric
We do not use this metric.
Vanessa Falkoff RN
Clinical Documentation Improvement Coordinator
University Medical Center of Southern Nevada
1800 W Charleston Blvd
Las Vegas, NV
vanessa.falkoff@umcsn.com
office 702-383-7322
Compassion * Accountability * Respect * Integrity
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, April 16, 2015 2:23 PM
To: Vanessa Falkoff
Subject: RE: [cdi_talk] agree/disagree metric
This has been my struggle too. On one hand, I think there are many scenarios where we do have a dx clearly in mind. However, it makes me slightly uncomfortable to say that any deviation from this is a ‘disagree’. It makes it very clear our agenda…. Additionally, I think there are many scenarios where we are simply looking for a response. So if I am querying for the specificity of degree of malnutrition and the dietician has stated it a ‘severe’, is there really anything wrong with the MD independently determining that it really was only moderate? My query was still justified. I still got a specific response which I wanted. And the provider is establishing their own diagnosis, which is perfectly appropriate, they are the diagnostician….
I appreciate all the responses ☺
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
---
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Copyright 2013
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CONFIDENTIALITY NOTICE: This communication and its attachments may contain confidential or privileged information intended solely for the use of the individual or entity to whom it is addressed. If you are not an intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it (or any portion of the contents) or the attachments is strictly prohibited. If you have received this communication in error, please contact the sender and immediately destroy all copies of the communication and attachments. Thank you.
When discussing agree/disagree metrics – I think there is real value in also counting those ‘clinically indeterminable’ responses (so 3 categories for the physician response).
With the knowledge base that I expect for CDS’s, when we are asking a query, I expect the CDS to already know what the clinically supported response would be. If the physician answers with something else, I do believe ‘disagree’ is appropriate.
For those situations where clarification is needed without good clinical evidence, or a connection needs to be established, seeking an etiology for a symptom, etc. – an appropriate diagnostic answer would be counted as agree.
For the 2 original posed – IF clinically clearly supported, would count both as disagree.
Don
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, April 16, 2015 5:23 PM
To: Butler, Don
Subject: RE: [cdi_talk] agree/disagree metric
This has been my struggle too. On one hand, I think there are many scenarios where we do have a dx clearly in mind. However, it makes me slightly uncomfortable to say that any deviation from this is a ‘disagree’. It makes it very clear our agenda…. Additionally, I think there are many scenarios where we are simply looking for a response. So if I am querying for the specificity of degree of malnutrition and the dietician has stated it a ‘severe’, is there really anything wrong with the MD independently determining that it really was only moderate? My query was still justified. I still got a specific response which I wanted. And the provider is establishing their own diagnosis, which is perfectly appropriate, they are the diagnostician….
I appreciate all the responses ☺
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
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, April 16, 2015 3:13 PM
To: Kathryn Good
Subject: Re: [cdi_talk] agree/disagree metric
1. I can see both ways. MY GUT says disagree by consultants would be agree.
2. IF there was no malnutrition in chart without query I think moderate would be agree. If we only get AGREE when the answer was for max reimbursment it seems like we are making a better case for those who think our queries are leading. Seems to indicate only a specific answer is warrented.
On Apr 16, 2015, at 2:09 PM, CDI Talk wrote:
1. Disagree.
2. Disagree
Mary.
Sent from my Verizon Wireless 4G LTE smartphone
-------- Original message --------
From: CDI Talk
Date: 04/16/2015 4:51 PM (GMT-05:00)
To: rmhosler@charter.net
Subject: [cdi_talk] agree/disagree metric
How do you define agree/disagree for query response at your facility (or do you not??)? Do you any mark as ‘agree’ if the provider gives you a response you were looking for? For example:
1. You query for ABLA and the provider responds with ‘dilutional’. Agree or disagree?
2. Dietary writes that the patient has severe PCM and you query with the info but the provider responds with moderate PCM. Agree or disagree?
Thanks!
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
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Also, I would not take a disagree when they say POA = N. You're not vested in the answer--you just want to know one way or the other, and they've told you. They agreed to answer and now your documentation is clearer. If you consider the answer a disagree, and your metrics are built such that a disagree is a CDI fail, then you're going to be reluctant to ask that POA question unless you're 100% sure it's a yes. That's not good.
I would save my disagrees for those cases where the answer doesn't improve the record. Perhaps you're trying to extrapolate heart failure from cardiomyopathy based on presenting signs and symptoms, and the physician says no, it's not HF, it's still only CM. I've dinged myself for a disagree when I asked for a link between hypertension and heart disease, and they said no.
Just my $0.02,
Renee
Linda Renee Brown, RN, MA, CCDS, CCS, CDIP
Director, Clinical Documentation
Tanner Health System
This is exactly why it is coming up for us. Until fairly recently, CDI's in our program used to follow patients from admission to discharge. So any queries a CDI wrote would be followed by the author. However, a while back we moved to a unit-based model. For the most part, this has been a huge improvement. Now, as patients are transferred between units (ie: ICU to the floor), a different CDI than the author may be the one determining whether the response to a query is an agree/disagree. This has brought up concerns about how agree/disagree is being applied. We have a 7 person team and it has been really interesting to see how different CDI's have been thinking about this metric because there certainly is variation, though I think that a fairly loose definition has been being applied across the board.
It also interesting because though this metric is reported, as of yet it has never been used for anything... Which begs the question, do we need it at all?
I am really appreciating everyone's thoughtful responses and explanations. Great discussion.
Thank you!
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
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, April 17, 2015 7:57 AM
To: Kathryn Good
Subject: RE: RE:[cdi_talk] agree/disagree metric
Jumping in on this bandwagon, I agree with Renee, and use a very liberal definition of agree vs disagree myself. If the physician gives us a response, regardless if it's one of my options in the query, I see that as agree with the need for more specificity and therefore, agree. The other issue I see is with large CDI departments, the difficulty of achieving consistency in agreements/disagreements, as these are very subjective terms. Even when there are guidelines for the definitions, I think there will be a lot of difference in interpreting the guidelines. I tend to want to error on the positive side of the statistic.
Good discussion Katy!
Thanks Karen
Karen Bridgeman MSN, RN, CCDS
CDI Educator
Clinical Documentation Integrity
Medical University of South Carolina
Phone: 843.792.4898
Pager: 843.792.0590.11984
Email: bridgema@musc.edu
Confidentiality Notice: If you have received this communication in error, please notify me immediately. The documents accompanying this facsimile/electronic transmission contain confidential information intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure. If the reader of this message is not the intended recipient, or an employee responsible for delivering the message to the intended recipient, you are hereby notified that any disclosure, dissemination, distribution, or copying of this communication is strictly prohibited.
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, April 17, 2015 8:31 AM
To: Bridgeman, Karen
Subject: RE:[cdi_talk] agree/disagree metric
I tend to go with a very liberal definition of agree vs disagree. When you may be asking about malnutrition with severe in mind, and the physician answers back with moderate, I don't think that's a disagree. They agreed that greater specificity needed to be documented, which in all reality is the objective of the query.
Also, I would not take a disagree when they say POA = N. You're not vested in the answer--you just want to know one way or the other, and they've told you. They agreed to answer and now your documentation is clearer. If you consider the answer a disagree, and your metrics are built such that a disagree is a CDI fail, then you're going to be reluctant to ask that POA question unless you're 100% sure it's a yes. That's not good.
I would save my disagrees for those cases where the answer doesn't improve the record. Perhaps you're trying to extrapolate heart failure from cardiomyopathy based on presenting signs and symptoms, and the physician says no, it's not HF, it's still only CM. I've dinged myself for a disagree when I asked for a link between hypertension and heart disease, and they said no.
Just my $0.02,
Renee
Linda Renee Brown, RN, MA, CCDS, CCS, CDIP Director, Clinical Documentation Tanner Health System
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Renee
Linda Renee Brown, RN, MA, CCDS, CCS, CDIP
Director, Clinical Documentation
Tanner Health System
If the first is the purpose, then Don’s method would seem appropriate. If the purpose is the second, then it would seem measurement in terms of Pr Dx or DRG change, MCC capture, CC capture, SOI/ROM change etc would be the best measure.
Sharon
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, April 16, 2015 8:28 PM
To: Salinas, Sharon
Subject: RE: [cdi_talk] agree/disagree metric
Agree that this is complex.
When discussing agree/disagree metrics – I think there is real value in also counting those ‘clinically indeterminable’ responses (so 3 categories for the physician response).
With the knowledge base that I expect for CDS’s, when we are asking a query, I expect the CDS to already know what the clinically supported response would be. If the physician answers with something else, I do believe ‘disagree’ is appropriate.
For those situations where clarification is needed without good clinical evidence, or a connection needs to be established, seeking an etiology for a symptom, etc. – an appropriate diagnostic answer would be counted as agree.
For the 2 original posed – IF clinically clearly supported, would count both as disagree.
Don
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, April 16, 2015 5:23 PM
To: Butler, Don
Subject: RE: [cdi_talk] agree/disagree metric
This has been my struggle too. On one hand, I think there are many scenarios where we do have a dx clearly in mind. However, it makes me slightly uncomfortable to say that any deviation from this is a ‘disagree’. It makes it very clear our agenda…. Additionally, I think there are many scenarios where we are simply looking for a response. So if I am querying for the specificity of degree of malnutrition and the dietician has stated it a ‘severe’, is there really anything wrong with the MD independently determining that it really was only moderate? My query was still justified. I still got a specific response which I wanted. And the provider is establishing their own diagnosis, which is perfectly appropriate, they are the diagnostician….
I appreciate all the responses ☺
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
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, April 16, 2015 3:13 PM
To: Kathryn Good
Subject: Re: [cdi_talk] agree/disagree metric
1. I can see both ways. MY GUT says disagree by consultants would be agree.
2. IF there was no malnutrition in chart without query I think moderate would be agree. If we only get AGREE when the answer was for max reimbursment it seems like we are making a better case for those who think our queries are leading. Seems to indicate only a specific answer is warrented.
On Apr 16, 2015, at 2:09 PM, CDI Talk wrote:
1. Disagree.
2. Disagree
Mary.
Sent from my Verizon Wireless 4G LTE smartphone
-------- Original message --------
From: CDI Talk
Date: 04/16/2015 4:51 PM (GMT-05:00)
To: rmhosler@charter.net
Subject: [cdi_talk] agree/disagree metric
How do you define agree/disagree for query response at your facility (or do you not??)? Do you any mark as ‘agree’ if the provider gives you a response you were looking for? For example:
1. You query for ABLA and the provider responds with ‘dilutional’. Agree or disagree?
2. Dietary writes that the patient has severe PCM and you query with the info but the provider responds with moderate PCM. Agree or disagree?
Thanks!
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
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As you can tell from the many responses, this metric is used and viewed in a variety of ways -- so there isn't a correct answer to your question.
I think the key for any data metric is to understand what & how you are measuring, so that you're aligned toward what question you want to answer. Defining this metric is problematic -- there are several items that can influence a particular response: how well was the query worded? what is the provider's understanding? collaboration/engagement? strength of clinical support? etc. This is a real drawback on this particular data point.
Renee's comments are spot on.
This is a metric where I personally feel the larger value is monitoring trends (among the entire medical staff, by service, as well as individual providers -- one reason why I feel it is better to include both agree/disagree and clinically indeterminable for data options). Knowing where the relative strengths are for engagement and collaboration really helps in focusing efforts. A change in the metric certainly indicates a requirement for some digging.
Donald A. Butler, RN, BSN
Manager, Clinical Documentation Advisor Program
Vidant Health, Greenville NC
252-847-6855