Charts completion by coding with Mismatched CDIS DRG

arozhkovskaya

Hello everyone,
Can someone share what process you have in place in collaboration with coding department regarding final coding DRG completion. Currently, we have very cumbersome process where coders, if they have DRG mismatch with CDIS working DRG, place charts hold before completion and reviewed by lead CDIS. Depending of their (CDIS leads) finding, CDIS either post additional queries or, in case of disagreement with coding, chart are farther being reviewed by CDI/coding management for final decision. It creates lots of tension and negativity between coding and CDIS who is right and who is wrong. 3M 360 CDI trainers suggested to adopt another process where coder would complete the charts without discussing with CDIS but CDIS leads would look at DRG mismatch report in 3M 360 on daily bases and if disagree, chart farther would be reviewed by management and if needed, re-billed later.
I'd really appreciate any feedback.

Anna Rozhkovskaya, RHIT, CCS, CCS-P
Manager, Clinical Documentation Improvement
Memorial Healthcare System
Health Information Management Department
2990 Executive Way, Miramar, Fl 33025
(954)276-9957 Office
(954)265-6974 Mobile 
(954)441-9459 Fax






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deanne_wilk

I think the new movement is to have them reviewed prior to dropping the bill. I do think that coding can make an initial decision if it is apparent as to the reason for the mismatch (procedure done, new condition not reviewed by CDI, etc). I think those we should hold are the ones where there is truly an educational opportunity or possible discrepancy in picking up a diagnosis or principal diagnosis change, etc.


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

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

Phone: 717-270-7582
Cell: 717-580-1436

jriley

Hi Anna.

I manage both coding and CDI and I understand the tension mismatches can create. When this happens the coder follows up directly with the CDS to discuss the case and if they don’t reach agreement our program director (a physician) reviews the documentation and makes the final determination. We place the account on hold for billing as you do. Our director usually gets back to us within the day; we have a 48-hr turnaround standard. We have been using this process for about 6 months and it has created a better working relationship between the CDS's and the coders.

We also have monthly meetings that include both the CDI nurses and the inpatient coders. We use the meetings to discuss current problems and initiatives and for educational presentations, and have found that they are extremely helpful in creating a cohesive team.


Judy Riley, RHIT, CCS, AHIMA-Approved ICD-10 Trainer
CDI/Coding Manager
LRGHealthcare
jriley@lrgh.org

arozhkovskaya

Thank you for sharing, guys. I will definitely share this with my management.

Sent from my iPhone

> On Nov 10, 2015, at 12:41 PM, CDI Talk wrote:
>
> Hi Anna.
>
> I manage both coding and CDI and I understand the tension mismatches can create. When this happens the coder follows up directly with the CDS to discuss the case and if they don

sharon.cooper@owensborohealth.org

Once the Coder completes final coding, a note will be placed stating rationale if there is discrepancy with DRG assignment and then place the account in a work queue for the CDS to perform a second, pre-bill review. The bill is on hold until the CDS releases. If the CDS agrees with all codes assigned (includes all secondary diagnoses and procedural codes) and DRG assignment by the Coder, the CDS will remove the hold and drop the bill. If the CDS disagrees with any of the assigned codes, she will email the Coder with concern and/or query the physician if indicated. The Coder will reply via email (typically within one day) and if agrees the codes will be adjusted accordingly. If the Coder disagrees with CDS, the account is immediately sent to the Coding Supervisor & CDS Supervisor to review/discuss. Once the Supervisors agree an email is sent to all with an explanation/rationale/supporting documentation as to why it should be coded one way or the other. Very rarely is the discrepancy elevated to the Manager of Coding and Manager of CD to review/discuss.

All accounts added to the CDS work queue for second, pre-bill review are reviewed on the date they are coded so that bills are not held unnecessarily. (CDS' work M-F, so accounts coded over the week-end are reviewed on Monday.)

The majority of discrepancies are resolved between the CDS & Coder within one day - only a minimum require Supervisor intervention - and very rarely Manager intervention. We have used this process for at least the last 7-8 years and it has worked well for us.

Sharon Cooper, RN-BC, CCS, CDIP, CCDS, CHTS-CP
AHIMA-Approved ICD-10-CM/PCS Trainer/Ambassador
Manager Clinical Documentation/Appeals

Owensboro Health Regional Hospital
P.O. Box 20007
Owensboro, KY 42304-0007
Office: 270-417-4612
Cell: 270-316-9088
Fax: 1-270-417-4609

arozhkovskaya

We had the same process but our management explores other options...