Final DRG verification with coders

arozhkovskaya

Hello, all,
I just wanted to ask you all what is the process in your facilities of completing the charts with DRG varying from CDIS. Do they have to place charts on hold before they complete it or CDIS and coder have to agree on DRG before completion? We have 3M 360 and EPIC and the process is bit complicated - placing charts on hold in EPIC, doing a notification in 360, CDIS (or managers) reviewing charts, and then letting coder to complete it. Our management team wants to simplify it and let coders to complete charts without verifying DRG with CDIS and just look at report 01 afterwards.
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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katysuegood@gmail.com

We do retro validation. CDIs run a report on their patients and reconcile any mismatches. If they feel that the DRG is incorrect they contact coding to resolve. This does result in more rebills but does allow for coding to drop records in a more timely manner.

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

martin.conroy

Coders complete wo review by cdi

We do not have staff to perform review & cdi concurrent work

Coders do ask cdi for feedback occasionally but they are excellant so we trust their judgement

Marty
Temple

mulled2

We do the same with reconciliation after coder review. If CDI and Coder do not agree it goes onto our DRG validators until agreement

paxneros

We use shared spreadsheet on a shared drive. Coder codes and drops account. CDI reviews DRG. If there is a discrepancy that CDI has question the account goes on the spreadsheet. Coders review their accts twice a week and make a response. If it leads to a DRG change they email Lead Coder who then lets Billing know the acct has been dropped again with new DRG.

We do not hold up accts for CDI because we have to be within 2 days of discharge. 

We do query - and sometimes follow up on a CDI query if the info is needed to impact DRG but if physician hasn't responded within 15 days, its dropped.

Thanks

Norma Brunson, BS, RHIA, CDIP,CCS, CCDS

sharon.cooper@owensborohealth.org

CDS' review all Medicare & Medicaid (traditional & MCO's for both) concurrently and assign pdx, cc, mcc, all severity diagnoses, and all procedure codes. Coder codes post-discharge and then places account in a CDS 2nd Look Work Queue in Epic. Placing account in the WQ automatically assigns a bill hold. We have 2 CDS's that work the WQ M-F, in addition to their (smaller) concurrent assignments. All accounts in the WQ are reviewed before CDS' leaves for the day. If no issues with assigned codes, the CDS releases the bill hold; if any issue with codes assigned, the CDS will email the Coder and typically the change is made that day or the next. The Coder will email the CDS to let her know the change has been made and the CDS will release bill hold. If the Coder disagrees with the CDS, the CDS Supervisor & Coding Supervisor will discuss (typically the same or next day) and come to a resolution. Rarely is the issue elevated to Managers.

This process works well for us and prevents re-bills. The only real delay is if the CDS identifies a need for a query. If query necessary, the CDS will initiate and notify the Coder so that she is aware.

We use JA Thomas CDI software so the 2nd Look CDS also reconciles the case in CDMPGuide once the 2nd look is complete.

Good luck with your process - we went thru several before we found one that worked for our team (CDS - Coder - Billing) and did not unnecessarily hold bill from being dropped!
Sharon

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

Thank you, Karen and all who responded!
Karen, which list you are using for mismatched DRG in 360? Do you mean the 01report?

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

arozhkovskaya

Ok, I see. Thanks, Karen. We spoke about this issue with 3M trainers and they recommend to use 01. I found it very confusing report..I know about 06 report, but our management want to eliminate all different DRG reasons except "optimal selection" since it creates negative impact on relationship between to groups- CDI and coders.

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