CDI in the ED
Has anyone started a CDI program in their ED? I am looking to start a program in the ED and I am curious to what you are using for measures. Our E/M level assignments are conducted by the coders, which are very thorough. I know I can bring in nursing documentation for charge capture of infusions. Do you look at HCCs here? The program we use is only for inpatients right now. If anyone has any worksheets or feedback I would greatly appreciate it.
Comments
Our CDI program looks at all IVP, Infusions and hydration given to ED patients. In other words, we do a bill review for all patients who receive the above while in our ED. We are also in the middle of an extensive project. I feel like I have been working on it for months! I was tasked with looking at how our physicians select E/M levels and how they compare with our facilities billing. While doing this audit I have found a lot of interesting errors (missed revenue opportunities, charge capture errors, process errors, etc..). I have recently started reading and researching HCC's and hope to make a difference there. I would love to discuss what your CDI program is doing or thinking of doing.
Also, how does one go about measuring success of a CDI program in the ED or with observation? Are there metrics that you use? Any information would be appreciated.
Hi, Sorry for my delayed response! In regards to your question about E/M levels, I have been working with our ED physicians on understanding how to charge their E/M levels. I run monthly reports showing each physicians level charges so they can compare them with each other. Then we analyze why they decided to charge a level 2 vs level 4, etc. The goal being that they are charging consistently. Before this project they were not charging consistently. I do an audit every month looking at how each physician is charging, and I also look for any missing revenue (missed charge capture).
Currently our CDI department is developing ways to track our success for our outpatient CDI program. We are working on metrics. Currently we are just keeping track of our monthly audits. This way we see how our education with the physicians is making a difference. We are seeing a difference!
For observation patients we are looking at documentation for hydration (start and stop times) and that the orders for OBS patients are entered correctly and timely. We also review for billable OBS hours.
Hoping to expand into our day surgery department in the future. And trying to understand/comprehend HCC's. Any help with that is appreciated.
Thank you!
Jessica Stevenson, RN CDIS
Yampa Valley Medical Center
970-871-2396