I was wondering, for those of you who have a mismatch process, do you hold CDI accountable for the correct PCS code as part of their evaluation/metric?
No. I try not to make DRG accuracy a focus with the CDI's. Its most important that they are clarifying documentation when indicated rather than selecting the appropriate DRG. Especially when it comes to PCS codes, I really don't want the CDI's spending an extensive amount of time figuring these out if they are not familiar with the procedure code.
We do reconcile DRG's but I have yet to evaluate them on PCS accuracy.
I do agree with Katy's comments, however CDI has found errors in procedural coding both in ICD-9 and ICD-10. Depending on your facilities resources, it can be an invaluable tool, especially when a particular proc code or DRG appears questionable. I would not hold CDI accountable, but would work with the DRG validator or lead coder at your site to review! Of course very challenging and time consuming Lori
We try to make sure that we have the correct APR DRG, but I try not to hold them accountable.If they are able to get at least the root operation then that will point to the correct APR. However, we do look for the correct documentation within the surgical note for example laterally.
Comments
No. I try not to make DRG accuracy a focus with the CDI's. Its most important that they are clarifying documentation when indicated rather than selecting the appropriate DRG. Especially when it comes to PCS codes, I really don't want the CDI's spending an extensive amount of time figuring these out if they are not familiar with the procedure code.
We do reconcile DRG's but I have yet to evaluate them on PCS accuracy.
Katy
I would not hold CDI accountable, but would work with the DRG validator or lead coder at your site to review!
Of course very challenging and time consuming
Lori