CDI/RN vs. CDI/Coder

The HIM Director at our hospital is looking to hire coders as CDI's to fill a few vacant CDI positions. My question is: Would the RN/CDIs be considered their managers & if so would the Coders/CDI be under the license/supervision of the RN/CDI's?  Also, would the coders be able to query the Physicians the same way the CDI/RNs do?

Comments

  • CDI professionals can be RN's, Coders, or other healthcare professionals. That is the determination of the hospital. Coder CDI's can work autonomously as just as RN's can and can work independently and place queries just as an RN. There is no credential requirement for CDI's.


    Katy 

  • Regardless of the credential of the CDI, nobody works under license of another person unless there's something dictated by your state law. Even if the CDI Supervisor/Mgr is an RN with an all RN staff, there's no functioning under someone's license. All persons issuing queries should adhere to the AHIMA/ACDIS Query Practice Brief.

    Jeff

  • Just a quick response to your questions, as this is really a Pandora's box!  The role of the CDI specialist is not limited to RNs, and there are many coders who are CDI specialists.  I would think that anyone who becomes a CDI specialist would report through the CDI manager, whether RN, coder, or MD.  There are many highly knowledgeable coders who seek positions as a CDI specialists and successfully sit for their CCDS certification.  The ACDIS/AHIMA Practice Brief for Compliant Query Practice does not differentiate who writes a query.  Many facilities have their coders issue queries to the physicians.   Critical thinking, communication skills, clinical knowledge, coding knowledge are all skills needed for a CDI specialist.  These are not limited to nurses, as many coders demonstrate these essential skills as well.   
  • Anyone issuing a query should follow industry published Best Practice, regardless of background.  If you wish to research,  CDI and Query Best Practice articles and position papers can be found in the search function of this web site.  I'd state, too, holders of the CCDS exam have passed a test demonstrating common core set of competence.  I'd urge all members of ACDIS to support each other, and honor this credential in order to ensure its place in this profession.

    Paul Evans, RHIA, CCDS

  • I have several CDI teams with staff members with either nursing or coding backgrounds. The varied backgrounds complement each other and  both are considered a valuable skillset. The coders review the clinical picture with the nurses and the nurses consult the coders for coding related guidance.  Both backgrounds are managed with the same expectations for productivity and query standards. 
  • Hi agree, a CDI can be RN, Coder, Resp therapist, and they all fall under the CDIS manger/ or supervisor.

    I think that having a melting pot of various background is a great mix.


    Steph

  • I started in a CDI background where the entire CDI team was RNs.  It was difficult because we were focused on an RN direction.  Now I work with a CDI coder in a relatively small community hospital.  We average about 20 charts a day.  We are usually at 150-200 bed capacity.

    I think having both a RN CDI and coder CDI brings a great concept to the table and I feel we are more advanced because I bring the clinical RN background and skillset but have relatively little knowledge about the ins/outs of sequencing guidelines, PDx determination and what the mindset of a coder is when they code the final chart.  The coder I work with also has insight into the charge and billing process as well as the bundling process, MIPS, MACRA and more which no RN would know about coming into the CDI field.  As an RN, I have knowledge with HACs, PSIs, medical necessity, core measures, procedures, sepsis, etc...  This allows us to approach doctors at more expanded levels than a CDI team with a single background/skillset. :-) 

    We currently both report to a coding supervisor and whether RN or coder or other professional, we all follow the AHIMA guidelines for the query process at our facility.

    Just as a side note, a coder CDI also helps out HIM management in our field.  Any question I used to have for coding staff in my former hospital, I can now direct to the CDI coder which takes away from any productivity issues from our inpatient coders, who we also work with - it also creates more trust between coding and RN...  when you're exposed to people that bring different skills to the table is like bringing together many different cultures, there previously was a huge tension between coding staff and CDI RNs at the last hospital I worked at because of the "I'm better than you" attitude actually among the RN staff, and I'm an RN :-(.

    Chris

  • My question is simple and yet Im confused.  I worked as a CDI/RN  at one facility and we were under Case Management and had an RN as our Supervisor, we were all nurses there.  
    At this present hospital I am under HIM, and work with a CDI/Coder.  
    What Im confused about is if I am  suppose to be under a clinical person because of questions that may clinically arise? I cannot ask my Cohort CDI/Coder any clinical reference questions. I also cannot ask my HIM manager as she is not clinical or a coder In this case, is this kosher ?  

    I worked at a federal facility in the past under UR and was told I can only be managed by a Nurse in UR and not a billing a manager, and the manager was removed, this is the reason I ask.  
    I am currently a coder now and an RN still however I just need to know what is the correct criteria for this position please?
  • My question is simple and yet Im confused.  I worked as a CDI/RN  at one facility and we were under Case Management and had an RN as our Supervisor, we were all nurses there.  
    At this present hospital I am under HIM, and work with a CDI/Coder.  
    What Im confused about is if I am  suppose to be under a clinical person because of questions that may clinically arise? I cannot ask my Cohort CDI/Coder any clinical reference questions. I also cannot ask my HIM manager as she is not clinical or a coder In this case, is this kosher ?  

    I worked at a federal facility in the past under UR and was told I can only be managed by a Nurse in UR and not a billing a manager, and the manager was removed, this is the reason I ask.  
    I am currently a coder now and an RN still however I just need to know what is the correct criteria for this position please?

    I don't think the credential of your supervisor matters. I report to an RHIA and I am an RN....P.S. I love it!!!

    Jeff

  • Jeff, I am an RN/CDIS/ and I just finished coding school.  Glad you are reporting to an RHIA and you love it.  Does anyone have a real answer please? 

    jwmorris1 said:
    My question is simple and yet Im confused.  I worked as a CDI/RN  at one facility and we were under Case Management and had an RN as our Supervisor, we were all nurses there.  
    At this present hospital I am under HIM, and work with a CDI/Coder.  
    What Im confused about is if I am  suppose to be under a clinical person because of questions that may clinically arise? I cannot ask my Cohort CDI/Coder any clinical reference questions. I also cannot ask my HIM manager as she is not clinical or a coder In this case, is this kosher ?  

    I worked at a federal facility in the past under UR and was told I can only be managed by a Nurse in UR and not a billing a manager, and the manager was removed, this is the reason I ask.  
    I am currently a coder now and an RN still however I just need to know what is the correct criteria for this position please?

    I don't think the credential of your supervisor matters. I report to an RHIA and I am an RN....P.S. I love it!!!

    Jeff


    jwmorris1 said:
    My question is simple and yet Im confused.  I worked as a CDI/RN  at one facility and we were under Case Management and had an RN as our Supervisor, we were all nurses there.  
    At this present hospital I am under HIM, and work with a CDI/Coder.  
    What Im confused about is if I am  suppose to be under a clinical person because of questions that may clinically arise? I cannot ask my Cohort CDI/Coder any clinical reference questions. I also cannot ask my HIM manager as she is not clinical or a coder In this case, is this kosher ?  

    I worked at a federal facility in the past under UR and was told I can only be managed by a Nurse in UR and not a billing a manager, and the manager was removed, this is the reason I ask.  
    I am currently a coder now and an RN still however I just need to know what is the correct criteria for this position please?

    I don't think the credential of your supervisor matters. I report to an RHIA and I am an RN....P.S. I love it!!!

    Jeff


    My question is, whom should I be working under, and can you provide that in writing please ?  My RHIA does not have any knowledge of an RN or CDIS work, I get no continuing education unless I am on this website. 

    I get coding education, because I work in coding, but I never understood it until I finished coding school.  My struggle is real, the other CDIS is a coder.   I have no one to throw around clinical ideas, suggestions or assistance.  You might ask " did you know this before you were hired "?  The answer is no. My interview was misleading like a query, I was made to believe the coder I work with was a nurse and my RHIA was knowlegeable about CDIS work. 

     She knows little or less, this is where I came up with the question.  When  I was under case management, I received CDIS education with other nurses, my manager was a nurse and I had other nurses to throw around clinical questions. Not to mention before I became a coder, I was interim coding all the way, and I still code now along with my CDIS responsibilities.  Dont get me wrong, I know more by coding but it hampers my true CDIS work.  Can anyone help with this please ? or email me instead diarove9@aol.com.
  • I am so sorry that I did not provide you with a "real" answer...hopefully someone can help you. It sounds like you need to talk with your supervisor and/or leadership. If true CDI duties are being hindered by you coding also, then the role of the CDI at your facility needs to be clearly defined.

    As far as education...come here to the forum and use all the resources of ACDIS, it's where many of us got our start! If it weren't for Paul Evans, Katy Good, ACDIS and many many more, I would still be lost.

    Good Luck,

    Jeff

  • It is unfortunate you were lead to believe your team would have clinical knowledge.  Our team is hybrid, and the collaboration is excellent; we all passed a clinical exam (JATA), and we have RHIAs and RHITs on the CDI team.  We all participate fully in every avenue of the CDI profession.  I'd echo Jeff's thoughts to utilize the resources of ACDIS as best you can in order to find and study clinical topics.  Our team also has a great many staff holding the CCDS credential, and clinical knowledge is required to sit for that exam.

    Paul Evans, RHIA, CCDS

  • Thanks Jeff and Paul.  I would do that, I will be taking the CCDS and the CCS exams shortly also.  Do you or anyone know the answer to my first question? Who should be in charge of the CCDS's / RN/s?
  • Hi,  There is no correct answer, in my opinion.   I work for the Quality Department, and they are great folks.  But, some of those to whom I report have no technical or practical knowledge about coding or for that matter, anything that pertains to CDI work.    Since you don't have any peers within your immediate department with whom you can share clinical issues or topics, it seems you may need to reach out to PAs, NPs, MDs, and RNs at your site that can provide you with clinical input and opinions?  I am very fortunate to work with a great team and we help each other quite a bit.  But, we also seek out clinical input from  the various subject matter (clinical) experts in our institution when we wish to dive deeply into select clinical issues.  We contact RD, or wound care, or nursing educators on a range of topics, and they often provide great advice.  I am an RHIA, and I am 'in charge' of my team, which includes RNs.  But, I did pass the CCDS test, which includes clinical topics, and I also passed the JATA exam....it depends upon the individual IMO.  Be assured I am very confident discussing clinical matters with my team and our physicians.

    Best,

    Paul Evans, RHIA, CCDS

  • Can you be my mentor for questions ? I have one...lol

  • Are you addressing me?  If so, here is my contact information.  I am always happy to share ideas with anyone. 


    Paul


    evanspx@sutterhealth.org

  • I concur with Jeff and Paul,

    There is no legal requirement that you be under someone with specific credentials, nor is there really a 'should'. There are many ways which a CDI is structured and in my experience, the deciding factor in the success of a program is the demeanor and drive of those doing the work, not the credentials they hold (not that credentials aren't valuable in general, as they establish baseline proficiency).

    Your situation is not unique. Most/many of us started in positions where we were uneducated in this specific field, under-prepared, and unsupported. I started CDI without even knowing what a DRG was and was tasked with starting a program. I was the sole CDI with an NP (without CDI experience) as my manager. This kind of role requires a ton of self-direction and perseverance. And a lot of HELP!

    Definitely reach out on these forums and pose questions to the group. Participate in any other ACDIS events you can attend (local chapter and/or national events). Sign up for free webinars, ACDISRadio, and quarterly calls. Read all the journals. The only way I made it through my first year as a CDI was by reading everything I would get my hands on and asking a lot of (dumb) questions. ACDIS is an incredible community and people are very supportive of eachother.

    Good luck!

    Katy Good, RN, BSN, CCS, CCDS

  • HA !, thanks Katy, I feel so much better now.... :)    Paul Im going to reach to you, thank you so much. I will stay on this site...continue learning as well.  All you guys are awesome!
  • edited October 13
    Thanks Jeff and Paul.  I would do that, I will be taking the CCDS and the CCS exams shortly also.  Do you or anyone know the answer to my first question? Who should be in charge of the CCDS's / RN/s?
    I work in a Magnet facility so all RNs must have a reporting structure that reports to a nursing professional. So, while myself and my RN colleagues report directly to the HIM director (RHIT), we also report through nursing to the Executive Director of Nursing, Acute Care Services

    We are the first nurses ever in our department (been about 2-1/2 years now) so there was no understanding of Magnet, of nursing requirements related to Magnet (for example, reporting certifications and achievements for Magnet redesignation, etc), recognition through nurse's week, or recognition of certified nursing achievements. One of the HIM staff members told me, "Well, you work in HIM now so you are not really a nurse" prior to our facility organizing the structure such that we reported to a nursing professional. Frankly, I found this comment offensive and had to point out what Magnet is and why RNs are always nurses, regardless of the setting. We are recognized during Nurse's Week and certified nurse's week by our nursing colleagues. 

    I am not sure if you work in a Magnet facility or if you have such a requirement, but in my personal experience, it is important to be recognized both as a nurse and CDS and be appreciated for the unique perspective nursing brings to the table working in an innovative and nontraditional role (just as coders are recognized and appreciated for their certifications and expertise).

    Jackie Touch, MSN, RN, CCDS, CCM, CPN

  • Hi Jackie,
    I know this is a late response, I am just now checking in to see if there is anything new I could learn. I am so happy to see you say all this from a Nursing perspective. Unfortnately, I was told the same exact thing from the HIM dept. staff, where I am as well.  I was a bit offended myself, at the time, not a Coder and I felt like I was in ISOLATION and at their mercy.
      They did say a Nurse can never do this 'job' as a CDIS and be as effecient as a CCS.  I honestly had  no idea how to code, however I did come from another facility where it was an all  RN based CDIS program and entering a DRG , working the Queries, along with educating the physicians etc was more of what I did. Without coding, meeting my benchmark productiity was easy.

    This place was an eye opener, I must say.  Even More shocking when I was told I will be taught how to interim code and the 3M program will be my teacher.  A coding productivity will be required and doing my job as a CDIS will be incorporated. I spend more time coding now than being a true CDIS to say the least.

    It was not expected for me to succeed, or even end up with the right DRG, (I just used my DRG Expert book, instead of the 3M, because I was at times being strayed in 3M if I wasnt sure which route to go.)  Then I went back to 3M to come up with the right DRG.

    I did interim code like a blind man, it was a hit and miss and alot of snickering.  Needless to say, I didnt do well at coding with very little guidance, but I took what CDIS knowledge I had and ran with it.  My accuracy was right on point.  I surprised the dept and was meeting their accuracy of 95% and above.

      That's the CDIS / RN knowledge kicking there.  I decided, I needed more background and I was not getting it here, so I signed up for coding school, because now I was having fun.  Today, they see me in  a different light, but I had to prove myself to the coders. I found out there has always been a tug of war, between Coders and CDIS(RNs),  however where I came from we all worked in synchroncity and picked each other's brains.  
    My goal here now is to change the culture here, Im still flying solo and has earned respect the hard way, however by encouraging team work, they are now coming around and understands that I mean well for all of us in the dept.
    I hope one day they hire another CDIS at this facility of 400 beds, we only have 2 CDIS    - 1 RN/CDIS  and 1 CCS Coder. It's tough, and I am held at the CDIS Benchmark criteria for my productivity, with nothing pertaining to CDIS.
      It is not that easy to code and live up to the CDIS benchmark Productivity, I do what I can and code really, really fast to get on the floors and do the CDIS part of my job.  I am tired and my days are long, I come in early and or stay back at least twice a week after hours to meet the productivity, I'm salaried so no one would truly notice, as long as I get the job done.

    As of now I use this website, along with Ahima guidelines, pay for webinars on my own etc to educate myself, because my Managers are still in the dark about CDIS education, it's all coding in this dept.  Now that Im a coder, Im ok with the coding education part, it helps alot and  I am now (waiting for my testing date), I have applied and taken all the help I can get.

    Other than that, it's me, ACDIS and I will seek out Paul if need be, :smile: .  So far alot of the questions asked here are my exact questions, I love this place. Thanks again.
  • We were set up as an all RN department in 2009 but I recently had an opening and who applied?  One of our former coders who has now become a nurse!  She only has a little over a year's experience as a nurse and HR has offered her a rate of pay that does NOT include her coding experience as being pertinent.  I am now in a battle with HR to prove her worth which I truly think outweighs any other candidate to date.  I think a good blend of the two worlds will bring a whole new attitude to our department and will leave me with the opportunity to potentially open the role up to coders in the future.  I am an RN but am director of both our CDI department and our Coding department.  I am realizing after taking on both departments that a good blend of both worlds will make a stronger CDI department in the end. 
  • edited November 3
    afloyd24 said:

      I am realizing after taking on both departments that a good blend of both worlds will make a stronger CDI department in the end. 
    So true!!

    When we started in our positions as RN CDSs it was with the understanding that we are not to code the record and that the role of the CDS is different than, yet complimentary to, the role of the coder. In an ideal world, RN CDSs and coders / coding CDSs should learn from each other. Essential to achieving that goal is effective and respectful communication, which can be challenging at times, but certainly not impossible!!


  • I'd personally not expect any CDS (regardless of background) to 'code' any record to the same level of precision expected of a coding professional.   The expectation and role of CDS is  to rough code a chart with awareness  as to if/when to issue a query that will help ensure reporting of accurate information. 


    I would not expect anyone to 'final' code a record without the prerequisite education and training (and credentials) expected of any other professional.    I am a professional 'coder' by background and training, performing CDI reviews;  as such, when I review charts, I 'only' rough code the chart as a portion of a CDS review. 

    It has reported that some RNs are being asked and expected to accurately code records to a 'fine' degree,  and this seem unfair to the RN and also impractical, IMO?


    Paul

  • I agree 100%, Paul.  Our CDSs rough code which does help formulate wording for queries and identify query needs but we never final code an account and to ask them to would not be in the best interest of the facility, greatly taking away from their review process.  Our CDSs and coders work hand in hand very well and I am very thankful for that complimentary relationship! 
  • I'd personally not expect any CDS (regardless of background) to 'code' any record to the same level of precision expected of a coding professional.   The expectation and role of CDS is  to rough code a chart with awareness  as to if/when to issue a query that will help ensure reporting of accurate information. 


    I would not expect anyone to 'final' code a record without the prerequisite education and training (and credentials) expected of any other professional.    I am a professional 'coder' by background and training, performing CDI reviews;  as such, when I review charts, I 'only' rough code the chart as a portion of a CDS review. 

    It has reported that some RNs are being asked and expected to accurately code records to a 'fine' degree,  and this seem unfair to the RN and also impractical, IMO?


    Paul

    I also agree. I have been seeing many posts indicating that some programs/ facilities do expect the CDS to code the record which is, IMO, not the best use of the CDS's time and yes, as Paul stated, unfair. IMO the CDS needs to rough code to the level of assigning the correct working DRG, identify opportunities to optimize the DRG, and interact with physicians and other providers.

Sign In or Register to comment.