Keeping DRG Mismatch Reconciliation Civil

ellen.ellis@mymlc.com

Hello All,

I am looking for any ideas for keeping the DRG Mismatch Reconciliation Process more civil between the Inpatient Coders and CDI Team. I manage both the Inpatient Coding and the CDI Teams. At our facility, when the Coder finishes coding a chart they review the working DRG assigned by the CDI Specialist. If there is a mismatch they send an email to the CDI Specialist to open discussion about the mismatch.

I would like to implement a template for the Coder and CDI Specialist to use for communication so that everyone sticks to the facts. Along with this would have to be a policy & procedure as well as education for all.

In my view the DRG Mismatch Reconciliation Process is an educational tool. If used properly the coder can learn from the CDI Specialists clinical expertise and the CDI Specialist can learn from the Coders coding expertise.

I am working on putting something together from scratch but am wondering if anyone has done anything similar they would be willing to share? If not their actual work, maybe just what they have included or anything they have done to mitigate this process and keep it professional.

Thank you in advance,
Cecilee Hiller, RHIA, CCS, AHIMA Approved ICD-10-CM/PCS Trainer
(Sitting for CCDS Certification in 2017)
cecilee.hiller@mymlc.com

bmurphy@hcpro.com

Hi Cecilee, we did an ACDIS Radio show on this topic which you can find here: https://acdis.org/acdis-radio/resolving-coder-and-cdi-clashes. Please let me know if you'd like to get in touch with the guest of the show Deanne Wilk!

Jane.Brown@ensemblehp.com

Cecilee,  I'm not sure what software you are using, but our teams are able to send one another a notification within the software.  Knowing that it will always be recorded there goes a long way, I think, to promoting cordial and professional communication.  We previously had a 250 character limit, which made communication difficult.  Per client requests, the vendor increased this limit to 4000 characters, which is really helpful.  We also have an escalation process so that if the coder and CDI cannot reach an agreement after communicating back and forth about the DRG, either of them can escalate the case to myself and the coding manager for review.  We rarely have any difficulty coming to an agreement.  This has been a work in progress at our organization for several years now, and I can see the progress we've made by making this a priority. Best of luck to you.  Janie Brown RN

spiiseven@msn.com

Hi, Cecilee,

We've done alot of work in this area, having grown from meetings where coders and CDSs were on separate sides of the room to being integrated and some even sharing social media (off-work, of course).  We have a written process in place to handle mismatches, and a template that we created.  Any cases that cannot be solved by coder/CDS in one back-and-forth email or phone call are escalated to the coding manager and me.  It is the expectation that coder and CDS will utilize coding clinics/guidelines/proper indexing, and credible clinical resources to support their perspective.  It is important for leadership to set the tone for professional behavior and communication.  Unprofessional communication must be formally addressed, and should not be tolerated.  No excuses! The CDS team is regularly coached through giving and receiving feedback appropriately, and this benefits the coding/CDS interaction as well.  I will send you a copy of our template.  I'm confident you will surmount this challenge!

Tammy Vidal, BSN, RN-BC, CCDS
Network Coordinator
tammy.vidal@sluhn.org

Sally.Hamilton@parknicollet.com

I would be interested in looking at your template.

Lori.Drodge@mainehealth.org

Our hospital created my position as CDI Liaison/DRG Coordinator for this purpose.  Our process is similar to Janie Brown's outline above.  We have monthly meetings for both clinical and coding education which is helpful as well. If you're interested in what this role involves, see pages 23-24 of the Sept/Oct 2016 CDI Journal.

Debra.Clark@sanfordhealth.org

I would also be interested in the template or if someone has established an algorithm related to the reconciliation process and escalation when a discrepancy is first identified, Coding/CDI cannot resolve, and there is escalation to a Physician Advisor.  Thank you.

gspatafore

Hi Tammy,

Could you post your template? I would also be interested.

Thanks,

Gina

Sharme.Brodie@hcpro.com

while teaching both CDS and coders I have found that most agree when needing a second level review of these cases with DRG mismatches everyone agrees that the person conducting the reviews should not have any stake in the final decision. I have also heard from many coders that loosing time with these cases causes stress regarding meeting productivity so maybe having a designated liaison would help the process, this position could be part-time or full-time depending on the need. Leadership should set the tone for these discussions, stressing that it is an educational process.

izusman

Our process is completely transparent. Coders are able to see all CDI notes when they are coding the record, and both teams are able to communicate through the CDI tool in the EHR. We have also implemented the position of CDI/Coding Liaison. The position encompasses many functions, one of them is resolving the disputes.