CDI program and when they query
Hello,
I have encountered a CDI team that will only perform concurrent and retrospective queries when it changes the DRG/SOI/ROM. If it does not then they will not query. Coders are not allowed to perform the retro queries at this facility and then the end result is that certain diagnosis are never reported . I thought this was inappropriate and unethical and not consistent with both AHIMA and the ACDIS code of ethics? I thought the main purpose, mission and vision for a CDI program was to facilitate the accurate representation of a patient’s clinical status that translates into coded data. To promote and ensure high quality documentation. Is this the same practice that other organization are doing? Coding is so much more the DRG/SOI/ROM. Coded data affects public health data, state reporting, cancer registry and disease tracking and trending, etc. etc. So what I am missing here?
Thank you for your insight
I have encountered a CDI team that will only perform concurrent and retrospective queries when it changes the DRG/SOI/ROM. If it does not then they will not query. Coders are not allowed to perform the retro queries at this facility and then the end result is that certain diagnosis are never reported . I thought this was inappropriate and unethical and not consistent with both AHIMA and the ACDIS code of ethics? I thought the main purpose, mission and vision for a CDI program was to facilitate the accurate representation of a patient’s clinical status that translates into coded data. To promote and ensure high quality documentation. Is this the same practice that other organization are doing? Coding is so much more the DRG/SOI/ROM. Coded data affects public health data, state reporting, cancer registry and disease tracking and trending, etc. etc. So what I am missing here?
Thank you for your insight
Comments
There are several important data points outside of DRG/SOI/ROM that merit a query. Examples include HCC level diagnoses, diagnoses which affect quality/value-based purchasing, patient safety data and now days, clinical validation and medical necessity. The days of only coding for MS and APR DRGs are gone and frankly, have been gone for some time now.
As a coding manager I find it unfeasible that coders not be allowed to do retrospective queries when coding the chart. What may be happening is a focus on the financial impact only along with a desire to limit the number of queries physicians have to fill out. Without knowing more I'd say there needs to be education provided to administration of the need for accurate reporting (thus the need for queries) so the policy is updated to reflect current times. Reflecting the accurate condition of your patients an capturing all data points (including HCC codes) requires a robust CDI and coding query program.
Erik Kilbo, CCS, CPC-I, CCDS, CDIP
As one that has managed both coding and CDI projects, I concur totally with Erik. We need to consider just how many impactful codes that are reported impacting $$ and quality measures. As one example, in our region, we have 35,000 discharges and we have 5 CDS assigned. We review about 10,000 accounts annually - not even 50%. No matter how well-trained and staffed, no CDI can concurrently review all key diagnoses at all sites; there should always be a mechanism for trained coders to perform queries.
Some coding teams are now forming subsets of coders (with the CCDS or CDIP) that function to both interact with the CDS team as well as to issue retrospective queries. Such teams insist these coders obtain training and credentials germane to the CDI process - the same process and training expected of any CDS professional.
The time constraints on production coders are enormous, as many are expected to code 25+ charts per shift...every diagnoses should be 'vetted' and then they have to assign PCS codes - this is a daunting task. I have done and managed both production coding and CDS for decades, and in my view, coding is more difficult and time-consuming.
I know that coders can, and do, function proficiently via the query process; but, given the time it takes to properly issue a query, many coding managers do not want the staff coders issuing queries as this greatly impacts 'productivity'. For that reason, some coding teams are forming these staff dedicated to work in the query function, complementing the concurrent CDS teams.
Paul Evans,
CCDS