RE: cdi_talk digest: February 16, 2011
Excellent discussion on CDI/coder teamwork, or lack thereof, which would indeed be unfortunate. We have had a program for 8+ years now and I can't imagine not having that close working relationship with the coders. We meet monthly, and our policies for CDI are written together and are the policies of both departments, which reinforces the concept of team despite being "different" (Quality and HI).
In our organization the CDS do all queries, and the coders forward us the details that support their thoughts regarding need for retro-queries. We then look at the chart and determine if we think the clinical picture supports the detail they seek or would like clarified. There is rarely a need to discuss because we are all looking for the same things, and the coders have the DC Summary while we do not. We only perform RQs based on set criteria-POA/HAC, only MCC/CC, impact on SOI/ROM. We give the MD 10 days to respond, then if no response it goes to the Chief Medical Officer who is VP of Medical Staff Services. He phones the MD and speaks to him directly. Usually we have a response quickly after that call.
All queries are pre-bill. We do case studies on ones we "disagree" on at our monthly meetings. It has been very educational for all of us and builds a strong team. That work as a team is responsible for the success of our program.
In our organization the CDS do all queries, and the coders forward us the details that support their thoughts regarding need for retro-queries. We then look at the chart and determine if we think the clinical picture supports the detail they seek or would like clarified. There is rarely a need to discuss because we are all looking for the same things, and the coders have the DC Summary while we do not. We only perform RQs based on set criteria-POA/HAC, only MCC/CC, impact on SOI/ROM. We give the MD 10 days to respond, then if no response it goes to the Chief Medical Officer who is VP of Medical Staff Services. He phones the MD and speaks to him directly. Usually we have a response quickly after that call.
All queries are pre-bill. We do case studies on ones we "disagree" on at our monthly meetings. It has been very educational for all of us and builds a strong team. That work as a team is responsible for the success of our program.