Code reconciliation

ferrot

I  am reaching out to other hospital systems to determine best practices! We are currently having an issue with code reconciliation upon discharge and have found that final codes are missing codes/risk variables that CDI picked up during their concurrent reviews. Many of them are more vague codes like cardiac arrhythmias, and debility risk variables such as weakness, malaise that CAC does not pick up, but that carry weight for SOI/ROM. We've tried several work flow tweaks and the problem persists. One option is to turn on the functionality of 3M to have coders "accept" CDI codes and we are wondering how many other hospitals use this functionality and what the pros/cons are.

1. If you use 3M, do you utilize the functionality that allows coders to accept CDI codes at the start of their review?

2. If not, why don't you? Pros/cons?

Thank you so much for your time!

Sincerely,

Tracy Ferro RN, MSN

Medical University of S.C.

sharon.cooper@owensborohealth.org

Tracy,

We do not use 3M.  I don't think we have ever considered utilizing a functionality that would allow the Coder to 'accept' CDI codes, but it certainly sounds doable.  We currently utilize the following pre-bill process to assure CDI & Coder assigned codes match: 

• CDI codes the chart concurrently. 

• Patient discharged.

• Coder codes the encounter and then routes the account to a CDI Work Queue in Epic.  A stop bill is automatically attached to all encounters added to this specific WQ by the Coder.

• CDI Supervisor compares codes assigned by Coder to codes assigned by CDI.  If omissions or discrepancies are found by the CDI Supervisor she will email the Coder and request codes be added/changed.

• Once code omissions or discrepancies are resolved the CDI Supervisor will complete the encounter in the WQ which in turn releases the bill hold. 

Thanks,

Sharon

Sharon Cooper, MSN, RN-BC, CCDS, CCS, CDIP, CHTS-CP, AHIMA-Approved ICD-10-CM/PCS Trainer                                                                                                                                                

Manager Clinical Documentation/Appeals                                                                                                

Owensboro Health Regional Hospital                                                                                                       

Owensboro, KY     

    

evanspx@sutterhealth.org

Have you asked Coding ‘why’ the do not pick some of these conditions?  Many times, coders will not code what your termed ‘vague’ codes because they may not be separately reportable or may not qualify as a reportable condition.  This seems to be a part of the issue

Cayleb

If I were you I would sit down with a coder and go through some examples, In order to determine if this is  a real issue or maybe this is happening because of what Paul is pointing out in his response.  

vparent@emhs.org

We do not utilize the ability for coders to accept CDI codes. The coders formulate their own and compare with the CDI results and if their are differences in SOI/ROM, DRG, etc. we discuss it before final billing.

aletmartinez@salud.unm.edu

Do you have specific expectations for the accuracy of the PDx that the CDS chooses?  Do your CDS's have to maintain a certain % of accurate PDx?  I cannot find any benchmarks for this so would love to know if any of you know where I can find these metrics.  Thanks!