Coding Mismatches

Good evening, 

I'm looking for any insight on practices/processes on how your programs are handling mismatches?  I'm available to discuss by phone (email me).  I have two examples. 

1. CF admission: Pt is admitted d/t CF exacerbation w/ cough/congestion/respiratory distress.  Documentation states admitted due to CF exacerbation triggered by coronavirus (non Covid-19) infection. Pt was treated for 14 days of IV abx and was d/c home. Pt also had Lukens growing Psuedomonas and several other bacterias. Coding wants to resequence the PDX from CF to coronavirus infection B34.  I sent a detailed message including coding clinics/and nosologies supporting CF exacerbation as PDX and the Coding Manager is still questioning my reasons for sequencing CF as PDX. 

2. RSV Bronchiolitis: Coding wants to report respiratory failure, CDI wants to report RSV bronchiolitis. RSV provides better LOS and RW (we use APR-DRG)



  • Hi Jorde,

    I see this is from April 2020, but I am interested how this played out.

    Case number 1 I agree with your assessment and am very interested to know what was decided. At University of Chicago we developed a QA team comprised of Coders and CDI's and when we have a mismatch that we cannot come to an agreement amongst each other we will request having it sent to QA team and they all do a review of the chart and we have a discussion and come to a final decision. This seems to work well as I came from another institution where the mismatch policy was "the coder has the final say". Which caused some animosity with CDI team as it felt like our clinical knowledge was undermined.

    Case number 2 I am unsure. I note many times coding wants to lead with respiratory failure and CDI as in this example would want to report the RSV bronchiolitis. I think from our perspective the LOS and RW (we use APR-DRG in our pediatric population as well) is more important. In our adult population we also have to take into consideration our risk models as well as we also concentrate on our O/E.

    I am very curious to know the outcomes of these cases. Feel free to contact me at my below information. As I have noted a lot of valuable information you have posted in other threads and I am searching the forum and other areas for information on Neonatal Cases. We have started up our NICU Reviews in Feb 2023. I am at University of Chicago/ Comer's Children's Hospital. We see about 1000 admits a year in our NICU. Our NICU features 47 designated tertiary care beds (Level III) and 18 convalescent (Level II) beds. We have some new providers in the NICU and they are very motivated to work with CDI. So any and all information you might have or any specific education you may know of to point me in the right direction would be most appreciated.

    I am mostly remote. When I am on campus I am out rounding and educating the new residents and fellows as it is that time of year again! 😊 We each do one day a week on campus for a few months for education of new providers. I am easiest to reach by text/cell or email.

    Thank you in advance.

    Shannon M. DiSilvestro (Sifuentes) BSN,RN, CCDS

    Clinical Documentation Specialist

    The University of Chicago Medicine

    5841 S. Maryland Ave. | Rm. W-020, B-04 | Chicago, IL

    Office: 773-702-4074

    Mobile: 773-571-3629

  • Shannon:

    Go on the networking groups section of this site and choose the Pediatric Networking Group. There are resources posted there on the site you are free to use.

  • Amy thank you so much!

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