Types of cases reviewed by programs

Good afternoon

I am interested in types of cases each program reviews.

D/C records. Once a case is discharged does your team review and write retro queries?

How long do you continue to review a record with drg 03 or 04?

Cases with long LOS as inpatients how long do you continue to review the case?

Please feel free to contact me

Robin Matthews manager of MaineHealth CDI program





  • Hello Robin,

    Our CDI program does, on occasion, review discharged cases. A little background- we use a prioritization software and sometimes a patient will be on our review list but will discharge. We do briefly review and, if there is opportunity, we will send a query after discharge (assuming the coder has not received the case).

    DRG 003 or 004- We continue to follow through discharge and ensure accuracy and specificity of conditions treated are documented. This does sometimes include redundant MCC/CC/HCC's but our goal is documentation integrity and accuracy.

    Long LOS- We follow cases from admission to discharge, including long LOS. Caveat- we rely upon our prioritization software to determine when a long LOS case comes up for review again- sometimes it's due to clinical change and other times is due to the time interval since last review.

    Hope this helps!

    Buddy Morgan, BSN, RN

    CDI Program Manager- Providence St. Peter Hospital, Providence Centralia Hospital, Providence St. Mary Hospital, Kadlec Regional Medical Center

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