CDS DRG not matching Coder DRG

mannb1

Someone here mentioned they no longer check for matching DRGs anymore - "not for the last 4 years", but focus more on the query process. How do you make the break from this comparison? We CDS nurses do feel "dinged" or that we have a "bad grade" when our DRGs don't match - but we are constantly told we aren't coders.
We try to read coding clinics., etc., but feel we can't be all knowing. Any suggestions?
thanks!

robert.hodges2

I only check for myself for educational purposes. No one grades me on a match and I'd be nervous if they did, for as you say, I'm not a coder. But there is always an opportunity to learn and I do ask my coders questions so I have a better understanding on how we can work together.

Robert

Robert S. Hodges, BSN, MSN, RN
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
 
P: 989-497-2500 x13101
F: 989-321-4912
E: Robert.Hodges2@va.gov
 
"To climb a steep hill requires a slow pace at first."  -William Shakespeare
 

bea.smith

What do you mean when you say "they no longer check for matching DRGs"? Who are you referring to? Do you mean the initial DRG compared to the final code DRG?

Unknown

This is the same process we use. Also sometimes if there is not a match it's because the coder missed something like a query that was in the chart and answered. We learn from each other. No one is "dinged" if we don't match, we are looking for the most accurate documentation.

Gina Spatafore, RN
Clinical Documentation Integrity Specialist
Waterbury Hospital
203 573 7647

dog

Technically I get "dinged" if I don't match the coders' DRGs and there isn't a reason such as a discharge summary that comes in after I've reviewed the chart. I used to care about it, as it shows up in my statistics, but now I am secure enough in the value I add to the hospital that I pay very little attention to it.

When the CDMP software company auditor comes twice a year to audit my program, that's when I hear about it. I've given up trying to explain my position to her. The coders themselves often can't agree on a code, but I'm supposed to be a 100% match? If not matching means that I've missed a documentation improvement opportunity, then I would care because I would have made a meaningful error. But if I pick the "wrong" DRG yet got an MCC documented that otherwise wasn't there, then I've done my job. Matchy-matchy is irrelevant, AFAIC.

Linda Renee Brown, RN, CCRN, CCDS
Clinical Documentation Specialist
Arizona Heart Hospital

kari.eskens

We do not have the CDI staff calculate a working DRG. They know the terms they are looking for and query for good documentation. I do not want RN's spending time coding. They are not coders. Our philosophy is let each staff do what they are good at. RN's work with MD's and clinical info, and the coders do the coding. We have monthly meetings to discuss issues, new query opportunities, or missed documentation. It works well for us.

Kari L. Eskens, RHIA
BryanLGH Medical Center
Coding & Clinical Documentation Manager

digardsk

We get something of a criticism by the consultants for not meeting an 80% coder correlation benchmark. I personally don't worry about it too much as the coders don't always agree either. The coders commented to me once that coders don't have a 100% correlation either.

One weakness in our software is that those cases where additional information has changed the DRG (like the d/c summary) are included in the denominator. It seems to me that they should be excluded from the mix.

It seems to me that if I am clarifying what needs to be clarified, and adding to the severity, etc, that I am doing MY job!

Kim

Kim Digardi, RN
Clinical Documentation Specialist
St. Helena Hospital
10 Woodland Road
St. Helena, CA 94574

Phone: 707.967.5936
Email: digardsk@ah.org

cstukenberg

I compare the working DRG to the final DRG for accuracy and a learning tool. However, I do not get "dinged" if they do not match because the coder gets the chart after me. However, if I feel there is a discrepancy from what I thought the DRG should be, compared to what it ended up as, I will ask the coder. We have an on going working relationship. They need to feel comfortable asking the CDI for information while the chart is active and we need to be able to ask questions about why a chart went a certain way after they coded it. This is not an "us versus them" working relationship. It is a "we" team.


Colleen Stukenberg MSN, RN, CMSRN, CCDS
815-599-6820

dbutler

This was one of the aspects that provided some difficulties for us for the first 1-2 years.
One of the things it did was to impede the efforts to build a good collaborative team work between the CDS and Coding professionals, one of the key requirements for program success.

I understand the most important intent -- point toward education opportunities, learn by seeing how that @*$#% case coded out anyway, etc. and agree that ensuring that part of the mechanism is strongly preserved is a MUST.
We did stop measuring the match rate but continued a feedback loop.

Another important factor -- one has to reliably be at the appropriate DRG given the documentation available to guide your areas of focus and effort. There needs to be a way to ensure this.

In addition to the fact that coders don't agree 100%, we also found some inconsistency in how the coders applied the 'grade'.

It is a tool that I wouldn't hesitate to use in so far as looking at measures -- ie, does one CDS fall significantly out of the range from among their peers? As an absolute measure of program success or quality, not so much.

We are not capturing this data measure and haven't for 3 years as we started to individualize our program away from the cookie cutter consultant model.

As far as how to approach -- look at what other measures you are using, consider a quality audit of reviews, etc. to help monitor the vitality and quality of the program and individual efforts.

Don

Donald A. Butler, RN, BSN
Manager, Clinical Documentation
PCMH, Greenville NC
dbutler@pcmh.com

dbutler

Exactly!!

And to agree with another point some one raised, often this process of comparing DRGs does reveal something that the coding professional (human like the rest of us) may have overlooked. Another aspect of organizational value.

Don

kelleywalrath

We can't expect to have all the up to date coding information - unless
you have 3M Encoder or something. Even then sometimes our DRG is more
appropriate because we may have the clinical knowledge that would arrive
at a different DRG. If you are a RN it's important to keep up with new
meds, dx, etc. When 2007 changes came about, there was so much for
everyone to learn that we often did not match the coder DRG. It was
causing a lot of interruptions especially for coders. I then suggested
we do just the principal and complications and that has worked much
better for all of us. We feel we should do our jobs - seeing what's
missing, clarifying, querying, teaching and let the coders see where the
DRG lands. If we have done our job right, they will have what they need
- unless of course, the discharge summary turns everything around. This
is not to say we don't try to keep up with coding guidelines and clinics
but that is not our main focus.
Kelley Walrath
Documentation Specialist Coordinator - Munroe Regional
BSN - CCDS
352-671-2589 or x6978

bea.smith

Just curious... How many on here are coders doing the CDI job without nursing degree?

kari.eskens

Our CDI team consists of 2 RN's and one RHIA/CCS to bring both components together into a cohesive team.

Kari L. Eskens, RHIA
BryanLGH Medical Center
Coding & Clinical Documentation Manager

kelleywalrath

lucky you. That sounds ideal.

Kelley Walrath
Documentation Specialist Coordinator
BSN - CCDS
352-671-2589 or x6978

mannb1

Our CDS team is one FTE & one

testes

We have two coders and 4 open spots we are actively recruiting on.....We would like a hybrid of both RN's and coders. We had one nurse but she left due to salary.


Tiffany Hanner Estes, RHIA
Documentation Specialist
UNC Hospitals
MIM Department
Phone 919-843-2449
testes@unch.unc.edu



"Having the best things is not a subsitute for having the best life." Oprah Winfrey

bea.smith

Yes I saw the survey, wonderful information. I agree, this forum is fantastic, especially for me as I am 2 weeks in to the CDI program at my hospital. I am a coder, which is why I am curious as to the ratio of nurses/ coders in the position. Any tips from anyone appreciated! I could read these posts all night!

mannb1

It's good to know that we have several coders on this site, too, so that we can really get advice from your coding expertise!

Becky Mann, RN, CDS

bea.smith

Sure I'd be happy to assist any way I can.

dbutler

Tiffany,

Do take a look at the salary survey. Have a feeling your scale might be low. Having said that, after seeing the survey I think we are also low, but haven't had any difficulty attracting very qualified candidates in the past.

At PCMH, we have a CDS team of 9 nurses & manager....currently looking at changing one position that will be coming open to specifically seek a coding professional. Work closely with and have a good relationship with the coding department.

Don

dbutler

Also look back on the web site poll questions. There was one recently (few months) and one within the first months that addressed that specific question. As I recall, 60% + nurses in the roll by these 2 polls.

Don

testes

Thanks Don, Yes we are low. Mainly because we are a state ran hospital and you know how hard it is to get money from the state!! Everything has so much red tape wrapped around it! We did ask for a salary increase in the new budget year.....don't know if will get approved though.


Tiffany Hanner Estes, RHIA
Documentation Specialist
UNC Hospitals
MIM Department
Phone 919-843-2449
testes@unch.unc.edu



"Having the best things is not a subsitute for having the best life." Oprah Winfrey

dallend@einstein.edu

Our program put this change in place about 4 years ago after much pleading. I saw no purpose in having CDS worrying about the DRG assignment. When MS DRGs came into the picture (all of the DRG numbers changed, MCC and CCs) it just reinforced what I was stating to my management. Do you want us to worry about the DRG#, with a MCC or CC... - it's nuts.
I felt that our job as Documentation nurses was to clarify any documentation discrepancies in the patient chart so the coders can do the best job possible when coding. There should be no questions (at least major ones) when they get the chart to code.
We do look at the prin dx and comorbidities after coding. There are times when we may have a different princ. dx or we queried for a CC or MCC and it is not coded. We take them back to the coder or the coding manager to be reviewed. We have a good relationship with our coders - usually this process goes smoothly.

dallend@einstein.edu

We have 3 FTEs, 2 RNs and I Coder with her BSN (is not taking boards).

dallend@einstein.edu

We stopped matching our DRG with coder DRGs about 4 years ago for the same reasons you have stated. Our job is to obtain the documentation the coders need to ensure the chart is coded to the appropriate DRG. We are not coding so we shouldn't have to worry about the DRG. If we have a different princ. dx than the coder - we may review the chart again and, if need be, take it back to the coder for review.

Unknown

For those of you who do not have CDS' calculate DRGs, how do you keep
track of DRGs that are moved with a query, or don't you?


Stacey Forgensi, RN, CCRN, CCDS
Clinical Documentation Specialist
Pager 642-1011

robert.hodges2

I’m still just me. But I do collaborate with the coders here. At the other VA’s where this is being done, they are using coders but want to add RN’s to the mix.



Robert



Robert S. Hodges, BSN, MSN, RN

Clinical Documentation Improvement Specialist

Aleda E. Lutz VAMC

Mail Code 136

1500 Weiss Street

Saginaw MI 48602



P: 989-497-2500 x13101

F: 989-321-4912

E: Robert.Hodges2@va.gov



"To climb a steep hill requires a slow pace at first." -William Shakespeare

kelleywalrath

We have a program by ID Inc that downloads the values of the drg's based
on the dx. We have it where we put in the working drg but the coders
do not see this. At the time coding comes back, we then insert their
drg and the system calculates the difference. We do have to manually
input the base rate each time. So we do our best guess at the drg and
if it is wrong, we haven't interrupted the coder's time. If we agree
with their code, but we did impact it, we put in the field what their
drg would have been had we not intervened. If it differs and we argue
it, there is also a way built in for us to put their original code
checked against ours.

Kelley Walrath
Documentation Specialist Coordinator
BSN - CCDS
352-671-2589 or x6978

nbrunson84

Our software calculates the DRG for us.

Also part of our job is to code the record. So we have CDI Software and
an Encoder for our use.

We enter our CDS DRG and if the DRG changes through documentation we
code the new documentation in the encoder and enter the new DRG into the
CDI software


N. Brunson, RHIA
Clinical Documentation Specialist
Bay Medical Center

arobinso

We have two RN's and one physician. However, we communicate with our coders daily. Works well for now!

Mandi Robinson, RN, BS
Clinical Documentation Specialist
Trover Health System
270-326-4982
arobinso@trover.org
"Excellent Care, Every Time"

nbrunson84

We have an LPN, RN and RHIA.



I have worked as a Clinical Inpatient Coder for 8 years (what I refer to as a "Line-coder"). But I also have 8

nbrunson84

I am a RHIA with Coding and Utilization Management background. I stated
in another post that I have always leaned towards the more clinical side
of my HIM degree.



N. Brunson, RHIA

Clinical Documentation Specialist

Bay Medical Center