CDIP

bea.smith

I am curious how some of your CDI programs are set up. Specifically, do
the coders do any concurrent coding? Who reviews the charts initially
and gets the working DRG in the system? If the CDIS finds a MCC or CC
while patient is inhouse, do you update the acct since it impacts the
DRG or do you notify the coders and they update the acct? Do all queries
come from the CDIS? Currently at my hospital, (keep in mind we are just
starting a CDIP) we have coders that do concurrent reviews each day on
their patients, and then I am on the floors most all day reviewing the
charts as well and trying to communicate/educate and verbally query the
physicians. The coders review the chart and put in the working DRG and
we meet daily to discuss any findings/ queries I have and they tell me
of any concerning charts they have, queries they have placed and need
answering, and so forth. I am not so sure this is the best use of my
time and theirs as well. Any thoughts?

Unknown

Sounds like double work.

Here I do the concurrent reviews. When the patient is discharged I have 48 hours to wrap up unanswered queries before the coder takes over.

Anytime my DRG is not a match with the final DRG the coder gives me the chart for further review and if I still disagree we talk it through.


Charlene

robert.hodges2

I do the concurrent reviews and queries for active patients. But coordinate daily with the inpatient coder should I have questions and let her know what my queries are so she can follow up if needed.

The coders don't do any concurrent coding that I'm aware of and I don't get graded on my final DRG matching their final, even though I do track that myself.

Robert

Robert S. Hodges, BSN, MSN, RN
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602

bea.smith

Do either of you enter the codes into coding software to update the DRG while the patient is inhouse or do coders do this?

dog

I do concurrent reviews; the coders do not. My software is only for me. I do not enter anything into the software that is used for actually coding the record.

If the patient is discharged before a query is answered, I notify my boss and the coders so they know there is an outstanding query and to hold the bill until I get an answer, and then let them know when I get a response.

Renee

robert.hodges2

I don't enter any codes into the coding software (I don't have access). I track it in my own database.

Robert

Robert S. Hodges, BSN, MSN, RN
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602

nbrunson84

We do the initial review - set the DRG and we do the concurrent Coding if MCC's/CC's are added or PDx changes, etc.

As I review my patient I am entering the codes in the encoder and my review into the CDI software.

My continued stays are the results of me reviewing the progress notes, reviewing my queries for documentation or speaking w/the physician. If I come across an MCC or CC I add it to the Encoder. If I do not find an MCC or CC on my initial review - or even something to query for, that's definitely a chart I'm going to look for the next day.

We have laptops loaded w/our Encoder, CDI, & Electronic Record programs - essentially all we need are the progress notes and we could really work only from our computers!! In the mornings we print out our lists, load up our "trucks" and head to the floor. Being able to review mostly from the EMR is helpful in that we don't have to "look for charts" or relinquish a chart to another discipline - or the physician.

Having the encoder is very helpful - especially when "educating" physicians and other providers. I can "show" them the impact of their documentation.

We can print our Queries to the nursing unit we are covering. I just place it on the chart.

Once the chart is discharged the Inpatient Coders finalize the Coding and either continue a query we still have outstanding or drop the chart. Hopefully all the information they need is already coded.

Currently we focus on one patient population. We have talked about all our Inpt Coders becoming CDI and covering one nursing station where we do "Everything". Part of the day would be putting the finishing touches on our charts and dropping them.

Unknown

No. I have a stand alone coding software for my use.


Charlene

bea.smith

So, if you find a MCC that will increase length of stay, how does Case Management know that the DRG has changed and more days are there? Or does this even matter? Maybe I am overthinking.

dog

When I finish my review, there is a "DRG portal" into which I enter my working DRG, including possible DRG pending queries. That portal goes to corporate, and the DRGs w/GLOS are loaded as part of a census report that goes out the next morning. That is how our case managers know what the DRG might be. I have warned them repeatedly, though, not to rely on my DRGs as gospel. Way too many variables.

Renee

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

dallend@einstein.edu

Our coders do not do concurrent reviews - coding is completed after discharge. We do not assign DRGs when we review.
We log our reviews and queries into SoftMed. Our coders review the message screen for info re: query diagnoses only.
After coding is completed we reconcile our worksheets with the attestations. If we see a discrepancy regarding prin. dx or a cc/mcc we send the case to the coder or, if need be, coding manager or compliance auditor for review.
We do all queries - concurrent and post discharge.

cbarnes

Our coders don't do any concurrent coding.
CDS's ( 4 RNs) review the chart initially.
We update the account every 24-48 hours depending on the needs of each particular case. We query up front and the coders do (@ times) post-discharge queries.
Our coders would have a cow if they had to do concurrent coding and deal w/the physicians one-to-one.