CDI & Concurrent Coding

dbutlerdbutler
edited May 2016 in CDI Talk Archive
Does anyone know of a facility that combines concurrent coding with CDI? where the primary role is BOTH concurrent coding and CDI? May seem like a bit of an oxymoron (a good coder who is coding concurrently I would expect would be querying concurrently.....but had a casual conversation with a HIMS manager at a small facility who is considering this kind of approach)

Thanks,
Don

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

Comments

  • michelleclynemichelleclyne
    edited May 2016
    It is my understanding that St Francis Medical Center in Grand Island,
    NE does this.
  • mahmed1mahmed1
    edited May 2016
    Our CDS staff doing both CDI with concurrent coding. we hired only physician with coding back ground. they also post LOS which help UM management.

    Thanks,

    Mohammad

    Mohammad K. Ahmed, M.D, CCS
    Clinical Documentation Specialist
    Bronx Lebanon Hospital Center
    Health Information Management
    1650 Grand Concourse
    Bronx, NY 10457
    Phone: 718-518-5119
    Fax: 718-518-5634
    Email: mahmed1@bronxleb.org
  • paxnerospaxneros
    edited May 2016
    We do some concurrent coding to the best of our ability. It is not as indepth as we want but we simply do not have the manpower.
    We make sure our PDx, MCCs, CCs, and PPx are assigned appropriately and then any other diagnoses are "gravy" for the discharge coders.

    However, I know there is an interest - in the future - for that to
    become one of our facility's goals - a CDS who can both interact concurrently with the physician to get the documentation, assign ICD coding AND...drop the bill the day of discharge.

    I have actually been a part of this process in the past when I worked in UM (before MS-DRGs and CDI) and it can be done, but you really need the manpower. You cannot allow your reviewers to carry a large census. It works if you have one large unit to cover or two small ones.

    As a Coder in the past I do focus more on "what does the coder need in order to code this chart accurately and completely" as I perform my reviews.

    NBrunson, RHIA, CCDS
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    I have some past experience performing concurrent coding - and it is a
    good idea, IF you have technology, and skilled manpower to perform.

    !. Working electronically, receive census daily for assigned patients.

    2. Code the charts concurrently based on documentation - ALL codes
    assigned as for final coding - takes a lot of time. Perform initial
    coding on day one and then add codes daily, if/when mandated by
    subsequent documentation.

    3. Query the MD if/when significant conditions need to be clarified.

    4. At discharge, send my proposed (DRAFT) codes electronically to an
    HIM-Coder for FINAL coding and bill drop. This person has final call
    and will wait for Discharge Summary and late dictations, if needed.

    Obvious advantage was enhanced opportunity to perform concurrent query.

    HIM coder had 'final' call regarding coding decisions - we still had to
    sometimes wait for late dictated reports, and still had some MDs that
    refused to answer a query - so, while this is one workflow, was not a
    solution for all of our data quality issues.



    Paul Evans, RHIA, CCS, CCS-P
    Supervisor, Clinical Documentation Integrity, Quality Department
    California Pacific Medical Center
    2351 Clay #243
    San Francisco, CA 94115
    Cell: 415.637.9002
    Fax: 415.600.1325
    Ofc: 415.600.3739
  • sbeattysbeatty
    I think if the CDS is a certified coder this is fine. In our facility we use RNs as CDS to facilitate the clinical conversations with the MDs. Our coders do the final coding. However, we use 3M's CDIS product, and our coders use the 3M encoder. This allows us to see what level of detail the coders will need to assign the most specific code possible to accurately portray the patient's presentation and care. The coders have access to our work as they final code. It's a team effort, but I would not as an RN be comfortable final coding the chart. For me that would be a quality and compliance issue. If you have your RNs become certified coders, that's a different circumstance. From a manpower/ROI standpoint, I'm not sure it makes sense to have RN reviewers and IP coders both doing concurrent review.
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