Re-reviews?
We are a relatively new program and both the other CDS at my institution and I did not have prior experience in CDI prior to our current positions. We were initially directed to review Medicare patients with the following goals:
1. Primary review within 48hours of admission.
2. Re-Review charts every 2 days.
We have been doing this for the last 10mo or so. We currently do not cover the all payers, although we have added more than just Medicare. To fully cover our mid-sized hospital it has been estimated that we would need 4 FTE’s and we have 2, with discussion to possibly add one additional FTE in the next year.
Currently, we Re-review until discharge. I am feeling like this may not be the best use of our limited resources. I review the patients in the ICU’s. Often, we have patients here for several weeks who within the first week we have maximized the DRG, multiple MCC’s documented with high SOI/ROM. I continue to review them for their ICU time and then if they move to the floor, the other CDI then RE-reviews them too. Although we could still have opportunity to query at some point for quality purposes, I am wondering if continuing to re-review in our circumstances is appropriate. Would it be better to stop re-reviews at that point and then be able to cover more patients?
What do other hospitals do? Do you RE-review until D/C? If not, what criteria do you use to determine that it is ok to stop re-reviewing a particular patient?
Thanks for your help,
Katy Good, RN, BSN
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Office: 928.214.3864
Cell: 928.814.9404
.
1. Primary review within 48hours of admission.
2. Re-Review charts every 2 days.
We have been doing this for the last 10mo or so. We currently do not cover the all payers, although we have added more than just Medicare. To fully cover our mid-sized hospital it has been estimated that we would need 4 FTE’s and we have 2, with discussion to possibly add one additional FTE in the next year.
Currently, we Re-review until discharge. I am feeling like this may not be the best use of our limited resources. I review the patients in the ICU’s. Often, we have patients here for several weeks who within the first week we have maximized the DRG, multiple MCC’s documented with high SOI/ROM. I continue to review them for their ICU time and then if they move to the floor, the other CDI then RE-reviews them too. Although we could still have opportunity to query at some point for quality purposes, I am wondering if continuing to re-review in our circumstances is appropriate. Would it be better to stop re-reviews at that point and then be able to cover more patients?
What do other hospitals do? Do you RE-review until D/C? If not, what criteria do you use to determine that it is ok to stop re-reviewing a particular patient?
Thanks for your help,
Katy Good, RN, BSN
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Office: 928.214.3864
Cell: 928.814.9404
.
Comments
I am a one person CDI team, covering only Medicare admits. At this time, I rarely re-review charts after the initial review unless there was a query. I do have another CDI position opening up, (YAY) and I am hoping that with two people we can follow cases every 3-5 days.
Vanessa Falkoff, RN
Clinical Documentation Coordinator
University Medical Center of Southern Nevada
office (702) 383-7322
cell (702) 204-0054
vanessa.falkoff@umcsn.com
We started w/two and because we could not get to our continued stays or the entire M'Care population of our facility we were approved for a third position and hoping now to hire a 4th.
We review admissions w/in 48 hours. Depending on the type of case(Surgical vs. Medical vs. Cardiac) we then followup w/in 3 days of admission, then w/in another 2 - 3 days until discharged. If they fall into a Resource Managment nightmare then I document in my notes we are waiting on placement or whatever the holdup may be. Those cases I followup once a week - keeping an eye out for falls, UTI's...
Queries are followup'ed on a daily basis until resolved or patient discharged.
As a coder, I work on getting my Principal Diagnosis/Principal Procedure refined and my MCC's/CC's. Once I have achieved maximum DRG potential I do not waste a whole of lot of time "tweaking" minor issues. I will occasionally leave queries for specificity depending on my caseload.
I focus on underlying causes more than anything. Underlying cause of Encephalopathy, GIB, Anemia, Decubitus, Sepsis, and getting complex Pneumonias documented - i.e. Aspiration.
I also review the ICU and most of those folks are fairly easy to review/code - plenty of MCC's/CC's. The LOS of these folks occasionally become excessive. At that point I drop to a weekly followup. I make sure to check Vent/Trach status as this can affect the DRG/SOI/ROM.
I believe followup reviews should be based on the type of patient. Surgical will move fast - unless you have complications. Medical will move average unless you have resource management issues. Cardiac will move VERY fast! So you need to base your followups accordingly. You wait too long - your patient will be discharged. Review too soon and you won't have all the information you need - or you waste your time on the wrong type of patient (Cardiac Chest Pains) when your focus could be somewhere else.
Define those areas and set goals for each.
N.Brunson, RHIA, CCDS
Thank you!
Katy Good, RN, BSN
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Office: 928.214.3864
Cell: 928.814.9404
Sharon Cole, RN, CCDS
Providence Health Center
Case Management Dept
254.751.4256
srcole@phn-waco.org