Acute Renal Failure
Since Acute Renal Failure is no longer a MCC. I would like some input on what other facilities are doing? Are you just coding the ARF, or are you asking the physicians for more specific from what is putting the patient in the ARF. Such as, the ones that are MCC',
Acute tubular necrosis, Lesion of renal cortical necrosis, renal medullary necrosis, and specified pathological lesion in kidney?
How are you approaching your doctor's on this change? This was a huge MCC for alot of facilities. Thanks for advice.
Deb.
Acute tubular necrosis, Lesion of renal cortical necrosis, renal medullary necrosis, and specified pathological lesion in kidney?
How are you approaching your doctor's on this change? This was a huge MCC for alot of facilities. Thanks for advice.
Deb.
Comments
.
Example:
(Place clinical data and risk factors from the EMR here)
Effective 10/1/10 documentation guidelines require increase specificity relative to the diagnosis of ARF/AKI. If known, please specify if the ARF/AKI is due to pre-renal, intrinsic renal, or post renal causes.
Pre-renal 2/2 dehydration Intrinsic renal 2/2 ATN
Intrinsic renal 2/2 AIN Post-renal 2/2 uretral obstruction
Other____________. Unable to determine
Debbie S.
-----Original Message-----
From: CDI Talk
To: dsmith12h@aol.com
Sent: Mon, Nov 1, 2010 5:47 pm
Subject: [cdi_talk] Acute Renal Failure
Since Acute Renal Failure is no longer a MCC. I would like some input on what
ther facilities are doing? Are you just coding the ARF, or are you asking the
hysicians for more specific from what is putting the patient in the ARF. Such
s, the ones that are MCC',
Acute tubular necrosis, Lesion of renal cortical necrosis, renal medullary
ecrosis, and specified pathological lesion in kidney?
ow are you approaching your doctor's on this change? This was a huge MCC for
lot of facilities. Thanks for advice.
Deb.
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opyright 2010
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underlying cause or condition. So essentially, nothing changed for me
or the way that I address the issue.
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
"The difference between the right word and the almost right word is the
difference between lightning and the lightning bug." Samuel "Mark Twain"
Clemens
"This email is intended only for the use of the person or office to
which it is addressed and may contain information that is privileged,
confidential, or protected by law. All others are hereby notified that
the receipt of this email does not waive any applicable privilege or
exemption for disclosure and that any dissemination, distribution, or
copying of this communication is prohibited. If you have received this
email in error, please notify this office immediately at the telephone
number listed above."
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, November 01, 2010 7:46 PM
To: Hodges, Robert
Subject: Re: [cdi_talk] Acute Renal Failure
We are asking for more specificity if the clinical critera and risk
factors are present
.
Example:
(Place clinical data and risk factors from the EMR here)
Effective 10/1/10 documentation guidelines require increase specificity
relative to the diagnosis of ARF/AKI. If known, please specify if the
ARF/AKI is due to pre-renal, intrinsic renal, or post renal causes.
Pre-renal 2/2 dehydration Intrinsic renal 2/2 ATN
Intrinsic renal 2/2 AIN Post-renal 2/2 uretral
obstruction
Other____________. Unable to determine
Debbie S.
-----Original Message-----
From: CDI Talk
To: dsmith12h@aol.com
Sent: Mon, Nov 1, 2010 5:47 pm
Subject: [cdi_talk] Acute Renal Failure
Since Acute Renal Failure is no longer a MCC. I would like some input on
what
other facilities are doing? Are you just coding the ARF, or are you
asking the
physicians for more specific from what is putting the patient in the
ARF. Such
as, the ones that are MCC',
Acute tubular necrosis, Lesion of renal cortical necrosis, renal
medullary
necrosis, and specified pathological lesion in kidney?
How are you approaching your doctor's on this change? This was a huge
MCC for
alot of facilities. Thanks for advice.
Deb.
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Judi Bates RN, BSN, CCDS
CDI Specialist
856-757-3161
Beeper 66x2906
________________________________
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 7:51 AM
To: Bates, Judith
Subject: RE: [cdi_talk] Acute Renal Failure
This is pretty much what I do. I always ask for the diagnosis with the underlying cause or condition. So essentially, nothing changed for me or the way that I address the issue.
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
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
"This email is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this email does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this email in error, please notify this office immediately at the telephone number listed above."
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, November 01, 2010 7:46 PM
To: Hodges, Robert
Subject: Re: [cdi_talk] Acute Renal Failure
We are asking for more specificity if the clinical critera and risk factors are present
.
Example:
(Place clinical data and risk factors from the EMR here)
Effective 10/1/10 documentation guidelines require increase specificity relative to the diagnosis of ARF/AKI. If known, please specify if the ARF/AKI is due to pre-renal, intrinsic renal, or post renal causes.
Pre-renal 2/2 dehydration Intrinsic renal 2/2 ATN
Intrinsic renal 2/2 AIN Post-renal 2/2 uretral obstruction
Other____________. Unable to determine
Debbie S.
-----Original Message-----
From: CDI Talk
To: dsmith12h@aol.com
Sent: Mon, Nov 1, 2010 5:47 pm
Subject: [cdi_talk] Acute Renal Failure
Since Acute Renal Failure is no longer a MCC. I would like some input on what
other facilities are doing? Are you just coding the ARF, or are you asking the
physicians for more specific from what is putting the patient in the ARF. Such
as, the ones that are MCC',
Acute tubular necrosis, Lesion of renal cortical necrosis, renal medullary
necrosis, and specified pathological lesion in kidney?
How are you approaching your doctor's on this change? This was a huge MCC for
alot of facilities. Thanks for advice.
Deb.
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Confidentiality Notice:
This e-mail, including any attachments is the
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It may contain information that is privileged and
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not the intended recipient, please delete this message, and
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Thank you
That’s the goal anyway and should be. A complete and accurate medical record. I can’t remember who said it before on here, but if the documentation is right, the finances follow. So the focus must be on getting the documentation right. If we don’t do that and only focus on the CC/MCC capture rate, then we aren’t doing the patient any favors and certainly aren’t doing anything to enhance continuity of care.
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
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
"This email is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this email does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this email in error, please notify this office immediately at the telephone number listed above."
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 11:15 PM
To: Hodges, Robert
Subject: RE: [cdi_talk] Acute Renal Failure
Folks, here is a novel idea, let's focus on the clinicals in the chart and capitalize upon the opportunity to educate physicians on the benefits of specificity, accuracy and detailedness of clinical documentation, how this information supports the reporting of their practice of medicine, the capture of the clinically relevant cc/mcc is a byproduct of our educational efforts. The continued focus upon capturing the "all mighty" CC/MCC is not and should not be the underlying foundation of clinical documentation improvement. Unfortunately, this is exactly what consulting companies are promulgating for their very existence. I have deep concerns about how this CC/MCC capture mentality is going to be a real detriment to our profession of CDI.
Thank you
-----Original Message-----
From: CDI Talk
Sent: Nov 2, 2010 7:36 AM
To: glennkrauss@earthlink.net
Subject: RE: [cdi_talk] Acute Renal Failure
We revamped our query for AKI to include questioning for the etiology of AKI to capture the ones that are MCC’s. We did not note them specifically thinking this would look to much like leading for the MCC’s.
Judi Bates RN, BSN, CCDS
CDI Specialist
856-757-3161
Beeper 66x2906
________________________________
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 7:51 AM
To: Bates, Judith
Subject: RE: [cdi_talk] Acute Renal Failure
This is pretty much what I do. I always ask for the diagnosis with the underlying cause or condition. So essentially, nothing changed for me or the way that I address the issue.
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
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
"This email is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this email does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this email in error, please notify this office immediately at the telephone number listed above."
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, November 01, 2010 7:46 PM
To: Hodges, Robert
Subject: Re: [cdi_talk] Acute Renal Failure
We are asking for more specificity if the clinical critera and risk factors are present
.
Example:
(Place clinical data and risk factors from the EMR here)
Effective 10/1/10 documentation guidelines require increase specificity relative to the diagnosis of ARF/AKI. If known, please specify if the ARF/AKI is due to pre-renal, intrinsic renal, or post renal causes.
Pre-renal 2/2 dehydration Intrinsic renal 2/2 ATN
Intrinsic renal 2/2 AIN Post-renal 2/2 uretral obstruction
Other____________. Unable to determine
Debbie S.
-----Original Message-----
From: CDI Talk
To: dsmith12h@aol.com
Sent: Mon, Nov 1, 2010 5:47 pm
Subject: [cdi_talk] Acute Renal Failure
Since Acute Renal Failure is no longer a MCC. I would like some input on what
other facilities are doing? Are you just coding the ARF, or are you asking the
physicians for more specific from what is putting the patient in the ARF. Such
as, the ones that are MCC',
Acute tubular necrosis, Lesion of renal cortical necrosis, renal medullary
necrosis, and specified pathological lesion in kidney?
How are you approaching your doctor's on this change? This was a huge MCC for
alot of facilities. Thanks for advice.
Deb.
---
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It may contain information that is privileged and
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the consulting company that works for us!! Currently we ask questions as
we see them ...... not if there is a MCC/CC ................ boy do they
have a problem with me!
Thank You,
Susan Tiffany RN, CCDS
Supervisor Clinical Documentation Program
Guthrie Healthcare System
phone: 570-882-6094, pager #465
fax: 570-882-6768
email: tiffany_susan@guthrie.org
"Twenty years from now you will be more disappointed by the things you
didn't do than by the ones you did do. So throw off the bowlines. Sail
away from safe harbor.Catch the trade winds in your sails. Explore. Dream.
Discover." Mark Twain
CDI Talk
11/03/2010 07:55 AM
Please respond to
cdi_talk@hcprotalk.com
To
tiffany_susan@guthrie.org
cc
Subject
RE: [cdi_talk] Acute Renal Failure
Here, here!
That’s the goal anyway and should be. A complete and accurate medical
record. I can’t remember who said it before on here, but if the
documentation is right, the finances follow. So the focus must be on
getting the documentation right. If we don’t do that and only focus on
the CC/MCC capture rate, then we aren’t doing the patient any favors and
certainly aren’t doing anything to enhance continuity of care.
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
"The difference between the right word and the almost right word is the
difference between lightning and the lightning bug." Samuel "Mark Twain"
Clemens
"This email is intended only for the use of the person or office to which
it is addressed and may contain information that is privileged,
confidential, or protected by law. All others are hereby notified that the
receipt of this email does not waive any applicable privilege or exemption
for disclosure and that any dissemination, distribution, or copying of
this communication is prohibited. If you have received this email in
error, please notify this office immediately at the telephone number
listed above."
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 11:15 PM
To: Hodges, Robert
Subject: RE: [cdi_talk] Acute Renal Failure
Folks, here is a novel idea, let's focus on the clinicals in the chart and
capitalize upon the opportunity to educate physicians on the benefits of
specificity, accuracy and detailedness of clinical documentation, how this
information supports the reporting of their practice of medicine, the
capture of the clinically relevant cc/mcc is a byproduct of our
educational efforts. The continued focus upon capturing the "all mighty"
CC/MCC is not and should not be the underlying foundation of clinical
documentation improvement. Unfortunately, this is exactly what consulting
companies are promulgating for their very existence. I have deep concerns
about how this CC/MCC capture mentality is going to be a real detriment to
our profession of CDI.
Thank you
-----Original Message-----
From: CDI Talk
Sent: Nov 2, 2010 7:36 AM
To: glennkrauss@earthlink.net
Subject: RE: [cdi_talk] Acute Renal Failure
We revamped our query for AKI to include questioning for the etiology of
AKI to capture the ones that are MCC’s. We did not note them specifically
thinking this would look to much like leading for the MCC’s.
Judi Bates RN, BSN, CCDS
CDI Specialist
856-757-3161
Beeper 66x2906
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 7:51 AM
To: Bates, Judith
Subject: RE: [cdi_talk] Acute Renal Failure
This is pretty much what I do. I always ask for the diagnosis with the
underlying cause or condition. So essentially, nothing changed for me or
the way that I address the issue.
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
"The difference between the right word and the almost right word is the
difference between lightning and the lightning bug." Samuel "Mark Twain"
Clemens
"This email is intended only for the use of the person or office to which
it is addressed and may contain information that is privileged,
confidential, or protected by law. All others are hereby notified that the
receipt of this email does not waive any applicable privilege or exemption
for disclosure and that any dissemination, distribution, or copying of
this communication is prohibited. If you have received this email in
error, please notify this office immediately at the telephone number
listed above."
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, November 01, 2010 7:46 PM
To: Hodges, Robert
Subject: Re: [cdi_talk] Acute Renal Failure
We are asking for more specificity if the clinical critera and risk
factors are present
.
Example:
(Place clinical data and risk factors from the EMR here)
Effective 10/1/10 documentation guidelines require increase specificity
relative to the diagnosis of ARF/AKI. If known, please specify if the
ARF/AKI is due to pre-renal, intrinsic renal, or post renal causes.
Pre-renal 2/2 dehydration Intrinsic renal 2/2 ATN
Intrinsic renal 2/2 AIN Post-renal 2/2 uretral obstruction
Other____________. Unable to determine
Debbie S.
-----Original Message-----
From: CDI Talk
To: dsmith12h@aol.com
Sent: Mon, Nov 1, 2010 5:47 pm
Subject: [cdi_talk] Acute Renal Failure
Since Acute Renal Failure is no longer a MCC. I would like some input on
what
other facilities are doing? Are you just coding the ARF, or are you asking
the
physicians for more specific from what is putting the patient in the ARF.
Such
as, the ones that are MCC',
Acute tubular necrosis, Lesion of renal cortical necrosis, renal
medullary
necrosis, and specified pathological lesion in kidney?
How are you approaching your doctor's on this change? This was a huge MCC
for
alot of facilities. Thanks for advice.
Deb.
---
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CONFIDENTIALITY NOTICE: This e-mail, including attachments, may
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Keep up the good work there at your facility
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
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
"This email is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this email does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this email in error, please notify this office immediately at the telephone number listed above."
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Wednesday, November 03, 2010 8:42 AM
To: Hodges, Robert
Subject: RE: [cdi_talk] Acute Renal Failure
I fully agree!!!! My biggest hurdle is not the facility I work for, but the consulting company that works for us!! Currently we ask questions as we see them ...... not if there is a MCC/CC ................ boy do they have a problem with me!
Thank You,
Susan Tiffany RN, CCDS
Supervisor Clinical Documentation Program
Guthrie Healthcare System
phone: 570-882-6094, pager #465
fax: 570-882-6768
email: tiffany_susan@guthrie.org
"Twenty years from now you will be more disappointed by the things you didn't do than by the ones you did do. So throw off the bowlines. Sail away from safe harbor.Catch the trade winds in your sails. Explore. Dream. Discover." Mark Twain
CDI Talk
11/03/2010 07:55 AM
Please respond to
cdi_talk@hcprotalk.com
To
tiffany_susan@guthrie.org
cc
Subject
RE: [cdi_talk] Acute Renal Failure
Here, here!
That’s the goal anyway and should be. A complete and accurate medical record. I can’t remember who said it before on here, but if the documentation is right, the finances follow. So the focus must be on getting the documentation right. If we don’t do that and only focus on the CC/MCC capture rate, then we aren’t doing the patient any favors and certainly aren’t doing anything to enhance continuity of care.
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
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
"This email is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this email does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this email in error, please notify this office immediately at the telephone number listed above."
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 11:15 PM
To: Hodges, Robert
Subject: RE: [cdi_talk] Acute Renal Failure
Folks, here is a novel idea, let's focus on the clinicals in the chart and capitalize upon the opportunity to educate physicians on the benefits of specificity, accuracy and detailedness of clinical documentation, how this information supports the reporting of their practice of medicine, the capture of the clinically relevant cc/mcc is a byproduct of our educational efforts. The continued focus upon capturing the "all mighty" CC/MCC is not and should not be the underlying foundation of clinical documentation improvement. Unfortunately, this is exactly what consulting companies are promulgating for their very existence. I have deep concerns about how this CC/MCC capture mentality is going to be a real detriment to our profession of CDI.
Thank you
-----Original Message-----
From: CDI Talk
Sent: Nov 2, 2010 7:36 AM
To: glennkrauss@earthlink.net
Subject: RE: [cdi_talk] Acute Renal Failure
We revamped our query for AKI to include questioning for the etiology of AKI to capture the ones that are MCC’s. We did not note them specifically thinking this would look to much like leading for the MCC’s.
Judi Bates RN, BSN, CCDS
CDI Specialist
856-757-3161
Beeper 66x2906
________________________________
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 7:51 AM
To: Bates, Judith
Subject: RE: [cdi_talk] Acute Renal Failure
This is pretty much what I do. I always ask for the diagnosis with the underlying cause or condition. So essentially, nothing changed for me or the way that I address the issue.
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
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
"This email is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this email does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this email in error, please notify this office immediately at the telephone number listed above."
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, November 01, 2010 7:46 PM
To: Hodges, Robert
Subject: Re: [cdi_talk] Acute Renal Failure
We are asking for more specificity if the clinical critera and risk factors are present
.
Example:
(Place clinical data and risk factors from the EMR here)
Effective 10/1/10 documentation guidelines require increase specificity relative to the diagnosis of ARF/AKI. If known, please specify if the ARF/AKI is due to pre-renal, intrinsic renal, or post renal causes.
Pre-renal 2/2 dehydration Intrinsic renal 2/2 ATN
Intrinsic renal 2/2 AIN Post-renal 2/2 uretral obstruction
Other____________. Unable to determine
Debbie S.
-----Original Message-----
From: CDI Talk
To: dsmith12h@aol.com
Sent: Mon, Nov 1, 2010 5:47 pm
Subject: [cdi_talk] Acute Renal Failure
Since Acute Renal Failure is no longer a MCC. I would like some input on what
other facilities are doing? Are you just coding the ARF, or are you asking the
physicians for more specific from what is putting the patient in the ARF. Such
as, the ones that are MCC',
Acute tubular necrosis, Lesion of renal cortical necrosis, renal medullary
necrosis, and specified pathological lesion in kidney?
How are you approaching your doctor's on this change? This was a huge MCC for
alot of facilities. Thanks for advice.
Deb.
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CONFIDENTIALITY NOTICE: This e-mail, including attachments, may include confidential, restricted, protected health and/or proprietary information, and may be used only for the person or entity to which it is addressed. If the reader of this e-mail is not the intended recipient or his or her authorized agent, the reader is hereby notified that any dissemination, distribution or copying of this e-mail is prohibited. If you have received this e-mail in error, please notify the sender by replying to this message and delete this e-mail immediately. Notice: The disclosure of medical information is strictly prohibited by federal regulation. Unauthorized release of medical information may result in administrative, civil and criminal sanctions.
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________________________________
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 10:15 PM
To: Stukenberg, Colleen M.
Subject: RE: [cdi_talk] Acute Renal Failure
Folks, here is a novel idea, let's focus on the clinicals in the chart and capitalize upon the opportunity to educate physicians on the benefits of specificity, accuracy and detailedness of clinical documentation, how this information supports the reporting of their practice of medicine, the capture of the clinically relevant cc/mcc is a byproduct of our educational efforts. The continued focus upon capturing the "all mighty" CC/MCC is not and should not be the underlying foundation of clinical documentation improvement. Unfortunately, this is exactly what consulting companies are promulgating for their very existence. I have deep concerns about how this CC/MCC capture mentality is going to be a real detriment to our profession of CDI.
Thank you
-----Original Message-----
From: CDI Talk
Sent: Nov 2, 2010 7:36 AM
To: glennkrauss@earthlink.net
Subject: RE: [cdi_talk] Acute Renal Failure
We revamped our query for AKI to include questioning for the etiology of AKI to capture the ones that are MCC's. We did not note them specifically thinking this would look to much like leading for the MCC's.
Judi Bates RN, BSN, CCDS
CDI Specialist
856-757-3161
Beeper 66x2906
________________________________
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 7:51 AM
To: Bates, Judith
Subject: RE: [cdi_talk] Acute Renal Failure
This is pretty much what I do. I always ask for the diagnosis with the underlying cause or condition. So essentially, nothing changed for me or the way that I address the issue.
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
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
"This email is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this email does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this email in error, please notify this office immediately at the telephone number listed above."
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, November 01, 2010 7:46 PM
To: Hodges, Robert
Subject: Re: [cdi_talk] Acute Renal Failure
We are asking for more specificity if the clinical critera and risk factors are present
.
Example:
(Place clinical data and risk factors from the EMR here)
Effective 10/1/10 documentation guidelines require increase specificity relative to the diagnosis of ARF/AKI. If known, please specify if the ARF/AKI is due to pre-renal, intrinsic renal, or post renal causes.
Pre-renal 2/2 dehydration Intrinsic renal 2/2 ATN
Intrinsic renal 2/2 AIN Post-renal 2/2 uretral obstruction
Other____________. Unable to determine
Debbie S.
-----Original Message-----
From: CDI Talk
To: dsmith12h@aol.com
Sent: Mon, Nov 1, 2010 5:47 pm
Subject: [cdi_talk] Acute Renal Failure
Since Acute Renal Failure is no longer a MCC. I would like some input on what
other facilities are doing? Are you just coding the ARF, or are you asking the
physicians for more specific from what is putting the patient in the ARF. Such
as, the ones that are MCC',
Acute tubular necrosis, Lesion of renal cortical necrosis, renal medullary
necrosis, and specified pathological lesion in kidney?
How are you approaching your doctor's on this change? This was a huge MCC for
alot of facilities. Thanks for advice.
Deb.
---
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related to documentation and coding, please refer to your regulatory source.
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Confidentiality Notice:
This e-mail, including any attachments is the
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for the sole use of the intended recipient(s).
It may contain information that is privileged and
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pretty much utilize their software ... and even that is lacking .. it
limits what payers we can review and they only want us to review Medicare
................ and it cost so much to switch software at this point!!! I
am so frustrated right now!!!!
Thank You,
Susan Tiffany RN, CCDS
Supervisor Clinical Documentation Program
Guthrie Healthcare System
phone: 570-882-6094, pager #465
fax: 570-882-6768
email: tiffany_susan@guthrie.org
"Twenty years from now you will be more disappointed by the things you
didn't do than by the ones you did do. So throw off the bowlines. Sail
away from safe harbor.Catch the trade winds in your sails. Explore. Dream.
Discover." Mark Twain
CDI Talk
11/03/2010 08:45 AM
Please respond to
cdi_talk@hcprotalk.com
To
tiffany_susan@guthrie.org
cc
Subject
RE: [cdi_talk] Acute Renal Failure
Hmmm. Makes me wonder how the consulting company gets paid……
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
"The difference between the right word and the almost right word is the
difference between lightning and the lightning bug." Samuel "Mark Twain"
Clemens
"This email is intended only for the use of the person or office to which
it is addressed and may contain information that is privileged,
confidential, or protected by law. All others are hereby notified that the
receipt of this email does not waive any applicable privilege or exemption
for disclosure and that any dissemination, distribution, or copying of
this communication is prohibited. If you have received this email in
error, please notify this office immediately at the telephone number
listed above."
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Wednesday, November 03, 2010 8:42 AM
To: Hodges, Robert
Subject: RE: [cdi_talk] Acute Renal Failure
I fully agree!!!! My biggest hurdle is not the facility I work for, but
the consulting company that works for us!! Currently we ask questions as
we see them ...... not if there is a MCC/CC ................ boy do they
have a problem with me!
Thank You,
Susan Tiffany RN, CCDS
Supervisor Clinical Documentation Program
Guthrie Healthcare System
phone: 570-882-6094, pager #465
fax: 570-882-6768
email: tiffany_susan@guthrie.org
"Twenty years from now you will be more disappointed by the things you
didn't do than by the ones you did do. So throw off the bowlines. Sail
away from safe harbor.Catch the trade winds in your sails. Explore. Dream.
Discover." Mark Twain
CDI Talk
11/03/2010 07:55 AM
Please respond to
cdi_talk@hcprotalk.com
To
tiffany_susan@guthrie.org
cc
Subject
RE: [cdi_talk] Acute Renal Failure
Here, here!
That’s the goal anyway and should be. A complete and accurate medical
record. I can’t remember who said it before on here, but if the
documentation is right, the finances follow. So the focus must be on
getting the documentation right. If we don’t do that and only focus on
the CC/MCC capture rate, then we aren’t doing the patient any favors and
certainly aren’t doing anything to enhance continuity of care.
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
"The difference between the right word and the almost right word is the
difference between lightning and the lightning bug." Samuel "Mark Twain"
Clemens
"This email is intended only for the use of the person or office to which
it is addressed and may contain information that is privileged,
confidential, or protected by law. All others are hereby notified that the
receipt of this email does not waive any applicable privilege or exemption
for disclosure and that any dissemination, distribution, or copying of
this communication is prohibited. If you have received this email in
error, please notify this office immediately at the telephone number
listed above."
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 11:15 PM
To: Hodges, Robert
Subject: RE: [cdi_talk] Acute Renal Failure
Folks, here is a novel idea, let's focus on the clinicals in the chart and
capitalize upon the opportunity to educate physicians on the benefits of
specificity, accuracy and detailedness of clinical documentation, how this
information supports the reporting of their practice of medicine, the
capture of the clinically relevant cc/mcc is a byproduct of our
educational efforts. The continued focus upon capturing the "all mighty"
CC/MCC is not and should not be the underlying foundation of clinical
documentation improvement. Unfortunately, this is exactly what consulting
companies are promulgating for their very existence. I have deep concerns
about how this CC/MCC capture mentality is going to be a real detriment to
our profession of CDI.
Thank you
-----Original Message-----
From: CDI Talk
Sent: Nov 2, 2010 7:36 AM
To: glennkrauss@earthlink.net
Subject: RE: [cdi_talk] Acute Renal Failure
We revamped our query for AKI to include questioning for the etiology of
AKI to capture the ones that are MCC’s. We did not note them specifically
thinking this would look to much like leading for the MCC’s.
Judi Bates RN, BSN, CCDS
CDI Specialist
856-757-3161
Beeper 66x2906
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 7:51 AM
To: Bates, Judith
Subject: RE: [cdi_talk] Acute Renal Failure
This is pretty much what I do. I always ask for the diagnosis with the
underlying cause or condition. So essentially, nothing changed for me or
the way that I address the issue.
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
"The difference between the right word and the almost right word is the
difference between lightning and the lightning bug." Samuel "Mark Twain"
Clemens
"This email is intended only for the use of the person or office to which
it is addressed and may contain information that is privileged,
confidential, or protected by law. All others are hereby notified that the
receipt of this email does not waive any applicable privilege or exemption
for disclosure and that any dissemination, distribution, or copying of
this communication is prohibited. If you have received this email in
error, please notify this office immediately at the telephone number
listed above."
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, November 01, 2010 7:46 PM
To: Hodges, Robert
Subject: Re: [cdi_talk] Acute Renal Failure
We are asking for more specificity if the clinical critera and risk
factors are present
.
Example:
(Place clinical data and risk factors from the EMR here)
Effective 10/1/10 documentation guidelines require increase specificity
relative to the diagnosis of ARF/AKI. If known, please specify if the
ARF/AKI is due to pre-renal, intrinsic renal, or post renal causes.
Pre-renal 2/2 dehydration Intrinsic renal 2/2 ATN
Intrinsic renal 2/2 AIN Post-renal 2/2 uretral obstruction
Other____________. Unable to determine
Debbie S.
-----Original Message-----
From: CDI Talk
To: dsmith12h@aol.com
Sent: Mon, Nov 1, 2010 5:47 pm
Subject: [cdi_talk] Acute Renal Failure
Since Acute Renal Failure is no longer a MCC. I would like some input on
what
other facilities are doing? Are you just coding the ARF, or are you asking
the
physicians for more specific from what is putting the patient in the ARF.
Such
as, the ones that are MCC',
Acute tubular necrosis, Lesion of renal cortical necrosis, renal
medullary
necrosis, and specified pathological lesion in kidney?
How are you approaching your doctor's on this change? This was a huge MCC
for
alot of facilities. Thanks for advice.
Deb.
---
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Confidentiality Notice:
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for the sole use of the intended recipient(s).
It may contain information that is privileged and
confidential. Any unauthorized review, use,
disclosure, or distribution is prohibited. If you are
not the intended recipient, please delete this message, and
reply to the sender regarding the error in a separate email.
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CONFIDENTIALITY NOTICE: This e-mail, including attachments, may
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not the intended recipient or his or her authorized agent, the
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of medical information is strictly prohibited by federal
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in administrative, civil and criminal sanctions.
judged based on the $$ amount we bring into the facility whether the
program is worth it. Also they base how many staff we need based on
this.
________________________________
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Wednesday, November 03, 2010 9:34 AM
To: Spatafore, Gina
Subject: RE: [cdi_talk] Acute Renal Failure
When I hear that the focus is only the CC/MCC capture rate, it really
makes me think they are missing the boat on what is really important.
The documentation needs to support an accurate picture of the clinical
condition of the patient. This information is not just for capturing $.
(At times, the accuracy of documentation can even change the DRG to a
lower weighted one.) It shows the true severity of illness with our
patients and risk for mortality, reflects on safe and quality care
including HAC and POA, and supports diagnoses and conditions we are
seeing in different populations and geographic areas, etc. When you try
to only capture the CC/MCC, you potentially skew data of what our
patient's population really has. In addition, it reflects on what our
physician profiles may look like. The door does not close at the end of
capturing CC/MCC, but can have a domino effect to areas we may not even
realize. Your administrative and fiscal team needs to realize this and
not focus on the $. If you are accurately and ethically doing your job,
the rest should come. And you can go home at the end of your day knowing
you did the right thing.
________________________________
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 10:15 PM
To: Stukenberg, Colleen M.
Subject: RE: [cdi_talk] Acute Renal Failure
Folks, here is a novel idea, let's focus on the clinicals in the chart
and capitalize upon the opportunity to educate physicians on the
benefits of specificity, accuracy and detailedness of clinical
documentation, how this information supports the reporting of their
practice of medicine, the capture of the clinically relevant cc/mcc is a
byproduct of our educational efforts. The continued focus upon capturing
the "all mighty" CC/MCC is not and should not be the underlying
foundation of clinical documentation improvement. Unfortunately, this is
exactly what consulting companies are promulgating for their very
existence. I have deep concerns about how this CC/MCC capture mentality
is going to be a real detriment to our profession of CDI.
Thank you
-----Original Message-----
From: CDI Talk
Sent: Nov 2, 2010 7:36 AM
To: glennkrauss@earthlink.net
Subject: RE: [cdi_talk] Acute Renal Failure
We revamped our query for AKI to include questioning for the etiology of
AKI to capture the ones that are MCC's. We did not note them
specifically thinking this would look to much like leading for the
MCC's.
Judi Bates RN, BSN, CCDS
CDI Specialist
856-757-3161
Beeper 66x2906
________________________________
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 7:51 AM
To: Bates, Judith
Subject: RE: [cdi_talk] Acute Renal Failure
This is pretty much what I do. I always ask for the diagnosis with the
underlying cause or condition. So essentially, nothing changed for me
or the way that I address the issue.
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
"The difference between the right word and the almost right word is the
difference between lightning and the lightning bug." Samuel "Mark Twain"
Clemens
"This email is intended only for the use of the person or office to
which it is addressed and may contain information that is privileged,
confidential, or protected by law. All others are hereby notified that
the receipt of this email does not waive any applicable privilege or
exemption for disclosure and that any dissemination, distribution, or
copying of this communication is prohibited. If you have received this
email in error, please notify this office immediately at the telephone
number listed above."
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, November 01, 2010 7:46 PM
To: Hodges, Robert
Subject: Re: [cdi_talk] Acute Renal Failure
We are asking for more specificity if the clinical critera and risk
factors are present
.
Example:
(Place clinical data and risk factors from the EMR here)
Effective 10/1/10 documentation guidelines require increase specificity
relative to the diagnosis of ARF/AKI. If known, please specify if the
ARF/AKI is due to pre-renal, intrinsic renal, or post renal causes.
Pre-renal 2/2 dehydration Intrinsic renal 2/2 ATN
Intrinsic renal 2/2 AIN Post-renal 2/2 uretral
obstruction
Other____________. Unable to determine
Debbie S.
-----Original Message-----
From: CDI Talk
To: dsmith12h@aol.com
Sent: Mon, Nov 1, 2010 5:47 pm
Subject: [cdi_talk] Acute Renal Failure
Since Acute Renal Failure is no longer a MCC. I would like some input on
what
other facilities are doing? Are you just coding the ARF, or are you
asking the
physicians for more specific from what is putting the patient in the
ARF. Such
as, the ones that are MCC',
Acute tubular necrosis, Lesion of renal cortical necrosis, renal
medullary
necrosis, and specified pathological lesion in kidney?
How are you approaching your doctor's on this change? This was a huge
MCC for
alot of facilities. Thanks for advice.
Deb.
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Confidentiality Notice:
This e-mail, including any attachments is the
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for the sole use of the intended recipient(s).
It may contain information that is privileged and
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not the intended recipient, please delete this message, and
reply to the sender regarding the error in a separate email.
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CONFIDENTIALITY NOTICE: This email and any attachments contain confidential information that is legally privileged. This information is intended only for the use of the individual or entity named above. The authorized recipient of this information is prohibited from disclosing this information to any other party unless required to do so by law or regulation.
If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or action taken in reliance on the contents of these documents is strictly prohibited. If you have received this information in error, please notify the sender immediately and delete these documents. Copyright (c) Waterbury Hospital
Thank You,
Susan Tiffany RN, CCDS
Supervisor Clinical Documentation Program
Guthrie Healthcare System
phone: 570-882-6094, pager #465
fax: 570-882-6768
email: tiffany_susan@guthrie.org
"Twenty years from now you will be more disappointed by the things you
didn't do than by the ones you did do. So throw off the bowlines. Sail
away from safe harbor.Catch the trade winds in your sails. Explore. Dream.
Discover." Mark Twain
CDI Talk
11/03/2010 10:02 AM
Please respond to
cdi_talk@hcprotalk.com
To
tiffany_susan@guthrie.org
cc
Subject
RE: [cdi_talk] Acute Renal Failure
I completely agree. Many of the consultants do focus on $$ and we are
judged based on the $$ amount we bring into the facility whether the
program is worth it. Also they base how many staff we need based on this.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Wednesday, November 03, 2010 9:34 AM
To: Spatafore, Gina
Subject: RE: [cdi_talk] Acute Renal Failure
When I hear that the focus is only the CC/MCC capture rate, it really
makes me think they are missing the boat on what is really important. The
documentation needs to support an accurate picture of the clinical
condition of the patient. This information is not just for capturing $.
(At times, the accuracy of documentation can even change the DRG to a
lower weighted one.) It shows the true severity of illness with our
patients and risk for mortality, reflects on safe and quality care
including HAC and POA, and supports diagnoses and conditions we are seeing
in different populations and geographic areas, etc. When you try to only
capture the CC/MCC, you potentially skew data of what our patient’s
population really has. In addition, it reflects on what our physician
profiles may look like. The door does not close at the end of capturing
CC/MCC, but can have a domino effect to areas we may not even realize.
Your administrative and fiscal team needs to realize this and not focus on
the $. If you are accurately and ethically doing your job, the rest should
come. And you can go home at the end of your day knowing you did the right
thing.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 10:15 PM
To: Stukenberg, Colleen M.
Subject: RE: [cdi_talk] Acute Renal Failure
Folks, here is a novel idea, let's focus on the clinicals in the chart and
capitalize upon the opportunity to educate physicians on the benefits of
specificity, accuracy and detailedness of clinical documentation, how this
information supports the reporting of their practice of medicine, the
capture of the clinically relevant cc/mcc is a byproduct of our
educational efforts. The continued focus upon capturing the "all mighty"
CC/MCC is not and should not be the underlying foundation of clinical
documentation improvement. Unfortunately, this is exactly what consulting
companies are promulgating for their very existence. I have deep concerns
about how this CC/MCC capture mentality is going to be a real detriment to
our profession of CDI.
Thank you
-----Original Message-----
From: CDI Talk
Sent: Nov 2, 2010 7:36 AM
To: glennkrauss@earthlink.net
Subject: RE: [cdi_talk] Acute Renal Failure
We revamped our query for AKI to include questioning for the etiology of
AKI to capture the ones that are MCC’s. We did not note them specifically
thinking this would look to much like leading for the MCC’s.
Judi Bates RN, BSN, CCDS
CDI Specialist
856-757-3161
Beeper 66x2906
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 7:51 AM
To: Bates, Judith
Subject: RE: [cdi_talk] Acute Renal Failure
This is pretty much what I do. I always ask for the diagnosis with the
underlying cause or condition. So essentially, nothing changed for me or
the way that I address the issue.
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
"The difference between the right word and the almost right word is the
difference between lightning and the lightning bug." Samuel "Mark Twain"
Clemens
"This email is intended only for the use of the person or office to which
it is addressed and may contain information that is privileged,
confidential, or protected by law. All others are hereby notified that the
receipt of this email does not waive any applicable privilege or exemption
for disclosure and that any dissemination, distribution, or copying of
this communication is prohibited. If you have received this email in
error, please notify this office immediately at the telephone number
listed above."
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, November 01, 2010 7:46 PM
To: Hodges, Robert
Subject: Re: [cdi_talk] Acute Renal Failure
We are asking for more specificity if the clinical critera and risk
factors are present
.
Example:
(Place clinical data and risk factors from the EMR here)
Effective 10/1/10 documentation guidelines require increase specificity
relative to the diagnosis of ARF/AKI. If known, please specify if the
ARF/AKI is due to pre-renal, intrinsic renal, or post renal causes.
Pre-renal 2/2 dehydration Intrinsic renal 2/2 ATN
Intrinsic renal 2/2 AIN Post-renal 2/2 uretral obstruction
Other____________. Unable to determine
Debbie S.
-----Original Message-----
From: CDI Talk
To: dsmith12h@aol.com
Sent: Mon, Nov 1, 2010 5:47 pm
Subject: [cdi_talk] Acute Renal Failure
Since Acute Renal Failure is no longer a MCC. I would like some input on
what
other facilities are doing? Are you just coding the ARF, or are you asking
the
physicians for more specific from what is putting the patient in the ARF.
Such
as, the ones that are MCC',
Acute tubular necrosis, Lesion of renal cortical necrosis, renal
medullary
necrosis, and specified pathological lesion in kidney?
How are you approaching your doctor's on this change? This was a huge MCC
for
alot of facilities. Thanks for advice.
Deb.
---
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HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
---
CDI Talk is offered for networking purposes. For official rules and
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HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
---
CDI Talk is offered for networking purposes. For official rules and
regulations related to documentation and coding, please refer to your
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Copyright 2010
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Confidentiality Notice:
This e-mail, including any attachments is the
property of Catholic Health East and is intended
for the sole use of the intended recipient(s).
It may contain information that is privileged and
confidential. Any unauthorized review, use,
disclosure, or distribution is prohibited. If you are
not the intended recipient, please delete this message, and
reply to the sender regarding the error in a separate email.
---
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CONFIDENTIALITY NOTICE: This email and any attachments contain
confidential information that is legally privileged. This information is
intended only for the use of the individual or entity named above. The
authorized recipient of this information is prohibited from disclosing
this information to any other party unless required to do so by law or
regulation.
If you are not the intended recipient, you are hereby notified that any
disclosure, copying, distribution or action taken in reliance on the
contents of these documents is strictly prohibited. If you have received
this information in error, please notify the sender immediately and delete
these documents. Copyright (c) Waterbury Hospital
CONFIDENTIALITY NOTICE: This e-mail, including attachments, may
include confidential, restricted, protected health and/or
proprietary information, and may be used only for the person or
entity to which it is addressed. If the reader of this e-mail is
not the intended recipient or his or her authorized agent, the
reader is hereby notified that any dissemination, distribution or
copying of this e-mail is prohibited. If you have received this
e-mail in error, please notify the sender by replying to this
message and delete this e-mail immediately. Notice: The disclosure
of medical information is strictly prohibited by federal
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in administrative, civil and criminal sanctions.
We do have outside consultants come in yearly - just to do educational updates, chart reviews, etc. Our management wants to make sure we are continually headed in the right direction. We have used various companies. Some consultants have been better than others.
It is nice to get different perspectives. You can use the pieces that you want - put the rest on the back burner.
Our program is 8 yrs old - I think after a while you just outgrow the original consulting firm and you need to do what works for your facility, medical providers and CDI program vs what was sold to the hospital in the early stages of a program. It's a question of program maturity.
Just my thoughts.
Debby Dallen,RN
----- Original Message -----
From: CDI Talk
To: dallendeb@comcast.net
Sent: Wed, 03 Nov 2010 14:39:43 -0000 (UTC)
Subject: RE: [cdi_talk] Acute Renal Failure
So, the question becomes ...... what
do we do!
Thank You,
Susan Tiffany RN, CCDS
Supervisor Clinical Documentation Program
Guthrie Healthcare System
phone: 570-882-6094, pager #465
fax: 570-882-6768
email: tiffany_susan@guthrie.org
"Twenty years from now you will be more disappointed by the things
you didn't do than by the ones you did do. So throw off the bowlines. Sail
away from safe harbor.Catch the trade winds in your sails. Explore. Dream.
Discover." Mark Twain
CDI Talk
11/03/2010 10:02 AM
Please respond to
cdi_talk@hcprotalk.com
To
tiffany_susan@guthrie.org
cc
Subject
RE: [cdi_talk] Acute Renal Failure
I completely agree. Many of
the consultants do focus on $$ and we are judged based on the $$ amount
we bring into the facility whether the program is worth it. Also they base
how many staff we need based on this.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Wednesday, November 03, 2010 9:34 AM
To: Spatafore, Gina
Subject: RE: [cdi_talk] Acute Renal Failure
When I hear that the focus
is only the CC/MCC capture rate, it really makes me think they are missing
the boat on what is really important. The documentation needs to support
an accurate picture of the clinical condition of the patient. This information
is not just for capturing $. (At times, the accuracy of documentation can
even change the DRG to a lower weighted one.) It shows the true severity
of illness with our patients and risk for mortality, reflects on safe and
quality care including HAC and POA, and supports diagnoses and conditions
we are seeing in different populations and geographic areas, etc. When
you try to only capture the CC/MCC, you potentially skew data of what our
patient’s population really has. In addition, it reflects on what our
physician profiles may look like. The door does not close at the end of
capturing CC/MCC, but can have a domino effect to areas we may not even
realize. Your administrative and fiscal team needs to realize this and
not focus on the $. If you are accurately and ethically doing your job,
the rest should come. And you can go home at the end of your day knowing
you did the right thing.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 10:15 PM
To: Stukenberg, Colleen M.
Subject: RE: [cdi_talk] Acute Renal Failure
Folks, here is a novel idea, let's focus
on the clinicals in the chart and capitalize upon the opportunity to educate
physicians on the benefits of specificity, accuracy and detailedness of
clinical documentation, how this information supports the reporting of
their practice of medicine, the capture of the clinically relevant cc/mcc
is a byproduct of our educational efforts. The continued focus upon capturing
the "all mighty" CC/MCC is not and should not be the underlying
foundation of clinical documentation improvement. Unfortunately, this is
exactly what consulting companies are promulgating for their very existence.
I have deep concerns about how this CC/MCC capture mentality is going to
be a real detriment to our profession of CDI.
Thank you
-----Original Message-----
From: CDI Talk
Sent: Nov 2, 2010 7:36 AM
To: glennkrauss@earthlink.net
Subject: RE: [cdi_talk] Acute Renal Failure
We revamped our query for AKI to include
questioning for the etiology of AKI to capture the ones that are MCC’s.
We did not note them specifically thinking this would look to much
like leading for the MCC’s.
Judi Bates RN, BSN, CCDS
CDI Specialist
856-757-3161
Beeper 66x2906
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 7:51 AM
To: Bates, Judith
Subject: RE: [cdi_talk] Acute Renal Failure
This is pretty much what
I do. I always ask for the diagnosis with the underlying cause or
condition. So essentially, nothing changed for me or the way that
I address the issue.
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
"The difference
between the right word and the almost right word is the difference between
lightning and the lightning bug." Samuel "Mark Twain" Clemens
"This email is intended only for
the use of the person or office to which it is addressed and may contain
information that is privileged, confidential, or protected by law. All
others are hereby notified that the receipt of this email does not waive
any applicable privilege or exemption for disclosure and that any dissemination,
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the telephone number listed above."
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, November 01, 2010 7:46 PM
To: Hodges, Robert
Subject: Re: [cdi_talk] Acute Renal Failure
We are asking for more specificity if the
clinical critera and risk factors are present
.
Example:
(Place clinical data and risk factors from
the EMR here)
Effective 10/1/10 documentation guidelines
require increase specificity relative to the diagnosis of ARF/AKI. If
known, please specify if the ARF/AKI is due to pre-renal, intrinsic renal,
or post renal causes.
Pre-renal 2/2 dehydration
Intrinsic renal 2/2 ATN
Intrinsic renal 2/2 AIN
Post-renal 2/2 uretral obstruction
Other____________.
Unable to determine
Debbie S.
-----Original Message-----
From: CDI Talk
To: dsmith12h@aol.com
Sent: Mon, Nov 1, 2010 5:47 pm
Subject: [cdi_talk] Acute Renal Failure
Since Acute Renal Failure is no longer
a MCC. I would like some input on what
other facilities are doing? Are you
just coding the ARF, or are you asking the
physicians for more specific from what
is putting the patient in the ARF. Such
as, the ones that are MCC',
Acute tubular necrosis, Lesion
of renal cortical necrosis, renal medullary
necrosis, and specified pathological
lesion in kidney?
How are you approaching your doctor's
on this change? This was a huge MCC for
alot of facilities. Thanks for advice.
Deb.
---
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CONFIDENTIALITY NOTICE:
This email and any attachments contain confidential information that is
legally privileged. This information is intended only for the use of the
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However you still need a point of measure in your program - CMI is one.
I found the last ACDIS weekly poll regarding APR DRG info. Very interesting. The two areas which held the highest answers were "yes" and "no".
We have now hit that honeymoon plateu where physicians are documenting fairly well. This is where we need the APR DRG info. To still reflect the impact of our program.
N.Brunson
CDI Talk wrote:
>We no longer have an ongoing relationship with a single consultant/company. We discontinued that relationship about 4 yrs ago. We query for a clean chart. Most of our queries do not impact DRG - but our CMI is keeping everyone happy. Our presence seems to encourage our physicians, etc to continue to improve their documentation. We do have our issues, don't get me wrong.
>We do have outside consultants come in yearly - just to do educational updates, chart reviews, etc. Our management wants to make sure we are continually headed in the right direction. We have used various companies. Some consultants have been better than others.
>It is nice to get different perspectives. You can use the pieces that you want - put the rest on the back burner.
>
>Our program is 8 yrs old - I think after a while you just outgrow the original consulting firm and you need to do what works for your facility, medical providers and CDI program vs what was sold to the hospital in the early stages of a program. It's a question of program maturity.
>
>Just my thoughts.
>Debby Dallen,RN
>
>----- Original Message -----
>From: CDI Talk
>To: dallendeb@comcast.net
>Sent: Wed, 03 Nov 2010 14:39:43 -0000 (UTC)
>Subject: RE: [cdi_talk] Acute Renal Failure
>
>
>
>
>So, the question becomes ...... what
>
>do we do!
>
>Thank You,
>
>
>Susan Tiffany RN, CCDS
>
>
>Supervisor Clinical Documentation Program
>
>
>Guthrie Healthcare System
>
>
>phone: 570-882-6094, pager #465
>
>
>fax: 570-882-6768
>
>
>email: tiffany_susan@guthrie.org
>
>
>"Twenty years from now you will be more disappointed by the things
>
>you didn't do than by the ones you did do. So throw off the bowlines. Sail
>
>away from safe harbor.Catch the trade winds in your sails. Explore. Dream.
>
>Discover." Mark Twain
>
>
>
>
>
>
>
>
>
>CDI Talk
>11/03/2010 10:02 AM
>
>
>
>
>Please respond to
>
>
>cdi_talk@hcprotalk.com
>
>
>
>
>
>
>To
>tiffany_susan@guthrie.org
>
>
>cc
>
>
>
>Subject
>RE: [cdi_talk] Acute Renal Failure
>
>
>
>
>
>
>
>
>
>I completely agree. Many of
>
>the consultants do focus on $$ and we are judged based on the $$ amount
>
>we bring into the facility whether the program is worth it. Also they base
>
>how many staff we need based on this.
>
>
>
>
>
>
>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>
>
>
>
>Sent: Wednesday, November 03, 2010 9:34 AM
>
>
>To: Spatafore, Gina
>
>
>Subject: RE: [cdi_talk] Acute Renal Failure
>
>When I hear that the focus
>
>is only the CC/MCC capture rate, it really makes me think they are missing
>
>the boat on what is really important. The documentation needs to support
>
>an accurate picture of the clinical condition of the patient. This information
>
>is not just for capturing $. (At times, the accuracy of documentation can
>
>even change the DRG to a lower weighted one.) It shows the true severity
>
>of illness with our patients and risk for mortality, reflects on safe and
>
>quality care including HAC and POA, and supports diagnoses and conditions
>
>we are seeing in different populations and geographic areas, etc. When
>
>you try to only capture the CC/MCC, you potentially skew data of what our
>
>patient’s population really has. In addition, it reflects on what our
>
>physician profiles may look like. The door does not close at the end of
>
>capturing CC/MCC, but can have a domino effect to areas we may not even
>
>realize. Your administrative and fiscal team needs to realize this and
>
>not focus on the $. If you are accurately and ethically doing your job,
>
>the rest should come. And you can go home at the end of your day knowing
>
>you did the right thing.
>
>
>
>
>
>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>
>
>
>
>Sent: Tuesday, November 02, 2010 10:15 PM
>
>
>To: Stukenberg, Colleen M.
>
>
>Subject: RE: [cdi_talk] Acute Renal Failure
>
>Folks, here is a novel idea, let's focus
>
>on the clinicals in the chart and capitalize upon the opportunity to educate
>
>physicians on the benefits of specificity, accuracy and detailedness of
>
>clinical documentation, how this information supports the reporting of
>
>their practice of medicine, the capture of the clinically relevant cc/mcc
>
>is a byproduct of our educational efforts. The continued focus upon capturing
>
>the "all mighty" CC/MCC is not and should not be the underlying
>
>foundation of clinical documentation improvement. Unfortunately, this is
>
>exactly what consulting companies are promulgating for their very existence.
>
>I have deep concerns about how this CC/MCC capture mentality is going to
>
>be a real detriment to our profession of CDI.
>
>Thank you
>-----Original Message-----
>
>
>From: CDI Talk
>
>
>Sent: Nov 2, 2010 7:36 AM
>
>
>To: glennkrauss@earthlink.net
>
>
>Subject: RE: [cdi_talk] Acute Renal Failure
>
>We revamped our query for AKI to include
>
>questioning for the etiology of AKI to capture the ones that are MCC’s.
>
> We did not note them specifically thinking this would look to much
>
>like leading for the MCC’s.
>
>Judi Bates RN, BSN, CCDS
>
>
>CDI Specialist
>
>
>856-757-3161
>
>
>Beeper 66x2906
>
>
>
>
>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>
>
>
>
>Sent: Tuesday, November 02, 2010 7:51 AM
>
>
>To: Bates, Judith
>
>
>Subject: RE: [cdi_talk] Acute Renal Failure
>
>This is pretty much what
>
>I do. I always ask for the diagnosis with the underlying cause or
>
>condition. So essentially, nothing changed for me or the way that
>
>I address the issue.
>
>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
>
>"The difference
>
>between the right word and the almost right word is the difference between
>
>lightning and the lightning bug." Samuel "Mark Twain" Clemens
>
>"This email is intended only for
>
>the use of the person or office to which it is addressed and may contain
>
>information that is privileged, confidential, or protected by law. All
>
>others are hereby notified that the receipt of this email does not waive
>
>any applicable privilege or exemption for disclosure and that any dissemination,
>
>distribution, or copying of this communication is prohibited. If you have
>
>received this email in error, please notify this office immediately at
>
>the telephone number listed above."
>
>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>
>
>
>
>Sent: Monday, November 01, 2010 7:46 PM
>
>
>To: Hodges, Robert
>
>
>Subject: Re: [cdi_talk] Acute Renal Failure
>
>We are asking for more specificity if the
>
>clinical critera and risk factors are present
>.
>Example:
>(Place clinical data and risk factors from
>
>the EMR here)
>
>Effective 10/1/10 documentation guidelines
>
>require increase specificity relative to the diagnosis of ARF/AKI. If
>
>known, please specify if the ARF/AKI is due to pre-renal, intrinsic renal,
>
>or post renal causes.
>
>Pre-renal 2/2 dehydration
>
> Intrinsic renal 2/2 ATN
>Intrinsic renal 2/2 AIN
>
> Post-renal 2/2 uretral obstruction
>
>
>Other____________.
>
> Unable to determine
>
>Debbie S.
>-----Original Message-----
>
>
>From: CDI Talk
>
>
>To: dsmith12h@aol.com
>
>
>Sent: Mon, Nov 1, 2010 5:47 pm
>
>
>Subject: [cdi_talk] Acute Renal Failure
>Since Acute Renal Failure is no longer
>
>a MCC. I would like some input on what
>other facilities are doing? Are you
>
>just coding the ARF, or are you asking the
>physicians for more specific from what
>
>is putting the patient in the ARF. Such
>as, the ones that are MCC',
> Acute tubular necrosis, Lesion
>
>of renal cortical necrosis, renal medullary
>necrosis, and specified pathological
>
>lesion in kidney?
>How are you approaching your doctor's
>
>on this change? This was a huge MCC for
>alot of facilities. Thanks for advice.
> Deb.
>---
>CDI Talk is offered for networking
>
>purposes. For official rules and regulations
>related to documentation and coding,
>
>please refer to your regulatory source.
>
>You are receiving this message as a
>
>member of CDI Talk as: dsmith12h@aol.com
>If you would like to be removed from
>
>CDI Talk, please send a blank email to
>leave-cdi_talk-10398685.2cb93ee246d6127eb38c6be0d9f2b2d7@hcprotalk.com
>---
>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead,
>
>MA 01945
>
>---
>CDI Talk is offered for networking
>
>purposes. For official rules and regulations related to documentation and
>
>coding, please refer to your regulatory source.
>
>You are receiving this message as a
>
>member of CDI Talk as: robert.hodges2@va.gov
>If you would like to be removed from
>
>CDI Talk, please send a blank email to
>leave-cdi_talk-10741982.fced5831ab44431e3f844a057071eb02@hcprotalk.com
>---
>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead,
>
>MA 01945
>
>---
>CDI Talk is offered for networking
>
>purposes. For official rules and regulations related to documentation and
>
>coding, please refer to your regulatory source.
>
>You are receiving this message as a
>
>member of CDI Talk as: batesj@lourdesnet.org
>If you would like to be removed from
>
>CDI Talk, please send a blank email to
>leave-cdi_talk-11574448.a103e4a5d44ebf54e5499c03ebb6c706@hcprotalk.com
>---
>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead,
>
>MA 01945
>Confidentiality Notice:
>
>
>This e-mail, including any attachments is the
>
>
>property of Catholic Health East and is intended
>
>
>for the sole use of the intended recipient(s).
>
>
>It may contain information that is privileged and
>
>
>confidential. Any unauthorized review, use,
>
>
>disclosure, or distribution is prohibited. If you are
>
>
>not the intended recipient, please delete this message, and
>
>
>reply to the sender regarding the error in a separate email.
>---
>CDI Talk is offered for networking
>
>purposes. For official rules and regulations related to documentation and
>
>coding, please refer to your regulatory source.
>
>You are receiving this message as a
>
>member of CDI Talk as: glennkrauss@earthlink.net
>If you would like to be removed from
>
>CDI Talk, please send a blank email to
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>---
>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead,
>
>MA 01945
>
>---
>CDI Talk is offered for networking
>
>purposes. For official rules and regulations related to documentation and
>
>coding, please refer to your regulatory source.
>
>You are receiving this message as a
>
>member of CDI Talk as: gspatafore@wtbyhosp.org
>If you would like to be removed from
>
>CDI Talk, please send a blank email to
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>---
>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead,
>
>MA 01945
>
>
>
>---
>
>
>CDI Talk is offered for networking purposes. For official rules and regulations
>
>related to documentation and coding, please refer to your regulatory source.
>
>
>
>You are receiving this message as a member of CDI Talk as: tiffany_susan@guthrie.org
>
>
>If you would like to be removed from CDI Talk, please send a blank email
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>to
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>
>leave-cdi_talk-10158288.f7a8b24ddbe67f45f0b67c0e345b85c8@hcprotalk.com
>
>
>---
>
>
>Copyright 2010
>
>
>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
>
>
>---
>
>
>CDI Talk is offered for networking purposes. For official rules and regulations
>
>related to documentation and coding, please refer to your regulatory source.
>
>
>
>You are receiving this message as a member of CDI Talk as: cstukenberg@fhn.org
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>If you would like to be removed from CDI Talk, please send a blank email
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>to
>
>
>leave-cdi_talk-10252104.f3768e731d54002d5a67e0ba93261fa8@hcprotalk.com
>
>
>---
>
>
>Copyright 2010
>
>
>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>CONFIDENTIALITY NOTICE:
>
>This email and any attachments contain confidential information that is
>
>legally privileged. This information is intended only for the use of the
>
>individual or entity named above. The authorized recipient of this information
>
>is prohibited from disclosing this information to any other party unless
>
>required to do so by law or regulation.
>If you are not the intended recipient,
>
>you are hereby notified that any disclosure, copying, distribution or action
>
>taken in reliance on the contents of these documents is strictly prohibited.
>
>If you have received this information in error, please notify the sender
>
>immediately and delete these documents. Copyright (c) Waterbury Hospital
>
>
>
>
>CONFIDENTIALITY NOTICE: This e-mail, including attachments, may
>
>include confidential, restricted, protected health and/or
>
>proprietary information, and may be used only for the person or
>
>entity to which it is addressed. If the reader of this e-mail is
>
>not the intended recipient or his or her authorized agent, the
>
>reader is hereby notified that any dissemination, distribution or
>
>copying of this e-mail is prohibited. If you have received this
>
>e-mail in error, please notify the sender by replying to this
>
>message and delete this e-mail immediately. Notice: The disclosure
>
>of medical information is strictly prohibited by federal
>
>regulation. Unauthorized release of medical information may result
>
>in administrative, civil and criminal sanctions.
>
>
>
>---
>
>CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
>
>
>You are receiving this message as a member of CDI Talk as: dallendeb@comcast.net
>
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>---
>
>Copyright 2010
>
>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
>
>---
>CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
>You are receiving this message as a member of CDI Talk as: paxneros@comcast.net
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>Copyright 2010
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We saw our severity and mortality scores improve.
We have the APR DRG grouper on our encoder.
We use our CMI as our primary measure, severity and mortality is our sec along with CC/MCC capture rates.
----- Original Message -----
From: CDI Talk
To: dallendeb@comcast.net
Sent: Wed, 03 Nov 2010 16:51:33 -0000 (UTC)
Subject: RE: [cdi_talk] Acute Renal Failure
I also belive that if you are just starting a CDIP you need to focus on the MCC/CC's. But as your program becomes more mature and physician docmentation becomes better you can change your focus.
However you still need a point of measure in your program - CMI is one.
I found the last ACDIS weekly poll regarding APR DRG info. Very interesting. The two areas which held the highest answers were "yes" and "no".
We have now hit that honeymoon plateu where physicians are documenting fairly well. This is where we need the APR DRG info. To still reflect the impact of our program.
N.Brunson
CDI Talk wrote:
>We no longer have an ongoing relationship with a single consultant/company. We discontinued that relationship about 4 yrs ago. We query for a clean chart. Most of our queries do not impact DRG - but our CMI is keeping everyone happy. Our presence seems to encourage our physicians, etc to continue to improve their documentation. We do have our issues, don't get me wrong.
>We do have outside consultants come in yearly - just to do educational updates, chart reviews, etc. Our management wants to make sure we are continually headed in the right direction. We have used various companies. Some consultants have been better than others.
>It is nice to get different perspectives. You can use the pieces that you want - put the rest on the back burner.
>
>Our program is 8 yrs old - I think after a while you just outgrow the original consulting firm and you need to do what works for your facility, medical providers and CDI program vs what was sold to the hospital in the early stages of a program. It's a question of program maturity.
>
>Just my thoughts.
>Debby Dallen,RN
>
>----- Original Message -----
>From: CDI Talk
>To: dallendeb@comcast.net
>Sent: Wed, 03 Nov 2010 14:39:43 -0000 (UTC)
>Subject: RE: [cdi_talk] Acute Renal Failure
>
>
>
>
>So, the question becomes ...... what
>
>do we do!
>
>Thank You,
>
>
>Susan Tiffany RN, CCDS
>
>
>Supervisor Clinical Documentation Program
>
>
>Guthrie Healthcare System
>
>
>phone: 570-882-6094, pager #465
>
>
>fax: 570-882-6768
>
>
>email: tiffany_susan@guthrie.org
>
>
>"Twenty years from now you will be more disappointed by the things
>
>you didn't do than by the ones you did do. So throw off the bowlines. Sail
>
>away from safe harbor.Catch the trade winds in your sails. Explore. Dream.
>
>Discover." Mark Twain
>
>
>
>
>
>
>
>
>
>CDI Talk
>11/03/2010 10:02 AM
>
>
>
>
>Please respond to
>
>
>cdi_talk@hcprotalk.com
>
>
>
>
>
>
>To
>tiffany_susan@guthrie.org
>
>
>cc
>
>
>
>Subject
>RE: [cdi_talk] Acute Renal Failure
>
>
>
>
>
>
>
>
>
>I completely agree. Many of
>
>the consultants do focus on $$ and we are judged based on the $$ amount
>
>we bring into the facility whether the program is worth it. Also they base
>
>how many staff we need based on this.
>
>
>
>
>
>
>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>
>
>
>
>Sent: Wednesday, November 03, 2010 9:34 AM
>
>
>To: Spatafore, Gina
>
>
>Subject: RE: [cdi_talk] Acute Renal Failure
>
>When I hear that the focus
>
>is only the CC/MCC capture rate, it really makes me think they are missing
>
>the boat on what is really important. The documentation needs to support
>
>an accurate picture of the clinical condition of the patient. This information
>
>is not just for capturing $. (At times, the accuracy of documentation can
>
>even change the DRG to a lower weighted one.) It shows the true severity
>
>of illness with our patients and risk for mortality, reflects on safe and
>
>quality care including HAC and POA, and supports diagnoses and conditions
>
>we are seeing in different populations and geographic areas, etc. When
>
>you try to only capture the CC/MCC, you potentially skew data of what our
>
>patient’s population really has. In addition, it reflects on what our
>
>physician profiles may look like. The door does not close at the end of
>
>capturing CC/MCC, but can have a domino effect to areas we may not even
>
>realize. Your administrative and fiscal team needs to realize this and
>
>not focus on the $. If you are accurately and ethically doing your job,
>
>the rest should come. And you can go home at the end of your day knowing
>
>you did the right thing.
>
>
>
>
>
>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>
>
>
>
>Sent: Tuesday, November 02, 2010 10:15 PM
>
>
>To: Stukenberg, Colleen M.
>
>
>Subject: RE: [cdi_talk] Acute Renal Failure
>
>Folks, here is a novel idea, let's focus
>
>on the clinicals in the chart and capitalize upon the opportunity to educate
>
>physicians on the benefits of specificity, accuracy and detailedness of
>
>clinical documentation, how this information supports the reporting of
>
>their practice of medicine, the capture of the clinically relevant cc/mcc
>
>is a byproduct of our educational efforts. The continued focus upon capturing
>
>the "all mighty" CC/MCC is not and should not be the underlying
>
>foundation of clinical documentation improvement. Unfortunately, this is
>
>exactly what consulting companies are promulgating for their very existence.
>
>I have deep concerns about how this CC/MCC capture mentality is going to
>
>be a real detriment to our profession of CDI.
>
>Thank you
>-----Original Message-----
>
>
>From: CDI Talk
>
>
>Sent: Nov 2, 2010 7:36 AM
>
>
>To: glennkrauss@earthlink.net
>
>
>Subject: RE: [cdi_talk] Acute Renal Failure
>
>We revamped our query for AKI to include
>
>questioning for the etiology of AKI to capture the ones that are MCC’s.
>
> We did not note them specifically thinking this would look to much
>
>like leading for the MCC’s.
>
>Judi Bates RN, BSN, CCDS
>
>
>CDI Specialist
>
>
>856-757-3161
>
>
>Beeper 66x2906
>
>
>
>
>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>
>
>
>
>Sent: Tuesday, November 02, 2010 7:51 AM
>
>
>To: Bates, Judith
>
>
>Subject: RE: [cdi_talk] Acute Renal Failure
>
>This is pretty much what
>
>I do. I always ask for the diagnosis with the underlying cause or
>
>condition. So essentially, nothing changed for me or the way that
>
>I address the issue.
>
>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
>
>"The difference
>
>between the right word and the almost right word is the difference between
>
>lightning and the lightning bug." Samuel "Mark Twain" Clemens
>
>"This email is intended only for
>
>the use of the person or office to which it is addressed and may contain
>
>information that is privileged, confidential, or protected by law. All
>
>others are hereby notified that the receipt of this email does not waive
>
>any applicable privilege or exemption for disclosure and that any dissemination,
>
>distribution, or copying of this communication is prohibited. If you have
>
>received this email in error, please notify this office immediately at
>
>the telephone number listed above."
>
>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>
>
>
>
>Sent: Monday, November 01, 2010 7:46 PM
>
>
>To: Hodges, Robert
>
>
>Subject: Re: [cdi_talk] Acute Renal Failure
>
>We are asking for more specificity if the
>
>clinical critera and risk factors are present
>.
>Example:
>(Place clinical data and risk factors from
>
>the EMR here)
>
>Effective 10/1/10 documentation guidelines
>
>require increase specificity relative to the diagnosis of ARF/AKI. If
>
>known, please specify if the ARF/AKI is due to pre-renal, intrinsic renal,
>
>or post renal causes.
>
>Pre-renal 2/2 dehydration
>
> Intrinsic renal 2/2 ATN
>Intrinsic renal 2/2 AIN
>
> Post-renal 2/2 uretral obstruction
>
>
>Other____________.
>
> Unable to determine
>
>Debbie S.
>-----Original Message-----
>
>
>From: CDI Talk
>
>
>To: dsmith12h@aol.com
>
>
>Sent: Mon, Nov 1, 2010 5:47 pm
>
>
>Subject: [cdi_talk] Acute Renal Failure
>Since Acute Renal Failure is no longer
>
>a MCC. I would like some input on what
>other facilities are doing? Are you
>
>just coding the ARF, or are you asking the
>physicians for more specific from what
>
>is putting the patient in the ARF. Such
>as, the ones that are MCC',
> Acute tubular necrosis, Lesion
>
>of renal cortical necrosis, renal medullary
>necrosis, and specified pathological
>
>lesion in kidney?
>How are you approaching your doctor's
>
>on this change? This was a huge MCC for
>alot of facilities. Thanks for advice.
> Deb.
>---
>CDI Talk is offered for networking
>
>purposes. For official rules and regulations
>related to documentation and coding,
>
>please refer to your regulatory source.
>
>You are receiving this message as a
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>If you would like to be removed from
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>CDI Talk, please send a blank email to
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>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead,
>
>MA 01945
>
>---
>CDI Talk is offered for networking
>
>purposes. For official rules and regulations related to documentation and
>
>coding, please refer to your regulatory source.
>
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>If you would like to be removed from
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>---
>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead,
>
>MA 01945
>
>---
>CDI Talk is offered for networking
>
>purposes. For official rules and regulations related to documentation and
>
>coding, please refer to your regulatory source.
>
>You are receiving this message as a
>
>member of CDI Talk as: batesj@lourdesnet.org
>If you would like to be removed from
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>CDI Talk, please send a blank email to
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>---
>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead,
>
>MA 01945
>Confidentiality Notice:
>
>
>This e-mail, including any attachments is the
>
>
>property of Catholic Health East and is intended
>
>
>for the sole use of the intended recipient(s).
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>It may contain information that is privileged and
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>
>confidential. Any unauthorized review, use,
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>disclosure, or distribution is prohibited. If you are
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>not the intended recipient, please delete this message, and
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>CDI Talk is offered for networking
>
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>
>coding, please refer to your regulatory source.
>
>You are receiving this message as a
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>If you would like to be removed from
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>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead,
>
>MA 01945
>
>---
>CDI Talk is offered for networking
>
>purposes. For official rules and regulations related to documentation and
>
>coding, please refer to your regulatory source.
>
>You are receiving this message as a
>
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>If you would like to be removed from
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>---
>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead,
>
>MA 01945
>
>
>
>---
>
>
>CDI Talk is offered for networking purposes. For official rules and regulations
>
>related to documentation and coding, please refer to your regulatory source.
>
>
>
>You are receiving this message as a member of CDI Talk as: tiffany_susan@guthrie.org
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>---
>
>
>Copyright 2010
>
>
>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
>
>
>---
>
>
>CDI Talk is offered for networking purposes. For official rules and regulations
>
>related to documentation and coding, please refer to your regulatory source.
>
>
>
>You are receiving this message as a member of CDI Talk as: cstukenberg@fhn.org
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>
>
>---
>
>
>Copyright 2010
>
>
>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>CONFIDENTIALITY NOTICE:
>
>This email and any attachments contain confidential information that is
>
>legally privileged. This information is intended only for the use of the
>
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>
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>If you are not the intended recipient,
>
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>CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
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>
>Copyright 2010
>
>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
>
>---
>CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
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---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: dallendeb@comcast.net
If you would like to be removed from CDI Talk, please send a blank email to
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Copyright 2010
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ICD 10 this approach will be helpful to prepare them for the inevitable
in 2013.
Virginia Bailey RN, CCDS
Certified Clinical Documentation Specialist
Morton Plant Northbay Hospital
727-859-4880 or ext 74880 from within system
________________________________
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 11:15 PM
To: Bailey, Virginia
Subject: RE: [cdi_talk] Acute Renal Failure
Folks, here is a novel idea, let's focus on the clinicals in the chart
and capitalize upon the opportunity to educate physicians on the
benefits of specificity, accuracy and detailedness of clinical
documentation, how this information supports the reporting of their
practice of medicine, the capture of the clinically relevant cc/mcc is a
byproduct of our educational efforts. The continued focus upon capturing
the "all mighty" CC/MCC is not and should not be the underlying
foundation of clinical documentation improvement. Unfortunately, this is
exactly what consulting companies are promulgating for their very
existence. I have deep concerns about how this CC/MCC capture mentality
is going to be a real detriment to our profession of CDI.
Thank you
-----Original Message-----
From: CDI Talk
Sent: Nov 2, 2010 7:36 AM
To: glennkrauss@earthlink.net
Subject: RE: [cdi_talk] Acute Renal Failure
We revamped our query for AKI to include questioning for the etiology of
AKI to capture the ones that are MCC's. We did not note them
specifically thinking this would look to much like leading for the
MCC's.
Judi Bates RN, BSN, CCDS
CDI Specialist
856-757-3161
Beeper 66x2906
________________________________
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 7:51 AM
To: Bates, Judith
Subject: RE: [cdi_talk] Acute Renal Failure
This is pretty much what I do. I always ask for the diagnosis with the
underlying cause or condition. So essentially, nothing changed for me
or the way that I address the issue.
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
"The difference between the right word and the almost right word is the
difference between lightning and the lightning bug." Samuel "Mark Twain"
Clemens
"This email is intended only for the use of the person or office to
which it is addressed and may contain information that is privileged,
confidential, or protected by law. All others are hereby notified that
the receipt of this email does not waive any applicable privilege or
exemption for disclosure and that any dissemination, distribution, or
copying of this communication is prohibited. If you have received this
email in error, please notify this office immediately at the telephone
number listed above."
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, November 01, 2010 7:46 PM
To: Hodges, Robert
Subject: Re: [cdi_talk] Acute Renal Failure
We are asking for more specificity if the clinical critera and risk
factors are present
.
Example:
(Place clinical data and risk factors from the EMR here)
Effective 10/1/10 documentation guidelines require increase specificity
relative to the diagnosis of ARF/AKI. If known, please specify if the
ARF/AKI is due to pre-renal, intrinsic renal, or post renal causes.
Pre-renal 2/2 dehydration Intrinsic renal 2/2 ATN
Intrinsic renal 2/2 AIN Post-renal 2/2 uretral
obstruction
Other____________. Unable to determine
Debbie S.
-----Original Message-----
From: CDI Talk
To: dsmith12h@aol.com
Sent: Mon, Nov 1, 2010 5:47 pm
Subject: [cdi_talk] Acute Renal Failure
Since Acute Renal Failure is no longer a MCC. I would like some input on
what
other facilities are doing? Are you just coding the ARF, or are you
asking the
physicians for more specific from what is putting the patient in the
ARF. Such
as, the ones that are MCC',
Acute tubular necrosis, Lesion of renal cortical necrosis, renal
medullary
necrosis, and specified pathological lesion in kidney?
How are you approaching your doctor's on this change? This was a huge
MCC for
alot of facilities. Thanks for advice.
Deb.
---
CDI Talk is offered for networking purposes. For official rules and
regulations
related to documentation and coding, please refer to your regulatory
source.
You are receiving this message as a member of CDI Talk as:
dsmith12h@aol.com
If you would like to be removed from CDI Talk, please send a blank email
to
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---
Copyright 2010
HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
---
CDI Talk is offered for networking purposes. For official rules and
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You are receiving this message as a member of CDI Talk as:
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Copyright 2010
HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
---
CDI Talk is offered for networking purposes. For official rules and
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Copyright 2010
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Confidentiality Notice:
This e-mail, including any attachments is the
property of Catholic Health East and is intended
for the sole use of the intended recipient(s).
It may contain information that is privileged and
confidential. Any unauthorized review, use,
disclosure, or distribution is prohibited. If you are
not the intended recipient, please delete this message, and
reply to the sender regarding the error in a separate email.
---
CDI Talk is offered for networking purposes. For official rules and
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HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
---
CDI Talk is offered for networking purposes. For official rules and
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Confidential: This electronic message and all contents contain information
from BayCare Health System which may be privileged, confidential or otherwise
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message and all copies.
budgets and yes, downsizing, unless we can prove our worth to
administration, they may decide that we do not represent a clear return
on investment. I believe that the documentation is the focus and
naturally that improvement brings enhanced reimbursements with it. But
again, most admins are numbers oriented and an impact on case mix index
and DRG movement as well as capture of CCs and MCCs with the associated
financial benefits, is something admins can understand.
Just a note to give support because these last notes seemed a little
harsh.
Mark
Mark Dominesey, RN/BSN, MBA
Clinical Documentation Improvement Specialist
Health Information Management Services
Martha Jefferson Hospital
459 Locust Ave
Charlottesville, VA 22902
Mark.Dominesey@mjh.org
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, November 04, 2010 9:28 AM
To: Dominesey, Mark N
Subject: RE: [cdi_talk] Acute Renal Failure
I agree completely. Additionally if we are to educate the physicians on
ICD 10 this approach will be helpful to prepare them for the inevitable
in 2013.
Virginia Bailey RN, CCDS
Certified Clinical Documentation Specialist
Morton Plant Northbay Hospital
727-859-4880 or ext 74880 from within system
________________________________
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 11:15 PM
To: Bailey, Virginia
Subject: RE: [cdi_talk] Acute Renal Failure
Folks, here is a novel idea, let's focus on the clinicals in the chart
and capitalize upon the opportunity to educate physicians on the
benefits of specificity, accuracy and detailedness of clinical
documentation, how this information supports the reporting of their
practice of medicine, the capture of the clinically relevant cc/mcc is a
byproduct of our educational efforts. The continued focus upon capturing
the "all mighty" CC/MCC is not and should not be the underlying
foundation of clinical documentation improvement. Unfortunately, this is
exactly what consulting companies are promulgating for their very
existence. I have deep concerns about how this CC/MCC capture mentality
is going to be a real detriment to our profession of CDI.
Thank you
-----Original Message-----
From: CDI Talk
Sent: Nov 2, 2010 7:36 AM
To: glennkrauss@earthlink.net
Subject: RE: [cdi_talk] Acute Renal Failure
We revamped our query for AKI to include questioning for the etiology of
AKI to capture the ones that are MCC's. We did not note them
specifically thinking this would look to much like leading for the
MCC's.
Judi Bates RN, BSN, CCDS
CDI Specialist
856-757-3161
Beeper 66x2906
________________________________
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 7:51 AM
To: Bates, Judith
Subject: RE: [cdi_talk] Acute Renal Failure
This is pretty much what I do. I always ask for the diagnosis with the
underlying cause or condition. So essentially, nothing changed for me
or the way that I address the issue.
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
"The difference between the right word and the almost right word is the
difference between lightning and the lightning bug." Samuel "Mark Twain"
Clemens
"This email is intended only for the use of the person or office to
which it is addressed and may contain information that is privileged,
confidential, or protected by law. All others are hereby notified that
the receipt of this email does not waive any applicable privilege or
exemption for disclosure and that any dissemination, distribution, or
copying of this communication is prohibited. If you have received this
email in error, please notify this office immediately at the telephone
number listed above."
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, November 01, 2010 7:46 PM
To: Hodges, Robert
Subject: Re: [cdi_talk] Acute Renal Failure
We are asking for more specificity if the clinical critera and risk
factors are present
.
Example:
(Place clinical data and risk factors from the EMR here)
Effective 10/1/10 documentation guidelines require increase specificity
relative to the diagnosis of ARF/AKI. If known, please specify if the
ARF/AKI is due to pre-renal, intrinsic renal, or post renal causes.
Pre-renal 2/2 dehydration Intrinsic renal 2/2 ATN
Intrinsic renal 2/2 AIN Post-renal 2/2 uretral
obstruction
Other____________. Unable to determine
Debbie S.
-----Original Message-----
From: CDI Talk
To: dsmith12h@aol.com
Sent: Mon, Nov 1, 2010 5:47 pm
Subject: [cdi_talk] Acute Renal Failure
Since Acute Renal Failure is no longer a MCC. I would like some input on
what
other facilities are doing? Are you just coding the ARF, or are you
asking the
physicians for more specific from what is putting the patient in the
ARF. Such
as, the ones that are MCC',
Acute tubular necrosis, Lesion of renal cortical necrosis, renal
medullary
necrosis, and specified pathological lesion in kidney?
How are you approaching your doctor's on this change? This was a huge
MCC for
alot of facilities. Thanks for advice.
Deb.
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Email Confidentiality Notice: The information contained in this transmission is confidential, proprietary or privileged and may be subject to protection under the law, including the Health Insurance Portability and Accountability Act (HIPAA). The message is intended for the sole use of the individual or entity to whom it is addressed. If you are not the intended recipient, you are notified that any use, distribution or copying of the message is strictly prohibited and may subject you to criminal or civil penalties. If you received this transmission in error, please contact the sender immediately by replying to this email and delete the material from any computer.
MCC/CC success. We need to show concrete data to valid our purpose and
money talks.
Stacy Vaughn, RHIT, CCS
Data Support Specialist/DRG Assurance
Aurora Baycare Medical Center
2845 Greenbrier Rd
Green Bay, WI 54311
Phone: (920) 288-8655
Fax: (920) 288-3052
CDI Talk
11/04/2010 08:44 AM
Please respond to
cdi_talk@hcprotalk.com
To
stacy.vaughn@aurora.org
cc
Subject
RE: [cdi_talk] Acute Renal Failure
I agree completely as well, but we have to remember in this era of tight
budgets and yes, downsizing, unless we can prove our worth to
administration, they may decide that we do not represent a clear return on
investment. I believe that the documentation is the focus and naturally
that improvement brings enhanced reimbursements with it. But again, most
admins are numbers oriented and an impact on case mix index and DRG
movement as well as capture of CCs and MCCs with the associated financial
benefits, is something admins can understand.
Just a note to give support because these last notes seemed a little
harsh.
Mark
Mark Dominesey, RN/BSN, MBA
Clinical Documentation Improvement Specialist
Health Information Management Services
Martha Jefferson Hospital
459 Locust Ave
Charlottesville, VA 22902
Mark.Dominesey@mjh.org
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, November 04, 2010 9:28 AM
To: Dominesey, Mark N
Subject: RE: [cdi_talk] Acute Renal Failure
I agree completely. Additionally if we are to educate the physicians on
ICD 10 this approach will be helpful to prepare them for the inevitable in
2013.
Virginia Bailey RN, CCDS
Certified Clinical Documentation Specialist
Morton Plant Northbay Hospital
727-859-4880 or ext 74880 from within system
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 11:15 PM
To: Bailey, Virginia
Subject: RE: [cdi_talk] Acute Renal Failure
Folks, here is a novel idea, let's focus on the clinicals in the chart and
capitalize upon the opportunity to educate physicians on the benefits of
specificity, accuracy and detailedness of clinical documentation, how this
information supports the reporting of their practice of medicine, the
capture of the clinically relevant cc/mcc is a byproduct of our
educational efforts. The continued focus upon capturing the "all mighty"
CC/MCC is not and should not be the underlying foundation of clinical
documentation improvement. Unfortunately, this is exactly what consulting
companies are promulgating for their very existence. I have deep concerns
about how this CC/MCC capture mentality is going to be a real detriment to
our profession of CDI.
Thank you
-----Original Message-----
From: CDI Talk
Sent: Nov 2, 2010 7:36 AM
To: glennkrauss@earthlink.net
Subject: RE: [cdi_talk] Acute Renal Failure
We revamped our query for AKI to include questioning for the etiology of
AKI to capture the ones that are MCC?s. We did not note them specifically
thinking this would look to much like leading for the MCC?s.
Judi Bates RN, BSN, CCDS
CDI Specialist
856-757-3161
Beeper 66x2906
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 7:51 AM
To: Bates, Judith
Subject: RE: [cdi_talk] Acute Renal Failure
This is pretty much what I do. I always ask for the diagnosis with the
underlying cause or condition. So essentially, nothing changed for me or
the way that I address the issue.
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
"The difference between the right word and the almost right word is the
difference between lightning and the lightning bug." Samuel "Mark Twain"
Clemens
"This email is intended only for the use of the person or office to which
it is addressed and may contain information that is privileged,
confidential, or protected by law. All others are hereby notified that the
receipt of this email does not waive any applicable privilege or exemption
for disclosure and that any dissemination, distribution, or copying of
this communication is prohibited. If you have received this email in
error, please notify this office immediately at the telephone number
listed above."
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, November 01, 2010 7:46 PM
To: Hodges, Robert
Subject: Re: [cdi_talk] Acute Renal Failure
We are asking for more specificity if the clinical critera and risk
factors are present
.
Example:
(Place clinical data and risk factors from the EMR here)
Effective 10/1/10 documentation guidelines require increase specificity
relative to the diagnosis of ARF/AKI. If known, please specify if the
ARF/AKI is due to pre-renal, intrinsic renal, or post renal causes.
Pre-renal 2/2 dehydration Intrinsic renal 2/2 ATN
Intrinsic renal 2/2 AIN Post-renal 2/2 uretral obstruction
Other____________. Unable to determine
Debbie S.
-----Original Message-----
From: CDI Talk
To: dsmith12h@aol.com
Sent: Mon, Nov 1, 2010 5:47 pm
Subject: [cdi_talk] Acute Renal Failure
Since Acute Renal Failure is no longer a MCC. I would like some input on
what
other facilities are doing? Are you just coding the ARF, or are you asking
the
physicians for more specific from what is putting the patient in the ARF.
Such
as, the ones that are MCC',
Acute tubular necrosis, Lesion of renal cortical necrosis, renal
medullary
necrosis, and specified pathological lesion in kidney?
How are you approaching your doctor's on this change? This was a huge MCC
for
alot of facilities. Thanks for advice.
Deb.
---
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Confidential: This electronic message and all contents contain
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and Accountability Act (HIPAA). The message is intended for the sole use
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Mark, thank you for your reply. On a side note, the next step in our CDIS endeavours is to educate our administrations on the role of clinical documentation beyond just reimbursement. There are a myriad of other "tangible" benefits of clinical documentation improvement that we can extoll including continuity of care, establishment of medical necessity for admission, safeguarding of the hospital's revenue through consistent documentation throughout the record, etc. However, by default CFOs resort to case mix, calculation of reimbursement, CC/MCC capture rate, and number of queries left by the CDIS ( "productivity). We will doing our profession a tremendous justice by stepping up to the plate and promoting the value of CDI to those who put us on the careful "microscope," hospital administrators.
Thank you
I would love to live in the world w/o focus on $$ but alas it is not the one I live in right now.
CDI Talk wrote:
>I agree completely as well, but we have to remember in this era of tight
>budgets and yes, downsizing, unless we can prove our worth to
>administration, they may decide that we do not represent a clear return
>on investment. I believe that the documentation is the focus and
>naturally that improvement brings enhanced reimbursements with it. But
>again, most admins are numbers oriented and an impact on case mix index
>and DRG movement as well as capture of CCs and MCCs with the associated
>financial benefits, is something admins can understand.
>
>
>
>Just a note to give support because these last notes seemed a little
>harsh.
>
>
>
>Mark
>
>
>
>
>
>Mark Dominesey, RN/BSN, MBA
>
>Clinical Documentation Improvement Specialist
>
>Health Information Management Services
>
>Martha Jefferson Hospital
>
>459 Locust Ave
>
>Charlottesville, VA 22902
>
>Mark.Dominesey@mjh.org
>
>
>
>
>
>
>
>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>Sent: Thursday, November 04, 2010 9:28 AM
>To: Dominesey, Mark N
>Subject: RE: [cdi_talk] Acute Renal Failure
>
>
>
>I agree completely. Additionally if we are to educate the physicians on
>ICD 10 this approach will be helpful to prepare them for the inevitable
>in 2013.
>
>
>
>Virginia Bailey RN, CCDS
>
>Certified Clinical Documentation Specialist
>
>Morton Plant Northbay Hospital
>
>727-859-4880 or ext 74880 from within system
>
>
>
>________________________________
>
>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>Sent: Tuesday, November 02, 2010 11:15 PM
>To: Bailey, Virginia
>Subject: RE: [cdi_talk] Acute Renal Failure
>
>
>
>Folks, here is a novel idea, let's focus on the clinicals in the chart
>and capitalize upon the opportunity to educate physicians on the
>benefits of specificity, accuracy and detailedness of clinical
>documentation, how this information supports the reporting of their
>practice of medicine, the capture of the clinically relevant cc/mcc is a
>byproduct of our educational efforts. The continued focus upon capturing
>the "all mighty" CC/MCC is not and should not be the underlying
>foundation of clinical documentation improvement. Unfortunately, this is
>exactly what consulting companies are promulgating for their very
>existence. I have deep concerns about how this CC/MCC capture mentality
>is going to be a real detriment to our profession of CDI.
>
>
>
>Thank you
>
>-----Original Message-----
>From: CDI Talk
>Sent: Nov 2, 2010 7:36 AM
>To: glennkrauss@earthlink.net
>Subject: RE: [cdi_talk] Acute Renal Failure
>
>
>
>We revamped our query for AKI to include questioning for the etiology of
>AKI to capture the ones that are MCC's. We did not note them
>specifically thinking this would look to much like leading for the
>MCC's.
>
>
>
>Judi Bates RN, BSN, CCDS
>CDI Specialist
>856-757-3161
>Beeper 66x2906
>
>________________________________
>
>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>Sent: Tuesday, November 02, 2010 7:51 AM
>To: Bates, Judith
>Subject: RE: [cdi_talk] Acute Renal Failure
>
>
>
>This is pretty much what I do. I always ask for the diagnosis with the
>underlying cause or condition. So essentially, nothing changed for me
>or the way that I address the issue.
>
>
>
>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
>
>
>
>"The difference between the right word and the almost right word is the
>difference between lightning and the lightning bug." Samuel "Mark Twain"
>Clemens
>
>
>
>"This email is intended only for the use of the person or office to
>which it is addressed and may contain information that is privileged,
>confidential, or protected by law. All others are hereby notified that
>the receipt of this email does not waive any applicable privilege or
>exemption for disclosure and that any dissemination, distribution, or
>copying of this communication is prohibited. If you have received this
>email in error, please notify this office immediately at the telephone
>number listed above."
>
>
>
>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>Sent: Monday, November 01, 2010 7:46 PM
>To: Hodges, Robert
>Subject: Re: [cdi_talk] Acute Renal Failure
>
>
>
>We are asking for more specificity if the clinical critera and risk
>factors are present
>
>.
>
>Example:
>
>(Place clinical data and risk factors from the EMR here)
>
>
>
>Effective 10/1/10 documentation guidelines require increase specificity
>relative to the diagnosis of ARF/AKI. If known, please specify if the
>ARF/AKI is due to pre-renal, intrinsic renal, or post renal causes.
>
>
>
>Pre-renal 2/2 dehydration Intrinsic renal 2/2 ATN
>
>Intrinsic renal 2/2 AIN Post-renal 2/2 uretral
>obstruction
>
>Other____________. Unable to determine
>
>
>
>Debbie S.
>
>-----Original Message-----
>From: CDI Talk
>To: dsmith12h@aol.com
>Sent: Mon, Nov 1, 2010 5:47 pm
>Subject: [cdi_talk] Acute Renal Failure
>
>Since Acute Renal Failure is no longer a MCC. I would like some input on
>what
>other facilities are doing? Are you just coding the ARF, or are you
>asking the
>physicians for more specific from what is putting the patient in the
>ARF. Such
>as, the ones that are MCC',
> Acute tubular necrosis, Lesion of renal cortical necrosis, renal
>medullary
>necrosis, and specified pathological lesion in kidney?
>How are you approaching your doctor's on this change? This was a huge
>MCC for
>alot of facilities. Thanks for advice.
> Deb.
>---
>CDI Talk is offered for networking purposes. For official rules and
>regulations
>related to documentation and coding, please refer to your regulatory
>source.
>
>You are receiving this message as a member of CDI Talk as:
>dsmith12h@aol.com
>If you would like to be removed from CDI Talk, please send a blank email
>to
>leave-cdi_talk-10398685.2cb93ee246d6127eb38c6be0d9f2b2d7@hcprotalk.com
>---
>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
>---
>CDI Talk is offered for networking purposes. For official rules and
>regulations related to documentation and coding, please refer to your
>regulatory source.
>
>You are receiving this message as a member of CDI Talk as:
>robert.hodges2@va.gov
>If you would like to be removed from CDI Talk, please send a blank email
>to
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>---
>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
>---
>CDI Talk is offered for networking purposes. For official rules and
>regulations related to documentation and coding, please refer to your
>regulatory source.
>
>You are receiving this message as a member of CDI Talk as:
>batesj@lourdesnet.org
>If you would like to be removed from CDI Talk, please send a blank email
>to
>leave-cdi_talk-11574448.a103e4a5d44ebf54e5499c03ebb6c706@hcprotalk.com
>---
>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
>Confidentiality Notice:
>This e-mail, including any attachments is the
>property of Catholic Health East and is intended
>for the sole use of the intended recipient(s).
>It may contain information that is privileged and
>confidential. Any unauthorized review, use,
>disclosure, or distribution is prohibited. If you are
>not the intended recipient, please delete this message, and
>reply to the sender regarding the error in a separate email.
>
>---
>CDI Talk is offered for networking purposes. For official rules and
>regulations related to documentation and coding, please refer to your
>regulatory source.
>
>You are receiving this message as a member of CDI Talk as:
>glennkrauss@earthlink.net
>If you would like to be removed from CDI Talk, please send a blank email
>to
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>---
>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
>Confidential: This electronic message and all contents contain
>information
>from BayCare Health System which may be privileged, confidential or
>otherwise
>protected from disclosure. The information is intended to be for the
>addressee
>only. If you are not the addressee, any disclosure, copy, distribution
>or use
>of the contents of this message is prohibited. If you have received
>this
>electronic message in error, please notify the sender and destroy the
>original
>message and all copies.
>
>
>---
>CDI Talk is offered for networking purposes. For official rules and
>regulations related to documentation and coding, please refer to your
>regulatory source.
>
>You are receiving this message as a member of CDI Talk as:
>mark.dominesey@mjh.org
>If you would like to be removed from CDI Talk, please send a blank email
>to
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>---
>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
>---
>CDI Talk is offered for networking purposes. For official rules and
>regulations related to documentation and coding, please refer to your
>regulatory source.
>
>You are receiving this message as a member of CDI Talk as:
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>If you would like to be removed from CDI Talk, please send a blank email
>to
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>---
>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
>
>Email Confidentiality Notice: The information contained in this transmission is confidential, proprietary or privileged and may be subject to protection under the law, including the Health Insurance Portability and Accountability Act (HIPAA). The message is intended for the sole use of the individual or entity to whom it is addressed. If you are not the intended recipient, you are notified that any use, distribution or copying of the message is strictly prohibited and may subject you to criminal or civil penalties. If you received this transmission in error, please contact the sender immediately by replying to this email and delete the material from any computer.
>
>---
>CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
>You are receiving this message as a member of CDI Talk as: paxneros@comcast.net
>If you would like to be removed from CDI Talk, please send a blank email to
>leave-cdi_talk-12055558.c302c3689dbc8049233b7b76c1441862@hcprotalk.com
>---
>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
-----Original Message-----
>From: CDI Talk
>Sent: Nov 4, 2010 10:41 AM
>To: glennkrauss@earthlink.net
>Subject: RE: [cdi_talk] Acute Renal Failure
>
>Thanks Mark- I can tell you feel our pain!
>
>I would love to live in the world w/o focus on $$ but alas it is not the one I live in right now.
>
>CDI Talk wrote:
>
>>I agree completely as well, but we have to remember in this era of tight
>>budgets and yes, downsizing, unless we can prove our worth to
>>administration, they may decide that we do not represent a clear return
>>on investment. I believe that the documentation is the focus and
>>naturally that improvement brings enhanced reimbursements with it. But
>>again, most admins are numbers oriented and an impact on case mix index
>>and DRG movement as well as capture of CCs and MCCs with the associated
>>financial benefits, is something admins can understand.
>>
>>
>>
>>Just a note to give support because these last notes seemed a little
>>harsh.
>>
>>
>>
>>Mark
>>
>>
>>
>>
>>
>>Mark Dominesey, RN/BSN, MBA
>>
>>Clinical Documentation Improvement Specialist
>>
>>Health Information Management Services
>>
>>Martha Jefferson Hospital
>>
>>459 Locust Ave
>>
>>Charlottesville, VA 22902
>>
>>Mark.Dominesey@mjh.org
>>
>>
>>
>>
>>
>>
>>
>>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>>Sent: Thursday, November 04, 2010 9:28 AM
>>To: Dominesey, Mark N
>>Subject: RE: [cdi_talk] Acute Renal Failure
>>
>>
>>
>>I agree completely. Additionally if we are to educate the physicians on
>>ICD 10 this approach will be helpful to prepare them for the inevitable
>>in 2013.
>>
>>
>>
>>Virginia Bailey RN, CCDS
>>
>>Certified Clinical Documentation Specialist
>>
>>Morton Plant Northbay Hospital
>>
>>727-859-4880 or ext 74880 from within system
>>
>>
>>
>>________________________________
>>
>>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>>Sent: Tuesday, November 02, 2010 11:15 PM
>>To: Bailey, Virginia
>>Subject: RE: [cdi_talk] Acute Renal Failure
>>
>>
>>
>>Folks, here is a novel idea, let's focus on the clinicals in the chart
>>and capitalize upon the opportunity to educate physicians on the
>>benefits of specificity, accuracy and detailedness of clinical
>>documentation, how this information supports the reporting of their
>>practice of medicine, the capture of the clinically relevant cc/mcc is a
>>byproduct of our educational efforts. The continued focus upon capturing
>>the "all mighty" CC/MCC is not and should not be the underlying
>>foundation of clinical documentation improvement. Unfortunately, this is
>>exactly what consulting companies are promulgating for their very
>>existence. I have deep concerns about how this CC/MCC capture mentality
>>is going to be a real detriment to our profession of CDI.
>>
>>
>>
>>Thank you
>>
>>-----Original Message-----
>>From: CDI Talk
>>Sent: Nov 2, 2010 7:36 AM
>>To: glennkrauss@earthlink.net
>>Subject: RE: [cdi_talk] Acute Renal Failure
>>
>>
>>
>>We revamped our query for AKI to include questioning for the etiology of
>>AKI to capture the ones that are MCC's. We did not note them
>>specifically thinking this would look to much like leading for the
>>MCC's.
>>
>>
>>
>>Judi Bates RN, BSN, CCDS
>>CDI Specialist
>>856-757-3161
>>Beeper 66x2906
>>
>>________________________________
>>
>>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>>Sent: Tuesday, November 02, 2010 7:51 AM
>>To: Bates, Judith
>>Subject: RE: [cdi_talk] Acute Renal Failure
>>
>>
>>
>>This is pretty much what I do. I always ask for the diagnosis with the
>>underlying cause or condition. So essentially, nothing changed for me
>>or the way that I address the issue.
>>
>>
>>
>>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
>>
>>
>>
>>"The difference between the right word and the almost right word is the
>>difference between lightning and the lightning bug." Samuel "Mark Twain"
>>Clemens
>>
>>
>>
>>"This email is intended only for the use of the person or office to
>>which it is addressed and may contain information that is privileged,
>>confidential, or protected by law. All others are hereby notified that
>>the receipt of this email does not waive any applicable privilege or
>>exemption for disclosure and that any dissemination, distribution, or
>>copying of this communication is prohibited. If you have received this
>>email in error, please notify this office immediately at the telephone
>>number listed above."
>>
>>
>>
>>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>>Sent: Monday, November 01, 2010 7:46 PM
>>To: Hodges, Robert
>>Subject: Re: [cdi_talk] Acute Renal Failure
>>
>>
>>
>>We are asking for more specificity if the clinical critera and risk
>>factors are present
>>
>>.
>>
>>Example:
>>
>>(Place clinical data and risk factors from the EMR here)
>>
>>
>>
>>Effective 10/1/10 documentation guidelines require increase specificity
>>relative to the diagnosis of ARF/AKI. If known, please specify if the
>>ARF/AKI is due to pre-renal, intrinsic renal, or post renal causes.
>>
>>
>>
>>Pre-renal 2/2 dehydration Intrinsic renal 2/2 ATN
>>
>>Intrinsic renal 2/2 AIN Post-renal 2/2 uretral
>>obstruction
>>
>>Other____________. Unable to determine
>>
>>
>>
>>Debbie S.
>>
>>-----Original Message-----
>>From: CDI Talk
>>To: dsmith12h@aol.com
>>Sent: Mon, Nov 1, 2010 5:47 pm
>>Subject: [cdi_talk] Acute Renal Failure
>>
>>Since Acute Renal Failure is no longer a MCC. I would like some input on
>>what
>>other facilities are doing? Are you just coding the ARF, or are you
>>asking the
>>physicians for more specific from what is putting the patient in the
>>ARF. Such
>>as, the ones that are MCC',
>> Acute tubular necrosis, Lesion of renal cortical necrosis, renal
>>medullary
>>necrosis, and specified pathological lesion in kidney?
>>How are you approaching your doctor's on this change? This was a huge
>>MCC for
>>alot of facilities. Thanks for advice.
>> Deb.
>>---
>>CDI Talk is offered for networking purposes. For official rules and
>>regulations
>>related to documentation and coding, please refer to your regulatory
>>source.
>>
>>You are receiving this message as a member of CDI Talk as:
>>dsmith12h@aol.com
>>If you would like to be removed from CDI Talk, please send a blank email
>>to
>>leave-cdi_talk-10398685.2cb93ee246d6127eb38c6be0d9f2b2d7@hcprotalk.com
>>---
>>Copyright 2010
>>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>>
>>---
>>CDI Talk is offered for networking purposes. For official rules and
>>regulations related to documentation and coding, please refer to your
>>regulatory source.
>>
>>You are receiving this message as a member of CDI Talk as:
>>robert.hodges2@va.gov
>>If you would like to be removed from CDI Talk, please send a blank email
>>to
>>leave-cdi_talk-10741982.fced5831ab44431e3f844a057071eb02@hcprotalk.com
>>---
>>Copyright 2010
>>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>>
>>---
>>CDI Talk is offered for networking purposes. For official rules and
>>regulations related to documentation and coding, please refer to your
>>regulatory source.
>>
>>You are receiving this message as a member of CDI Talk as:
>>batesj@lourdesnet.org
>>If you would like to be removed from CDI Talk, please send a blank email
>>to
>>leave-cdi_talk-11574448.a103e4a5d44ebf54e5499c03ebb6c706@hcprotalk.com
>>---
>>Copyright 2010
>>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>>
>>Confidentiality Notice:
>>This e-mail, including any attachments is the
>>property of Catholic Health East and is intended
>>for the sole use of the intended recipient(s).
>>It may contain information that is privileged and
>>confidential. Any unauthorized review, use,
>>disclosure, or distribution is prohibited. If you are
>>not the intended recipient, please delete this message, and
>>reply to the sender regarding the error in a separate email.
>>
>>---
>>CDI Talk is offered for networking purposes. For official rules and
>>regulations related to documentation and coding, please refer to your
>>regulatory source.
>>
>>You are receiving this message as a member of CDI Talk as:
>>glennkrauss@earthlink.net
>>If you would like to be removed from CDI Talk, please send a blank email
>>to
>>leave-cdi_talk-11551594.832b8c147a2b8ab21fc91edd9c8c82b4@hcprotalk.com
>>---
>>Copyright 2010
>>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>>
>>Confidential: This electronic message and all contents contain
>>information
>>from BayCare Health System which may be privileged, confidential or
>>otherwise
>>protected from disclosure. The information is intended to be for the
>>addressee
>>only. If you are not the addressee, any disclosure, copy, distribution
>>or use
>>of the contents of this message is prohibited. If you have received
>>this
>>electronic message in error, please notify the sender and destroy the
>>original
>>message and all copies.
>>
>>
>>---
>>CDI Talk is offered for networking purposes. For official rules and
>>regulations related to documentation and coding, please refer to your
>>regulatory source.
>>
>>You are receiving this message as a member of CDI Talk as:
>>mark.dominesey@mjh.org
>>If you would like to be removed from CDI Talk, please send a blank email
>>to
>>leave-cdi_talk-12208259.3b0b4ba7a090e135fc67beeeee850cc1@hcprotalk.com
>>---
>>Copyright 2010
>>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>>
>>---
>>CDI Talk is offered for networking purposes. For official rules and
>>regulations related to documentation and coding, please refer to your
>>regulatory source.
>>
>>You are receiving this message as a member of CDI Talk as:
>>virginia.bailey@baycare.org
>>If you would like to be removed from CDI Talk, please send a blank email
>>to
>>leave-cdi_talk-10442134.7bf08d40085f5407016ba01357165f5e@hcprotalk.com
>>---
>>Copyright 2010
>>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>>
>>
>>Email Confidentiality Notice: The information contained in this transmission is confidential, proprietary or privileged and may be subject to protection under the law, including the Health Insurance Portability and Accountability Act (HIPAA). The message is intended for the sole use of the individual or entity to whom it is addressed. If you are not the intended recipient, you are notified that any use, distribution or copying of the message is strictly prohibited and may subject you to criminal or civil penalties. If you received this transmission in error, please contact the sender immediately by replying to this email and delete the material from any computer.
>>
>>---
>>CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>>
>>You are receiving this message as a member of CDI Talk as: paxneros@comcast.net
>>If you would like to be removed from CDI Talk, please send a blank email to
>>leave-cdi_talk-12055558.c302c3689dbc8049233b7b76c1441862@hcprotalk.com
>>---
>>Copyright 2010
>>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>---
>CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
>You are receiving this message as a member of CDI Talk as: glennkrauss@earthlink.net
>If you would like to be removed from CDI Talk, please send a blank email to
>leave-cdi_talk-11551594.832b8c147a2b8ab21fc91edd9c8c82b4@hcprotalk.com
>---
>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
Robert
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
"This email is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this email does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this email in error, please notify this office immediately at the telephone number listed above."
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, November 04, 2010 10:46 AM
To: Hodges, Robert
Subject: RE: [cdi_talk] Acute Renal Failure
The focus on money is a shortsighted proposition at best. I would not want to be working in that environment.
-----Original Message-----
>From: CDI Talk
>Sent: Nov 4, 2010 10:41 AM
>To: glennkrauss@earthlink.net
>Subject: RE: [cdi_talk] Acute Renal Failure
>
>Thanks Mark- I can tell you feel our pain!
>
>I would love to live in the world w/o focus on $$ but alas it is not the one I live in right now.
>
>CDI Talk wrote:
>
>>I agree completely as well, but we have to remember in this era of tight
>>budgets and yes, downsizing, unless we can prove our worth to
>>administration, they may decide that we do not represent a clear return
>>on investment. I believe that the documentation is the focus and
>>naturally that improvement brings enhanced reimbursements with it. But
>>again, most admins are numbers oriented and an impact on case mix index
>>and DRG movement as well as capture of CCs and MCCs with the associated
>>financial benefits, is something admins can understand.
>>
>>
>>
>>Just a note to give support because these last notes seemed a little
>>harsh.
>>
>>
>>
>>Mark
>>
>>
>>
>>
>>
>>Mark Dominesey, RN/BSN, MBA
>>
>>Clinical Documentation Improvement Specialist
>>
>>Health Information Management Services
>>
>>Martha Jefferson Hospital
>>
>>459 Locust Ave
>>
>>Charlottesville, VA 22902
>>
>>Mark.Dominesey@mjh.org
>>
>>
>>
>>
>>
>>
>>
>>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>>Sent: Thursday, November 04, 2010 9:28 AM
>>To: Dominesey, Mark N
>>Subject: RE: [cdi_talk] Acute Renal Failure
>>
>>
>>
>>I agree completely. Additionally if we are to educate the physicians on
>>ICD 10 this approach will be helpful to prepare them for the inevitable
>>in 2013.
>>
>>
>>
>>Virginia Bailey RN, CCDS
>>
>>Certified Clinical Documentation Specialist
>>
>>Morton Plant Northbay Hospital
>>
>>727-859-4880 or ext 74880 from within system
>>
>>
>>
>>________________________________
>>
>>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>>Sent: Tuesday, November 02, 2010 11:15 PM
>>To: Bailey, Virginia
>>Subject: RE: [cdi_talk] Acute Renal Failure
>>
>>
>>
>>Folks, here is a novel idea, let's focus on the clinicals in the chart
>>and capitalize upon the opportunity to educate physicians on the
>>benefits of specificity, accuracy and detailedness of clinical
>>documentation, how this information supports the reporting of their
>>practice of medicine, the capture of the clinically relevant cc/mcc is a
>>byproduct of our educational efforts. The continued focus upon capturing
>>the "all mighty" CC/MCC is not and should not be the underlying
>>foundation of clinical documentation improvement. Unfortunately, this is
>>exactly what consulting companies are promulgating for their very
>>existence. I have deep concerns about how this CC/MCC capture mentality
>>is going to be a real detriment to our profession of CDI.
>>
>>
>>
>>Thank you
>>
>>-----Original Message-----
>>From: CDI Talk
>>Sent: Nov 2, 2010 7:36 AM
>>To: glennkrauss@earthlink.net
>>Subject: RE: [cdi_talk] Acute Renal Failure
>>
>>
>>
>>We revamped our query for AKI to include questioning for the etiology of
>>AKI to capture the ones that are MCC's. We did not note them
>>specifically thinking this would look to much like leading for the
>>MCC's.
>>
>>
>>
>>Judi Bates RN, BSN, CCDS
>>CDI Specialist
>>856-757-3161
>>Beeper 66x2906
>>
>>________________________________
>>
>>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>>Sent: Tuesday, November 02, 2010 7:51 AM
>>To: Bates, Judith
>>Subject: RE: [cdi_talk] Acute Renal Failure
>>
>>
>>
>>This is pretty much what I do. I always ask for the diagnosis with the
>>underlying cause or condition. So essentially, nothing changed for me
>>or the way that I address the issue.
>>
>>
>>
>>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
>>
>>
>>
>>"The difference between the right word and the almost right word is the
>>difference between lightning and the lightning bug." Samuel "Mark Twain"
>>Clemens
>>
>>
>>
>>"This email is intended only for the use of the person or office to
>>which it is addressed and may contain information that is privileged,
>>confidential, or protected by law. All others are hereby notified that
>>the receipt of this email does not waive any applicable privilege or
>>exemption for disclosure and that any dissemination, distribution, or
>>copying of this communication is prohibited. If you have received this
>>email in error, please notify this office immediately at the telephone
>>number listed above."
>>
>>
>>
>>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>>Sent: Monday, November 01, 2010 7:46 PM
>>To: Hodges, Robert
>>Subject: Re: [cdi_talk] Acute Renal Failure
>>
>>
>>
>>We are asking for more specificity if the clinical critera and risk
>>factors are present
>>
>>.
>>
>>Example:
>>
>>(Place clinical data and risk factors from the EMR here)
>>
>>
>>
>>Effective 10/1/10 documentation guidelines require increase specificity
>>relative to the diagnosis of ARF/AKI. If known, please specify if the
>>ARF/AKI is due to pre-renal, intrinsic renal, or post renal causes.
>>
>>
>>
>>Pre-renal 2/2 dehydration Intrinsic renal 2/2 ATN
>>
>>Intrinsic renal 2/2 AIN Post-renal 2/2 uretral
>>obstruction
>>
>>Other____________. Unable to determine
>>
>>
>>
>>Debbie S.
>>
>>-----Original Message-----
>>From: CDI Talk
>>To: dsmith12h@aol.com
>>Sent: Mon, Nov 1, 2010 5:47 pm
>>Subject: [cdi_talk] Acute Renal Failure
>>
>>Since Acute Renal Failure is no longer a MCC. I would like some input on
>>what
>>other facilities are doing? Are you just coding the ARF, or are you
>>asking the
>>physicians for more specific from what is putting the patient in the
>>ARF. Such
>>as, the ones that are MCC',
>> Acute tubular necrosis, Lesion of renal cortical necrosis, renal
>>medullary
>>necrosis, and specified pathological lesion in kidney?
>>How are you approaching your doctor's on this change? This was a huge
>>MCC for
>>alot of facilities. Thanks for advice.
>> Deb.
>>---
>>CDI Talk is offered for networking purposes. For official rules and
>>regulations
>>related to documentation and coding, please refer to your regulatory
>>source.
>>
>>You are receiving this message as a member of CDI Talk as:
>>dsmith12h@aol.com
>>If you would like to be removed from CDI Talk, please send a blank email
>>to
>>leave-cdi_talk-10398685.2cb93ee246d6127eb38c6be0d9f2b2d7@hcprotalk.com
>>---
>>Copyright 2010
>>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>>
>>---
>>CDI Talk is offered for networking purposes. For official rules and
>>regulations related to documentation and coding, please refer to your
>>regulatory source.
>>
>>You are receiving this message as a member of CDI Talk as:
>>robert.hodges2@va.gov
>>If you would like to be removed from CDI Talk, please send a blank email
>>to
>>leave-cdi_talk-10741982.fced5831ab44431e3f844a057071eb02@hcprotalk.com
>>---
>>Copyright 2010
>>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>>
>>---
>>CDI Talk is offered for networking purposes. For official rules and
>>regulations related to documentation and coding, please refer to your
>>regulatory source.
>>
>>You are receiving this message as a member of CDI Talk as:
>>batesj@lourdesnet.org
>>If you would like to be removed from CDI Talk, please send a blank email
>>to
>>leave-cdi_talk-11574448.a103e4a5d44ebf54e5499c03ebb6c706@hcprotalk.com
>>---
>>Copyright 2010
>>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>>
>>Confidentiality Notice:
>>This e-mail, including any attachments is the
>>property of Catholic Health East and is intended
>>for the sole use of the intended recipient(s).
>>It may contain information that is privileged and
>>confidential. Any unauthorized review, use,
>>disclosure, or distribution is prohibited. If you are
>>not the intended recipient, please delete this message, and
>>reply to the sender regarding the error in a separate email.
>>
>>---
>>CDI Talk is offered for networking purposes. For official rules and
>>regulations related to documentation and coding, please refer to your
>>regulatory source.
>>
>>You are receiving this message as a member of CDI Talk as:
>>glennkrauss@earthlink.net
>>If you would like to be removed from CDI Talk, please send a blank email
>>to
>>leave-cdi_talk-11551594.832b8c147a2b8ab21fc91edd9c8c82b4@hcprotalk.com
>>---
>>Copyright 2010
>>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>>
>>Confidential: This electronic message and all contents contain
>>information
>>from BayCare Health System which may be privileged, confidential or
>>otherwise
>>protected from disclosure. The information is intended to be for the
>>addressee
>>only. If you are not the addressee, any disclosure, copy, distribution
>>or use
>>of the contents of this message is prohibited. If you have received
>>this
>>electronic message in error, please notify the sender and destroy the
>>original
>>message and all copies.
>>
>>
>>---
>>CDI Talk is offered for networking purposes. For official rules and
>>regulations related to documentation and coding, please refer to your
>>regulatory source.
>>
>>You are receiving this message as a member of CDI Talk as:
>>mark.dominesey@mjh.org
>>If you would like to be removed from CDI Talk, please send a blank email
>>to
>>leave-cdi_talk-12208259.3b0b4ba7a090e135fc67beeeee850cc1@hcprotalk.com
>>---
>>Copyright 2010
>>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>>
>>---
>>CDI Talk is offered for networking purposes. For official rules and
>>regulations related to documentation and coding, please refer to your
>>regulatory source.
>>
>>You are receiving this message as a member of CDI Talk as:
>>virginia.bailey@baycare.org
>>If you would like to be removed from CDI Talk, please send a blank email
>>to
>>leave-cdi_talk-10442134.7bf08d40085f5407016ba01357165f5e@hcprotalk.com
>>---
>>Copyright 2010
>>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>>
>>
>>Email Confidentiality Notice: The information contained in this transmission is confidential, proprietary or privileged and may be subject to protection under the law, including the Health Insurance Portability and Accountability Act (HIPAA). The message is intended for the sole use of the individual or entity to whom it is addressed. If you are not the intended recipient, you are notified that any use, distribution or copying of the message is strictly prohibited and may subject you to criminal or civil penalties. If you received this transmission in error, please contact the sender immediately by replying to this email and delete the material from any computer.
>>
>>---
>>CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>>
>>You are receiving this message as a member of CDI Talk as: paxneros@comcast.net
>>If you would like to be removed from CDI Talk, please send a blank email to
>>leave-cdi_talk-12055558.c302c3689dbc8049233b7b76c1441862@hcprotalk.com
>>---
>>Copyright 2010
>>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>---
>CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
>You are receiving this message as a member of CDI Talk as: glennkrauss@earthlink.net
>If you would like to be removed from CDI Talk, please send a blank email to
>leave-cdi_talk-11551594.832b8c147a2b8ab21fc91edd9c8c82b4@hcprotalk.com
>---
>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: robert.hodges2@va.gov
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-10741982.fced5831ab44431e3f844a057071eb02@hcprotalk.com
---
Copyright 2010
HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
hospital CFO) has done quite a bit of work in association with the
Quality folks putting the finance impact/value on the quality
initiatives -- both savings in direct care with decreased central line
infections as well as the gained opportunity with the shorter stay.
There is the clear perspective that it is not all about the money, but
rather that we are in this business to take care of people and to have a
black bottom line to be able to reinvest into the community and
organization.
Don
>>> "CDI Talk" 11/4/2010 10:05 AM >>>
Mark, thank you for your reply. On a side note, the next step in our
CDIS endeavours is to educate our administrations on the role of
clinical documentation beyond just reimbursement. There are a myriad of
other "tangible" benefits of clinical documentation improvement that we
can extoll including continuity of care, establishment of medical
necessity for admission, safeguarding of the hospital's revenue through
consistent documentation throughout the record, etc. However, by default
CFOs resort to case mix, calculation of reimbursement, CC/MCC capture
rate, and number of queries left by the CDIS ( "productivity). We will
doing our profession a tremendous justice by stepping up to the plate
and promoting the value of CDI to those who put us on the careful
"microscope," hospital administrators.
Thank you
-----Original Message-----
From: CDI Talk
Sent: Nov 4, 2010 9:47 AM
To: glennkrauss@earthlink.net
Subject: RE: [cdi_talk] Acute Renal Failure
I agree completely as well, but we have to remember in this era of
tight budgets and yes, downsizing, unless we can prove our worth to
administration, they may decide that we do not represent a clear return
on investment. I believe that the documentation is the focus and
naturally that improvement brings enhanced reimbursements with it. But
again, most admins are numbers oriented and an impact on case mix index
and DRG movement as well as capture of CCs and MCCs with the associated
financial benefits, is something admins can understand.
Just a note to give support because these last notes seemed a little
harsh.
Mark
Mark Dominesey, RN/BSN, MBA
Clinical Documentation Improvement Specialist
Health Information Management Services
Martha Jefferson Hospital
459 Locust Ave
Charlottesville, VA 22902
Mark.Dominesey@mjh.org
From:CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, November 04, 2010 9:28 AM
To: Dominesey, Mark N
Subject: RE: [cdi_talk] Acute Renal Failure
I agree completely. Additionally if we are to educate the physicians on
ICD 10 this approach will be helpful to prepare them for the inevitable
in 2013.
Virginia Bailey RN, CCDS
Certified Clinical Documentation Specialist
Morton Plant Northbay Hospital
727-859-4880 or ext 74880 from within system
From:CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 11:15 PM
To: Bailey, Virginia
Subject: RE: [cdi_talk] Acute Renal Failure
Folks, here is a novel idea, let's focus on the clinicals in the chart
and capitalize upon the opportunity to educate physicians on the
benefits of specificity, accuracy and detailedness of clinical
documentation, how this information supports the reporting of their
practice of medicine, the capture of the clinically relevant cc/mcc is a
byproduct of our educational efforts. The continued focus upon capturing
the "all mighty" CC/MCC is not and should not be the underlying
foundation of clinical documentation improvement. Unfortunately, this is
exactly what consulting companies are promulgating for their very
existence. I have deep concerns about how this CC/MCC capture mentality
is going to be a real detriment to our profession of CDI.
Thank you
-----Original Message-----
From: CDI Talk
Sent: Nov 2, 2010 7:36 AM
To: glennkrauss@earthlink.net
Subject: RE: [cdi_t
alk] Acute Renal Failure
We revamped our query for AKI to include questioning for the etiology
of AKI to capture the ones that are MCC’s. We did not note them
specifically thinking this would look to much like leading for the
MCC’s.
Judi Bates RN, BSN, CCDS
CDI Specialist
856-757-3161
Beeper 66x2906
From:CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 7:51 AM
To: Bates, Judith
Subject: RE: [cdi_talk] Acute Renal Failure
This is pretty much what I do. I always ask for the diagnosis with the
underlying cause or condition. So essentially, nothing changed for me
or the way that I address the issue.
Robert
Robert S. Hodges, BSN, MSN, RN
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
SaginawMI48602
P: 989-497-2500 x13101
F: 989-321-4912
E: Robert.Hodges2@va.gov
"The difference between the right word and the almost right word is the
difference between lightning and the lightning bug." Samuel "Mark Twain"
Clemens
"This email is intended only for the use of the person or office to
which it is addressed and may contain information that is privileged,
confidential, or protected by law. All others are hereby notified that
the receipt of this email does not waive any applicable privilege or
exemption for disclosure and that any dissemination, distribution, or
copying of this communication is prohibited. If you have received this
email in error, please notify this office immediately at the telephone
number listed above."
From:CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, November 01, 2010 7:46 PM
To: Hodges, Robert
Subject: Re: [cdi_talk] Acute Renal Failure
We are asking for more specificity if the clinical critera and risk
factors are present
.
Example:
(Place clinical data and risk factors from the EMR here)
Effective 10/1/10 documentation guidelines require increase specificity
relative to the diagnosis of ARF/AKI. If known, please specify if the
ARF/AKI is due to pre-renal, intrinsic renal, or post renal causes.
Pre-renal 2/2 dehydration Intrinsic renal 2/2 ATN
Intrinsic renal 2/2 AIN Post-renal 2/2 uretral
obstruction
Other____________. Unable to determine
Debbie S.
-----Original Message-----
From: CDI Talk
To: dsmith12h@aol.com
Sent: Mon, Nov 1, 2010 5:47 pm
Subject: [cdi_talk] Acute Renal FailureSince Acute Renal Failure is no
longer a MCC. I would like some input on what other facilities are
doing? Are you just coding the ARF, or are you asking the physicians for
more specific from what is putting the patient in the ARF. Such as, the
ones that are MCC',Acute tubular necrosis, Lesion of renal cortical
necrosis, renal medullary necrosis, and specified pathological lesion in
kidney?How are you approaching your doctor's on this change? This was a
huge MCC for alot of facilities. Thanks for advice. Deb.---CDI Talk is
offered for networking purposes. For official rules and regulations
related to documentation and coding, please refer to your regulatory
source. You are receiving this message as a member of CDI Talk as:
dsmith12h@aol.comIf you would like to be removed from CDI Talk,
please send a blank email to
leave-cdi_talk-10398685.2cb93ee246d6127eb38c6be0d9f2b2d7@hcprotalk.com---Copyright
2010HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
---CDI Talk is offered for networking purposes. For official rules and
regulations related to documentation and coding, please refer to your
regulatory source. You are receiving this message as a member of CDI
Talk as: robert.hodges2@va.govIf you would like to be removed from CDI
Talk, please send a blank email to
leave-cdi_talk-10741982.fced5831ab44431e3f844a057071eb02@hcprotalk.com---Copyright
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offered for networking purposes. For official rules and regulations
related to documentation
and coding, please refer to your regulatory
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batesj@lourdesnet.orgIf you would like to be removed from CDI Talk,
please send a blank email to
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Confidentiality Notice:
This e-mail, including any attachments is the
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It may contain information that is privileged and
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reply to the sender regarding the error in a separate email.---CDI Talk
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Confidential: This electronic message and all contents contain
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Email Confidentiality Notice: The information contained in this
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Your points are well taken and probably as well understood by most CDISs on this message board and elsewhere. We do have much to do as a profession to educate physicians and administrators that clarity, specificity and completeness is the goal….. but, what many keep asking is…. “show me the data”. It is very difficult to pin down the results of our contribution in some concrete fashion. Impact on the bottom line, unfortunately is what most people, admins, shareholders, others, can understand. Your blog posts about the RACs are excellent; I encourage all readers here to read them. Glenn elucidates why documentation is so important, but again, most of us face the position of having to justify our positions and our programs. Can we come up with better metrics other than financial impact? (metrics that can be understood by all the stakeholders, medical, nursing, admin, others)
Thanks so much for your input and comments.
Mark
Mark Dominesey, RN/BSN, MBA
Clinical Documentation Improvement Specialist
Health Information Management Services
Martha Jefferson Hospital
459 Locust Ave
Charlottesville, VA 22902
434-654-7692
Mark.Dominesey@mjh.org
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, November 04, 2010 10:05 AM
To: Dominesey, Mark N
Subject: RE: [cdi_talk] Acute Renal Failure
Mark, thank you for your reply. On a side note, the next step in our CDIS endeavours is to educate our administrations on the role of clinical documentation beyond just reimbursement. There are a myriad of other "tangible" benefits of clinical documentation improvement that we can extoll including continuity of care, establishment of medical necessity for admission, safeguarding of the hospital's revenue through consistent documentation throughout the record, etc. However, by default CFOs resort to case mix, calculation of reimbursement, CC/MCC capture rate, and number of queries left by the CDIS ( "productivity). We will doing our profession a tremendous justice by stepping up to the plate and promoting the value of CDI to those who put us on the careful "microscope," hospital administrators.
Thank you
-----Original Message-----
From: CDI Talk
Sent: Nov 4, 2010 9:47 AM
To: glennkrauss@earthlink.net
Subject: RE: [cdi_talk] Acute Renal Failure
I agree completely as well, but we have to remember in this era of tight budgets and yes, downsizing, unless we can prove our worth to administration, they may decide that we do not represent a clear return on investment. I believe that the documentation is the focus and naturally that improvement brings enhanced reimbursements with it. But again, most admins are numbers oriented and an impact on case mix index and DRG movement as well as capture of CCs and MCCs with the associated financial benefits, is something admins can understand.
Just a note to give support because these last notes seemed a little harsh.
Mark
Mark Dominesey, RN/BSN, MBA
Clinical Documentation Improvement Specialist
Health Information Management Services
Martha Jefferson Hospital
459 Locust Ave
Charlottesville, VA 22902
Mark.Dominesey@mjh.org
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, November 04, 2010 9:28 AM
To: Dominesey, Mark N
Subject: RE: [cdi_talk] Acute Renal Failure
I agree completely. Additionally if we are to educate the physicians on ICD 10 this approach will be helpful to prepare them for the inevitable in 2013.
Virginia Bailey RN, CCDS
Certified Clinical Documentation Specialist
Morton Plant Northbay Hospital
727-859-4880 or ext 74880 from within system
________________________________
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 11:15 PM
To: Bailey, Virginia
Subject: RE: [cdi_talk] Acute Renal Failure
Folks, here is a novel idea, let's focus on the clinicals in the chart and capitalize upon the opportunity to educate physicians on the benefits of specificity, accuracy and detailedness of clinical documentation, how this information supports the reporting of their practice of medicine, the capture of the clinically relevant cc/mcc is a byproduct of our educational efforts. The continued focus upon capturing the "all mighty" CC/MCC is not and should not be the underlying foundation of clinical documentation improvement. Unfortunately, this is exactly what consulting companies are promulgating for their very existence. I have deep concerns about how this CC/MCC capture mentality is going to be a real detriment to our profession of CDI.
Thank you
-----Original Message-----
From: CDI Talk
Sent: Nov 2, 2010 7:36 AM
To: glennkrauss@earthlink.net
Subject: RE: [cdi_talk] Acute Renal Failure
We revamped our query for AKI to include questioning for the etiology of AKI to capture the ones that are MCC’s. We did not note them specifically thinking this would look to much like leading for the MCC’s.
Judi Bates RN, BSN, CCDS
CDI Specialist
856-757-3161
Beeper 66x2906
________________________________
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 7:51 AM
To: Bates, Judith
Subject: RE: [cdi_talk] Acute Renal Failure
This is pretty much what I do. I always ask for the diagnosis with the underlying cause or condition. So essentially, nothing changed for me or the way that I address the issue.
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
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
"This email is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this email does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this email in error, please notify this office immediately at the telephone number listed above."
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, November 01, 2010 7:46 PM
To: Hodges, Robert
Subject: Re: [cdi_talk] Acute Renal Failure
We are asking for more specificity if the clinical critera and risk factors are present
.
Example:
(Place clinical data and risk factors from the EMR here)
Effective 10/1/10 documentation guidelines require increase specificity relative to the diagnosis of ARF/AKI. If known, please specify if the ARF/AKI is due to pre-renal, intrinsic renal, or post renal causes.
Pre-renal 2/2 dehydration Intrinsic renal 2/2 ATN
Intrinsic renal 2/2 AIN Post-renal 2/2 uretral obstruction
Other____________. Unable to determine
Debbie S.
-----Original Message-----
From: CDI Talk
To: dsmith12h@aol.com
Sent: Mon, Nov 1, 2010 5:47 pm
Subject: [cdi_talk] Acute Renal Failure
Since Acute Renal Failure is no longer a MCC. I would like some input on what
other facilities are doing? Are you just coding the ARF, or are you asking the
physicians for more specific from what is putting the patient in the ARF. Such
as, the ones that are MCC',
Acute tubular necrosis, Lesion of renal cortical necrosis, renal medullary
necrosis, and specified pathological lesion in kidney?
How are you approaching your doctor's on this change? This was a huge MCC for
alot of facilities. Thanks for advice.
Deb.
---
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need to keep trying!
Thank You,
Susan Tiffany RN, CCDS
Supervisor Clinical Documentation Program
Guthrie Healthcare System
phone: 570-882-6094, pager #465
fax: 570-882-6768
email: tiffany_susan@guthrie.org
"Twenty years from now you will be more disappointed by the things you
didn't do than by the ones you did do. So throw off the bowlines. Sail
away from safe harbor.Catch the trade winds in your sails. Explore. Dream.
Discover." Mark Twain
CDI Talk
11/05/2010 07:58 AM
Please respond to
cdi_talk@hcprotalk.com
To
tiffany_susan@guthrie.org
cc
Subject
RE: [cdi_talk] Acute Renal Failure
Glenn,
Your points are well taken and probably as well understood by most CDISs
on this message board and elsewhere. We do have much to do as a profession
to educate physicians and administrators that clarity, specificity and
completeness is the goal….. but, what many keep asking is…. “show me the
data”. It is very difficult to pin down the results of our contribution in
some concrete fashion. Impact on the bottom line, unfortunately is what
most people, admins, shareholders, others, can understand. Your blog posts
about the RACs are excellent; I encourage all readers here to read them.
Glenn elucidates why documentation is so important, but again, most of us
face the position of having to justify our positions and our programs. Can
we come up with better metrics other than financial impact? (metrics that
can be understood by all the stakeholders, medical, nursing, admin,
others)
Thanks so much for your input and comments.
Mark
Mark Dominesey, RN/BSN, MBA
Clinical Documentation Improvement Specialist
Health Information Management Services
Martha Jefferson Hospital
459 Locust Ave
Charlottesville, VA 22902
434-654-7692
Mark.Dominesey@mjh.org
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, November 04, 2010 10:05 AM
To: Dominesey, Mark N
Subject: RE: [cdi_talk] Acute Renal Failure
Mark, thank you for your reply. On a side note, the next step in our CDIS
endeavours is to educate our administrations on the role of clinical
documentation beyond just reimbursement. There are a myriad of other
"tangible" benefits of clinical documentation improvement that we can
extoll including continuity of care, establishment of medical necessity
for admission, safeguarding of the hospital's revenue through consistent
documentation throughout the record, etc. However, by default CFOs resort
to case mix, calculation of reimbursement, CC/MCC capture rate, and
number of queries left by the CDIS ( "productivity). We will doing our
profession a tremendous justice by stepping up to the plate and promoting
the value of CDI to those who put us on the careful "microscope," hospital
administrators.
Thank you
-----Original Message-----
From: CDI Talk
Sent: Nov 4, 2010 9:47 AM
To: glennkrauss@earthlink.net
Subject: RE: [cdi_talk] Acute Renal Failure
I agree completely as well, but we have to remember in this era of tight
budgets and yes, downsizing, unless we can prove our worth to
administration, they may decide that we do not represent a clear return on
investment. I believe that the documentation is the focus and naturally
that improvement brings enhanced reimbursements with it. But again, most
admins are numbers oriented and an impact on case mix index and DRG
movement as well as capture of CCs and MCCs with the associated financial
benefits, is something admins can understand.
Just a note to give support because these last notes seemed a little
harsh.
Mark
Mark Dominesey, RN/BSN, MBA
Clinical Documentation Improvement Specialist
Health Information Management Services
Martha Jefferson Hospital
459 Locust Ave
Charlottesville, VA 22902
Mark.Dominesey@mjh.org
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, November 04, 2010 9:28 AM
To: Dominesey, Mark N
Subject: RE: [cdi_talk] Acute Renal Failure
I agree completely. Additionally if we are to educate the physicians on
ICD 10 this approach will be helpful to prepare them for the inevitable in
2013.
Virginia Bailey RN, CCDS
Certified Clinical Documentation Specialist
Morton Plant Northbay Hospital
727-859-4880 or ext 74880 from within system
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 11:15 PM
To: Bailey, Virginia
Subject: RE: [cdi_talk] Acute Renal Failure
Folks, here is a novel idea, let's focus on the clinicals in the chart and
capitalize upon the opportunity to educate physicians on the benefits of
specificity, accuracy and detailedness of clinical documentation, how this
information supports the reporting of their practice of medicine, the
capture of the clinically relevant cc/mcc is a byproduct of our
educational efforts. The continued focus upon capturing the "all mighty"
CC/MCC is not and should not be the underlying foundation of clinical
documentation improvement. Unfortunately, this is exactly what consulting
companies are promulgating for their very existence. I have deep concerns
about how this CC/MCC capture mentality is going to be a real detriment to
our profession of CDI.
Thank you
-----Original Message-----
From: CDI Talk
Sent: Nov 2, 2010 7:36 AM
To: glennkrauss@earthlink.net
Subject: RE: [cdi_talk] Acute Renal Failure
We revamped our query for AKI to include questioning for the etiology of
AKI to capture the ones that are MCC’s. We did not note them specifically
thinking this would look to much like leading for the MCC’s.
Judi Bates RN, BSN, CCDS
CDI Specialist
856-757-3161
Beeper 66x2906
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, November 02, 2010 7:51 AM
To: Bates, Judith
Subject: RE: [cdi_talk] Acute Renal Failure
This is pretty much what I do. I always ask for the diagnosis with the
underlying cause or condition. So essentially, nothing changed for me or
the way that I address the issue.
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
"The difference between the right word and the almost right word is the
difference between lightning and the lightning bug." Samuel "Mark Twain"
Clemens
"This email is intended only for the use of the person or office to which
it is addressed and may contain information that is privileged,
confidential, or protected by law. All others are hereby notified that the
receipt of this email does not waive any applicable privilege or exemption
for disclosure and that any dissemination, distribution, or copying of
this communication is prohibited. If you have received this email in
error, please notify this office immediately at the telephone number
listed above."
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, November 01, 2010 7:46 PM
To: Hodges, Robert
Subject: Re: [cdi_talk] Acute Renal Failure
We are asking for more specificity if the clinical critera and risk
factors are present
.
Example:
(Place clinical data and risk factors from the EMR here)
Effective 10/1/10 documentation guidelines require increase specificity
relative to the diagnosis of ARF/AKI. If known, please specify if the
ARF/AKI is due to pre-renal, intrinsic renal, or post renal causes.
Pre-renal 2/2 dehydration Intrinsic renal 2/2 ATN
Intrinsic renal 2/2 AIN Post-renal 2/2 uretral obstruction
Other____________. Unable to determine
Debbie S.
-----Original Message-----
From: CDI Talk
To: dsmith12h@aol.com
Sent: Mon, Nov 1, 2010 5:47 pm
Subject: [cdi_talk] Acute Renal Failure
Since Acute Renal Failure is no longer a MCC. I would like some input on
what
other facilities are doing? Are you just coding the ARF, or are you asking
the
physicians for more specific from what is putting the patient in the ARF.
Such
as, the ones that are MCC',
Acute tubular necrosis, Lesion of renal cortical necrosis, renal
medullary
necrosis, and specified pathological lesion in kidney?
How are you approaching your doctor's on this change? This was a huge MCC
for
alot of facilities. Thanks for advice.
Deb.
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CONFIDENTIALITY NOTICE: This e-mail, including attachments, may
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CDI Talk wrote:
>Glenn,
>
>
>
>Your points are well taken and probably as well understood by most CDISs on this message board and elsewhere. We do have much to do as a profession to educate physicians and administrators that clarity, specificity and completeness is the goal….. but, what many keep asking is…. “show me the data”. It is very difficult to pin down the results of our contribution in some concrete fashion. Impact on the bottom line, unfortunately is what most people, admins, shareholders, others, can understand. Your blog posts about the RACs are excellent; I encourage all readers here to read them. Glenn elucidates why documentation is so important, but again, most of us face the position of having to justify our positions and our programs. Can we come up with better metrics other than financial impact? (metrics that can be understood by all the stakeholders, medical, nursing, admin, others)
>
>
>
>Thanks so much for your input and comments.
>
>
>
>Mark
>
>
>
>
>
>Mark Dominesey, RN/BSN, MBA
>
>Clinical Documentation Improvement Specialist
>
>Health Information Management Services
>
>Martha Jefferson Hospital
>
>459 Locust Ave
>
>Charlottesville, VA 22902
>
>434-654-7692
>
>Mark.Dominesey@mjh.org
>
>
>
>
>
>
>
>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>Sent: Thursday, November 04, 2010 10:05 AM
>To: Dominesey, Mark N
>Subject: RE: [cdi_talk] Acute Renal Failure
>
>
>
>Mark, thank you for your reply. On a side note, the next step in our CDIS endeavours is to educate our administrations on the role of clinical documentation beyond just reimbursement. There are a myriad of other "tangible" benefits of clinical documentation improvement that we can extoll including continuity of care, establishment of medical necessity for admission, safeguarding of the hospital's revenue through consistent documentation throughout the record, etc. However, by default CFOs resort to case mix, calculation of reimbursement, CC/MCC capture rate, and number of queries left by the CDIS ( "productivity). We will doing our profession a tremendous justice by stepping up to the plate and promoting the value of CDI to those who put us on the careful "microscope," hospital administrators.
>
>
>
>Thank you
>
>
>
> -----Original Message-----
> From: CDI Talk
> Sent: Nov 4, 2010 9:47 AM
> To: glennkrauss@earthlink.net
> Subject: RE: [cdi_talk] Acute Renal Failure
>
>
>
>
> I agree completely as well, but we have to remember in this era of tight budgets and yes, downsizing, unless we can prove our worth to administration, they may decide that we do not represent a clear return on investment. I believe that the documentation is the focus and naturally that improvement brings enhanced reimbursements with it. But again, most admins are numbers oriented and an impact on case mix index and DRG movement as well as capture of CCs and MCCs with the associated financial benefits, is something admins can understand.
>
>
>
> Just a note to give support because these last notes seemed a little harsh.
>
>
>
> Mark
>
>
>
>
>
> Mark Dominesey, RN/BSN, MBA
>
> Clinical Documentation Improvement Specialist
>
> Health Information Management Services
>
> Martha Jefferson Hospital
>
> 459 Locust Ave
>
> Charlottesville, VA 22902
>
> Mark.Dominesey@mjh.org
>
>
>
>
>
>
>
> From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
> Sent: Thursday, November 04, 2010 9:28 AM
> To: Dominesey, Mark N
> Subject: RE: [cdi_talk] Acute Renal Failure
>
>
>
> I agree completely. Additionally if we are to educate the physicians on ICD 10 this approach will be helpful to prepare them for the inevitable in 2013.
>
>
>
> Virginia Bailey RN, CCDS
>
> Certified Clinical Documentation Specialist
>
> Morton Plant Northbay Hospital
>
> 727-859-4880 or ext 74880 from within system
>
>
>
>
>________________________________
>
>
> From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
> Sent: Tuesday, November 02, 2010 11:15 PM
> To: Bailey, Virginia
> Subject: RE: [cdi_talk] Acute Renal Failure
>
>
>
> Folks, here is a novel idea, let's focus on the clinicals in the chart and capitalize upon the opportunity to educate physicians on the benefits of specificity, accuracy and detailedness of clinical documentation, how this information supports the reporting of their practice of medicine, the capture of the clinically relevant cc/mcc is a byproduct of our educational efforts. The continued focus upon capturing the "all mighty" CC/MCC is not and should not be the underlying foundation of clinical documentation improvement. Unfortunately, this is exactly what consulting companies are promulgating for their very existence. I have deep concerns about how this CC/MCC capture mentality is going to be a real detriment to our profession of CDI.
>
>
>
> Thank you
>
> -----Original Message-----
> From: CDI Talk
> Sent: Nov 2, 2010 7:36 AM
> To: glennkrauss@earthlink.net
> Subject: RE: [cdi_talk] Acute Renal Failure
>
>
>
>
> We revamped our query for AKI to include questioning for the etiology of AKI to capture the ones that are MCC’s. We did not note them specifically thinking this would look to much like leading for the MCC’s.
>
>
>
> Judi Bates RN, BSN, CCDS
> CDI Specialist
> 856-757-3161
> Beeper 66x2906
>
>
>________________________________
>
>
> From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
> Sent: Tuesday, November 02, 2010 7:51 AM
> To: Bates, Judith
> Subject: RE: [cdi_talk] Acute Renal Failure
>
>
>
> This is pretty much what I do. I always ask for the diagnosis with the underlying cause or condition. So essentially, nothing changed for me or the way that I address the issue.
>
>
>
> 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
>
>
>
> "The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
>
>
>
> "This email is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this email does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this email in error, please notify this office immediately at the telephone number listed above."
>
>
>
> From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
> Sent: Monday, November 01, 2010 7:46 PM
> To: Hodges, Robert
> Subject: Re: [cdi_talk] Acute Renal Failure
>
>
>
> We are asking for more specificity if the clinical critera and risk factors are present
>
> .
>
> Example:
>
> (Place clinical data and risk factors from the EMR here)
>
>
>
> Effective 10/1/10 documentation guidelines require increase specificity relative to the diagnosis of ARF/AKI. If known, please specify if the ARF/AKI is due to pre-renal, intrinsic renal, or post renal causes.
>
>
>
> Pre-renal 2/2 dehydration Intrinsic renal 2/2 ATN
>
> Intrinsic renal 2/2 AIN Post-renal 2/2 uretral obstruction
>
> Other____________. Unable to determine
>
>
>
> Debbie S.
>
> -----Original Message-----
> From: CDI Talk
> To: dsmith12h@aol.com
> Sent: Mon, Nov 1, 2010 5:47 pm
> Subject: [cdi_talk] Acute Renal Failure
>
> Since Acute Renal Failure is no longer a MCC. I would like some input on what
> other facilities are doing? Are you just coding the ARF, or are you asking the
> physicians for more specific from what is putting the patient in the ARF. Such
> as, the ones that are MCC',
> Acute tubular necrosis, Lesion of renal cortical necrosis, renal medullary
> necrosis, and specified pathological lesion in kidney?
> How are you approaching your doctor's on this change? This was a huge MCC for
> alot of facilities. Thanks for advice.
> Deb.
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations
> related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: dsmith12h@aol.com
> If you would like to be removed from CDI Talk, please send a blank email to
> leave-cdi_talk-10398685.2cb93ee246d6127eb38c6be0d9f2b2d7@hcprotalk.com
> ---
> Copyright 2010
> HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: robert.hodges2@va.gov
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> ---
> Copyright 2010
> HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: batesj@lourdesnet.org
> If you would like to be removed from CDI Talk, please send a blank email to
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> ---
> Copyright 2010
> HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
> Confidentiality Notice:
> This e-mail, including any attachments is the
> property of Catholic Health East and is intended
> for the sole use of the intended recipient(s).
> It may contain information that is privileged and
> confidential. Any unauthorized review, use,
> disclosure, or distribution is prohibited. If you are
> not the intended recipient, please delete this message, and
> reply to the sender regarding the error in a separate email.
>
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: glennkrauss@earthlink.net
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> ---
> Copyright 2010
> HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
> Confidential: This electronic message and all contents contain information
> from BayCare Health System which may be privileged, confidential or otherwise
> protected from disclosure. The information is intended to be for the addressee
> only. If you are not the addressee, any disclosure, copy, distribution or use
> of the contents of this message is prohibited. If you have received this
> electronic message in error, please notify the sender and destroy the original
> message and all copies.
>
>
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: mark.dominesey@mjh.org
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> ---
> Copyright 2010
> HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: virginia.bailey@baycare.org
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> Copyright 2010
> HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
> Email Confidentiality Notice: The information contained in this transmission is confidential, proprietary or privileged and may be subject to protection under the law, including the Health Insurance Portability and Accountability Act (HIPAA). The message is intended for the sole use of the individual or entity to whom it is addressed. If you are not the intended recipient, you are notified that any use, distribution or copying of the message is strictly prohibited and may subject you to criminal or civil penalties. If you received this transmission in error, please contact the sender immediately by replying to this email and delete the material from any computer.
>
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
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> ---
> Copyright 2010
> HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
>
>---
>CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
>You are receiving this message as a member of CDI Talk as: mark.dominesey@mjh.org
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>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
>
>Email Confidentiality Notice: The information contained in this transmission is confidential, proprietary or privileged and may be subject to protection under the law, including the Health Insurance Portability and Accountability Act (HIPAA). The message is intended for the sole use of the individual or entity to whom it is addressed. If you are not the intended recipient, you are notified that any use, distribution or copying of the message is strictly prohibited and may subject you to criminal or civil penalties. If you received this transmission in error, please contact the sender immediately by replying to this email and delete the material from any computer.
>
>---
>CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
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>If you would like to be removed from CDI Talk, please send a blank email to
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>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
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
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
"This email is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this email does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this email in error, please notify this office immediately at the telephone number listed above."
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, November 05, 2010 9:50 AM
To: Hodges, Robert
Subject: RE: [cdi_talk] Acute Renal Failure
Very nicely said, Mark.
CDI Talk wrote:
>Glenn,
>
>
>
>Your points are well taken and probably as well understood by most CDISs on this message board and elsewhere. We do have much to do as a profession to educate physicians and administrators that clarity, specificity and completeness is the goal….. but, what many keep asking is…. “show me the data”. It is very difficult to pin down the results of our contribution in some concrete fashion. Impact on the bottom line, unfortunately is what most people, admins, shareholders, others, can understand. Your blog posts about the RACs are excellent; I encourage all readers here to read them. Glenn elucidates why documentation is so important, but again, most of us face the position of having to justify our positions and our programs. Can we come up with better metrics other than financial impact? (metrics that can be understood by all the stakeholders, medical, nursing, admin, others)
>
>
>
>Thanks so much for your input and comments.
>
>
>
>Mark
>
>
>
>
>
>Mark Dominesey, RN/BSN, MBA
>
>Clinical Documentation Improvement Specialist
>
>Health Information Management Services
>
>Martha Jefferson Hospital
>
>459 Locust Ave
>
>Charlottesville, VA 22902
>
>434-654-7692
>
>Mark.Dominesey@mjh.org
>
>
>
>
>
>
>
>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>Sent: Thursday, November 04, 2010 10:05 AM
>To: Dominesey, Mark N
>Subject: RE: [cdi_talk] Acute Renal Failure
>
>
>
>Mark, thank you for your reply. On a side note, the next step in our CDIS endeavours is to educate our administrations on the role of clinical documentation beyond just reimbursement. There are a myriad of other "tangible" benefits of clinical documentation improvement that we can extoll including continuity of care, establishment of medical necessity for admission, safeguarding of the hospital's revenue through consistent documentation throughout the record, etc. However, by default CFOs resort to case mix, calculation of reimbursement, CC/MCC capture rate, and number of queries left by the CDIS ( "productivity). We will doing our profession a tremendous justice by stepping up to the plate and promoting the value of CDI to those who put us on the careful "microscope," hospital administrators.
>
>
>
>Thank you
>
>
>
> -----Original Message-----
> From: CDI Talk
> Sent: Nov 4, 2010 9:47 AM
> To: glennkrauss@earthlink.net
> Subject: RE: [cdi_talk] Acute Renal Failure
>
>
>
>
> I agree completely as well, but we have to remember in this era of tight budgets and yes, downsizing, unless we can prove our worth to administration, they may decide that we do not represent a clear return on investment. I believe that the documentation is the focus and naturally that improvement brings enhanced reimbursements with it. But again, most admins are numbers oriented and an impact on case mix index and DRG movement as well as capture of CCs and MCCs with the associated financial benefits, is something admins can understand.
>
>
>
> Just a note to give support because these last notes seemed a little harsh.
>
>
>
> Mark
>
>
>
>
>
> Mark Dominesey, RN/BSN, MBA
>
> Clinical Documentation Improvement Specialist
>
> Health Information Management Services
>
> Martha Jefferson Hospital
>
> 459 Locust Ave
>
> Charlottesville, VA 22902
>
> Mark.Dominesey@mjh.org
>
>
>
>
>
>
>
> From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
> Sent: Thursday, November 04, 2010 9:28 AM
> To: Dominesey, Mark N
> Subject: RE: [cdi_talk] Acute Renal Failure
>
>
>
> I agree completely. Additionally if we are to educate the physicians on ICD 10 this approach will be helpful to prepare them for the inevitable in 2013.
>
>
>
> Virginia Bailey RN, CCDS
>
> Certified Clinical Documentation Specialist
>
> Morton Plant Northbay Hospital
>
> 727-859-4880 or ext 74880 from within system
>
>
>
>
>________________________________
>
>
> From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
> Sent: Tuesday, November 02, 2010 11:15 PM
> To: Bailey, Virginia
> Subject: RE: [cdi_talk] Acute Renal Failure
>
>
>
> Folks, here is a novel idea, let's focus on the clinicals in the chart and capitalize upon the opportunity to educate physicians on the benefits of specificity, accuracy and detailedness of clinical documentation, how this information supports the reporting of their practice of medicine, the capture of the clinically relevant cc/mcc is a byproduct of our educational efforts. The continued focus upon capturing the "all mighty" CC/MCC is not and should not be the underlying foundation of clinical documentation improvement. Unfortunately, this is exactly what consulting companies are promulgating for their very existence. I have deep concerns about how this CC/MCC capture mentality is going to be a real detriment to our profession of CDI.
>
>
>
> Thank you
>
> -----Original Message-----
> From: CDI Talk
> Sent: Nov 2, 2010 7:36 AM
> To: glennkrauss@earthlink.net
> Subject: RE: [cdi_talk] Acute Renal Failure
>
>
>
>
> We revamped our query for AKI to include questioning for the etiology of AKI to capture the ones that are MCC’s. We did not note them specifically thinking this would look to much like leading for the MCC’s.
>
>
>
> Judi Bates RN, BSN, CCDS
> CDI Specialist
> 856-757-3161
> Beeper 66x2906
>
>
>________________________________
>
>
> From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
> Sent: Tuesday, November 02, 2010 7:51 AM
> To: Bates, Judith
> Subject: RE: [cdi_talk] Acute Renal Failure
>
>
>
> This is pretty much what I do. I always ask for the diagnosis with the underlying cause or condition. So essentially, nothing changed for me or the way that I address the issue.
>
>
>
> 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
>
>
>
> "The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
>
>
>
> "This email is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this email does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this email in error, please notify this office immediately at the telephone number listed above."
>
>
>
> From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
> Sent: Monday, November 01, 2010 7:46 PM
> To: Hodges, Robert
> Subject: Re: [cdi_talk] Acute Renal Failure
>
>
>
> We are asking for more specificity if the clinical critera and risk factors are present
>
> .
>
> Example:
>
> (Place clinical data and risk factors from the EMR here)
>
>
>
> Effective 10/1/10 documentation guidelines require increase specificity relative to the diagnosis of ARF/AKI. If known, please specify if the ARF/AKI is due to pre-renal, intrinsic renal, or post renal causes.
>
>
>
> Pre-renal 2/2 dehydration Intrinsic renal 2/2 ATN
>
> Intrinsic renal 2/2 AIN Post-renal 2/2 uretral obstruction
>
> Other____________. Unable to determine
>
>
>
> Debbie S.
>
> -----Original Message-----
> From: CDI Talk
> To: dsmith12h@aol.com
> Sent: Mon, Nov 1, 2010 5:47 pm
> Subject: [cdi_talk] Acute Renal Failure
>
> Since Acute Renal Failure is no longer a MCC. I would like some input on what
> other facilities are doing? Are you just coding the ARF, or are you asking the
> physicians for more specific from what is putting the patient in the ARF. Such
> as, the ones that are MCC',
> Acute tubular necrosis, Lesion of renal cortical necrosis, renal medullary
> necrosis, and specified pathological lesion in kidney?
> How are you approaching your doctor's on this change? This was a huge MCC for
> alot of facilities. Thanks for advice.
> Deb.
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations
> related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: dsmith12h@aol.com
> If you would like to be removed from CDI Talk, please send a blank email to
> leave-cdi_talk-10398685.2cb93ee246d6127eb38c6be0d9f2b2d7@hcprotalk.com
> ---
> Copyright 2010
> HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: robert.hodges2@va.gov
> If you would like to be removed from CDI Talk, please send a blank email to
> leave-cdi_talk-10741982.fced5831ab44431e3f844a057071eb02@hcprotalk.com
> ---
> Copyright 2010
> HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: batesj@lourdesnet.org
> If you would like to be removed from CDI Talk, please send a blank email to
> leave-cdi_talk-11574448.a103e4a5d44ebf54e5499c03ebb6c706@hcprotalk.com
> ---
> Copyright 2010
> HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
> Confidentiality Notice:
> This e-mail, including any attachments is the
> property of Catholic Health East and is intended
> for the sole use of the intended recipient(s).
> It may contain information that is privileged and
> confidential. Any unauthorized review, use,
> disclosure, or distribution is prohibited. If you are
> not the intended recipient, please delete this message, and
> reply to the sender regarding the error in a separate email.
>
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: glennkrauss@earthlink.net
> If you would like to be removed from CDI Talk, please send a blank email to
> leave-cdi_talk-11551594.832b8c147a2b8ab21fc91edd9c8c82b4@hcprotalk.com
> ---
> Copyright 2010
> HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
> Confidential: This electronic message and all contents contain information
> from BayCare Health System which may be privileged, confidential or otherwise
> protected from disclosure. The information is intended to be for the addressee
> only. If you are not the addressee, any disclosure, copy, distribution or use
> of the contents of this message is prohibited. If you have received this
> electronic message in error, please notify the sender and destroy the original
> message and all copies.
>
>
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: mark.dominesey@mjh.org
> If you would like to be removed from CDI Talk, please send a blank email to
> leave-cdi_talk-12208259.3b0b4ba7a090e135fc67beeeee850cc1@hcprotalk.com
> ---
> Copyright 2010
> HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: virginia.bailey@baycare.org
> If you would like to be removed from CDI Talk, please send a blank email to
> leave-cdi_talk-10442134.7bf08d40085f5407016ba01357165f5e@hcprotalk.com
> ---
> Copyright 2010
> HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
> Email Confidentiality Notice: The information contained in this transmission is confidential, proprietary or privileged and may be subject to protection under the law, including the Health Insurance Portability and Accountability Act (HIPAA). The message is intended for the sole use of the individual or entity to whom it is addressed. If you are not the intended recipient, you are notified that any use, distribution or copying of the message is strictly prohibited and may subject you to criminal or civil penalties. If you received this transmission in error, please contact the sender immediately by replying to this email and delete the material from any computer.
>
> ---
> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
> You are receiving this message as a member of CDI Talk as: glennkrauss@earthlink.net
> If you would like to be removed from CDI Talk, please send a blank email to
> leave-cdi_talk-11551594.832b8c147a2b8ab21fc91edd9c8c82b4@hcprotalk.com
> ---
> Copyright 2010
> HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
>
>---
>CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
>You are receiving this message as a member of CDI Talk as: mark.dominesey@mjh.org
>If you would like to be removed from CDI Talk, please send a blank email to
>leave-cdi_talk-12208259.3b0b4ba7a090e135fc67beeeee850cc1@hcprotalk.com
>---
>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>
>
>Email Confidentiality Notice: The information contained in this transmission is confidential, proprietary or privileged and may be subject to protection under the law, including the Health Insurance Portability and Accountability Act (HIPAA). The message is intended for the sole use of the individual or entity to whom it is addressed. If you are not the intended recipient, you are notified that any use, distribution or copying of the message is strictly prohibited and may subject you to criminal or civil penalties. If you received this transmission in error, please contact the sender immediately by replying to this email and delete the material from any computer.
>
>---
>CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>
>You are receiving this message as a member of CDI Talk as: paxneros@comcast.net
>If you would like to be removed from CDI Talk, please send a blank email to
>leave-cdi_talk-12055558.c302c3689dbc8049233b7b76c1441862@hcprotalk.com
>---
>Copyright 2010
>HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: robert.hodges2@va.gov
If you would like to be removed from CDI Talk, please send a blank email to
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---
Copyright 2010
HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
CDI Talk wrote:
>I Agree, very well said Mark. As a point, one of my measurements is "More precise code applied" and is identified by the coder based on my query. It's a start.
>
>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
>
>"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
>
>"This email is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this email does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this email in error, please notify this office immediately at the telephone number listed above."
>
>
>
>-----Original Message-----
>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>Sent: Friday, November 05, 2010 9:50 AM
>To: Hodges, Robert
>Subject: RE: [cdi_talk] Acute Renal Failure
>
>Very nicely said, Mark.
>
>CDI Talk wrote:
>
>>Glenn,
>>
>>
>>
>>Your points are well taken and probably as well understood by most CDISs on this message board and elsewhere. We do have much to do as a profession to educate physicians and administrators that clarity, specificity and completeness is the goal….. but, what many keep asking is…. “show me the data”. It is very difficult to pin down the results of our contribution in some concrete fashion. Impact on the bottom line, unfortunately is what most people, admins, shareholders, others, can understand. Your blog posts about the RACs are excellent; I encourage all readers here to read them. Glenn elucidates why documentation is so important, but again, most of us face the position of having to justify our positions and our programs. Can we come up with better metrics other than financial impact? (metrics that can be understood by all the stakeholders, medical, nursing, admin, others)
>>
>>
>>
>>Thanks so much for your input and comments.
>>
>>
>>
>>Mark
>>
>>
>>
>>
>>
>>Mark Dominesey, RN/BSN, MBA
>>
>>Clinical Documentation Improvement Specialist
>>
>>Health Information Management Services
>>
>>Martha Jefferson Hospital
>>
>>459 Locust Ave
>>
>>Charlottesville, VA 22902
>>
>>434-654-7692
>>
>>Mark.Dominesey@mjh.org
>>
>>
>>
>>
>>
>>
>>
>>From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>>Sent: Thursday, November 04, 2010 10:05 AM
>>To: Dominesey, Mark N
>>Subject: RE: [cdi_talk] Acute Renal Failure
>>
>>
>>
>>Mark, thank you for your reply. On a side note, the next step in our CDIS endeavours is to educate our administrations on the role of clinical documentation beyond just reimbursement. There are a myriad of other "tangible" benefits of clinical documentation improvement that we can extoll including continuity of care, establishment of medical necessity for admission, safeguarding of the hospital's revenue through consistent documentation throughout the record, etc. However, by default CFOs resort to case mix, calculation of reimbursement, CC/MCC capture rate, and number of queries left by the CDIS ( "productivity). We will doing our profession a tremendous justice by stepping up to the plate and promoting the value of CDI to those who put us on the careful "microscope," hospital administrators.
>>
>>
>>
>>Thank you
>>
>>
>>
>> -----Original Message-----
>> From: CDI Talk
>> Sent: Nov 4, 2010 9:47 AM
>> To: glennkrauss@earthlink.net
>> Subject: RE: [cdi_talk] Acute Renal Failure
>>
>>
>>
>>
>> I agree completely as well, but we have to remember in this era of tight budgets and yes, downsizing, unless we can prove our worth to administration, they may decide that we do not represent a clear return on investment. I believe that the documentation is the focus and naturally that improvement brings enhanced reimbursements with it. But again, most admins are numbers oriented and an impact on case mix index and DRG movement as well as capture of CCs and MCCs with the associated financial benefits, is something admins can understand.
>>
>>
>>
>> Just a note to give support because these last notes seemed a little harsh.
>>
>>
>>
>> Mark
>>
>>
>>
>>
>>
>> Mark Dominesey, RN/BSN, MBA
>>
>> Clinical Documentation Improvement Specialist
>>
>> Health Information Management Services
>>
>> Martha Jefferson Hospital
>>
>> 459 Locust Ave
>>
>> Charlottesville, VA 22902
>>
>> Mark.Dominesey@mjh.org
>>
>>
>>
>>
>>
>>
>>
>> From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>> Sent: Thursday, November 04, 2010 9:28 AM
>> To: Dominesey, Mark N
>> Subject: RE: [cdi_talk] Acute Renal Failure
>>
>>
>>
>> I agree completely. Additionally if we are to educate the physicians on ICD 10 this approach will be helpful to prepare them for the inevitable in 2013.
>>
>>
>>
>> Virginia Bailey RN, CCDS
>>
>> Certified Clinical Documentation Specialist
>>
>> Morton Plant Northbay Hospital
>>
>> 727-859-4880 or ext 74880 from within system
>>
>>
>>
>>
>>________________________________
>>
>>
>> From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>> Sent: Tuesday, November 02, 2010 11:15 PM
>> To: Bailey, Virginia
>> Subject: RE: [cdi_talk] Acute Renal Failure
>>
>>
>>
>> Folks, here is a novel idea, let's focus on the clinicals in the chart and capitalize upon the opportunity to educate physicians on the benefits of specificity, accuracy and detailedness of clinical documentation, how this information supports the reporting of their practice of medicine, the capture of the clinically relevant cc/mcc is a byproduct of our educational efforts. The continued focus upon capturing the "all mighty" CC/MCC is not and should not be the underlying foundation of clinical documentation improvement. Unfortunately, this is exactly what consulting companies are promulgating for their very existence. I have deep concerns about how this CC/MCC capture mentality is going to be a real detriment to our profession of CDI.
>>
>>
>>
>> Thank you
>>
>> -----Original Message-----
>> From: CDI Talk
>> Sent: Nov 2, 2010 7:36 AM
>> To: glennkrauss@earthlink.net
>> Subject: RE: [cdi_talk] Acute Renal Failure
>>
>>
>>
>>
>> We revamped our query for AKI to include questioning for the etiology of AKI to capture the ones that are MCC’s. We did not note them specifically thinking this would look to much like leading for the MCC’s.
>>
>>
>>
>> Judi Bates RN, BSN, CCDS
>> CDI Specialist
>> 856-757-3161
>> Beeper 66x2906
>>
>>
>>________________________________
>>
>>
>> From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>> Sent: Tuesday, November 02, 2010 7:51 AM
>> To: Bates, Judith
>> Subject: RE: [cdi_talk] Acute Renal Failure
>>
>>
>>
>> This is pretty much what I do. I always ask for the diagnosis with the underlying cause or condition. So essentially, nothing changed for me or the way that I address the issue.
>>
>>
>>
>> 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
>>
>>
>>
>> "The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
>>
>>
>>
>> "This email is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this email does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this email in error, please notify this office immediately at the telephone number listed above."
>>
>>
>>
>> From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
>> Sent: Monday, November 01, 2010 7:46 PM
>> To: Hodges, Robert
>> Subject: Re: [cdi_talk] Acute Renal Failure
>>
>>
>>
>> We are asking for more specificity if the clinical critera and risk factors are present
>>
>> .
>>
>> Example:
>>
>> (Place clinical data and risk factors from the EMR here)
>>
>>
>>
>> Effective 10/1/10 documentation guidelines require increase specificity relative to the diagnosis of ARF/AKI. If known, please specify if the ARF/AKI is due to pre-renal, intrinsic renal, or post renal causes.
>>
>>
>>
>> Pre-renal 2/2 dehydration Intrinsic renal 2/2 ATN
>>
>> Intrinsic renal 2/2 AIN Post-renal 2/2 uretral obstruction
>>
>> Other____________. Unable to determine
>>
>>
>>
>> Debbie S.
>>
>> -----Original Message-----
>> From: CDI Talk
>> To: dsmith12h@aol.com
>> Sent: Mon, Nov 1, 2010 5:47 pm
>> Subject: [cdi_talk] Acute Renal Failure
>>
>> Since Acute Renal Failure is no longer a MCC. I would like some input on what
>> other facilities are doing? Are you just coding the ARF, or are you asking the
>> physicians for more specific from what is putting the patient in the ARF. Such
>> as, the ones that are MCC',
>> Acute tubular necrosis, Lesion of renal cortical necrosis, renal medullary
>> necrosis, and specified pathological lesion in kidney?
>> How are you approaching your doctor's on this change? This was a huge MCC for
>> alot of facilities. Thanks for advice.
>> Deb.
>> ---
>> CDI Talk is offered for networking purposes. For official rules and regulations
>> related to documentation and coding, please refer to your regulatory source.
>>
>> You are receiving this message as a member of CDI Talk as: dsmith12h@aol.com
>> If you would like to be removed from CDI Talk, please send a blank email to
>> leave-cdi_talk-10398685.2cb93ee246d6127eb38c6be0d9f2b2d7@hcprotalk.com
>> ---
>> Copyright 2010
>> HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>>
>> ---
>> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>>
>> You are receiving this message as a member of CDI Talk as: robert.hodges2@va.gov
>> If you would like to be removed from CDI Talk, please send a blank email to
>> leave-cdi_talk-10741982.fced5831ab44431e3f844a057071eb02@hcprotalk.com
>> ---
>> Copyright 2010
>> HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>>
>> ---
>> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>>
>> You are receiving this message as a member of CDI Talk as: batesj@lourdesnet.org
>> If you would like to be removed from CDI Talk, please send a blank email to
>> leave-cdi_talk-11574448.a103e4a5d44ebf54e5499c03ebb6c706@hcprotalk.com
>> ---
>> Copyright 2010
>> HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>>
>> Confidentiality Notice:
>> This e-mail, including any attachments is the
>> property of Catholic Health East and is intended
>> for the sole use of the intended recipient(s).
>> It may contain information that is privileged and
>> confidential. Any unauthorized review, use,
>> disclosure, or distribution is prohibited. If you are
>> not the intended recipient, please delete this message, and
>> reply to the sender regarding the error in a separate email.
>>
>> ---
>> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>>
>> You are receiving this message as a member of CDI Talk as: glennkrauss@earthlink.net
>> If you would like to be removed from CDI Talk, please send a blank email to
>> leave-cdi_talk-11551594.832b8c147a2b8ab21fc91edd9c8c82b4@hcprotalk.com
>> ---
>> Copyright 2010
>> HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945
>>
>> Confidential: This electronic message and all contents contain information
>> from BayCare Health System which may be privileged, confidential or otherwise
>> protected from disclosure. The information is intended to be for the addressee
>> only. If you are not the addressee, any disclosure, copy, distribution or use
>> of the contents of this message is prohibited. If you have received this
>> electronic message in error, please notify the sender and destroy the original
>> message and all copies.
>>
>>
>> ---
>> CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
>>
>> You are receiving this message as a member of CDI Talk as: mark.dominesey@mjh.org
>> If you would like to be removed from CDI Talk, please send a blank email to
>> leave-cdi_talk-12208259.3b0b4ba7a090e135fc67beeeee850cc1@hcprotalk.com
>> ---
>> Copyright 2010
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· Acute Kidney Injury/Acute Renal Failure– A complex disorder for which currently there is no accepted definition. The term Acute Kidney Injury is proposed to represent the entire spectrum of acute renal failure. Diagnostic criteria/staging system are proposed based on acute alterations in serum creatinine or urine output. (Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. R. Mehta, et al, Critical Care 2007)
(Only one criterion (creatinine or urine output) has to be fulfilled to qualify for a stage)
Stage
Serum Creatinine Criteria*
Urine Output Criteria
1
Increase in serum creatinine of more than or equal to 0.3 mg/dl (≥ 26.4 μmol/l) or increase to more than or equal to 150% to 200% (1.5- to 2-fold) from baseline
Less than 0.5 ml/kg per hour for more than 6 hours
2b
Increase in serum creatinine to more than 200% to 300% (> 2- to 3-fold) from baseline
Less than 0.5 ml/kg per hour for more than 12 hours
3c
Increase in serum creatinine to more than 300% (> 3-fold) from baseline (or serum creatinine of more than or equal to 4.0 mg/dl [≥ 354 μmol/l] with an acute increase of at least 0.5 mg/dl [44 μmol/l])
Less than 0.3 ml/kg per hour for 24 hours or anuria for 12 hours
*Modified from RIFLE (Risk, Injury, Failure, Loss, and End-stage kidney disease) criteria. Only one criterion (creatinine or urine output) has to be fulfilled to qualify for a stage. b200% to 300% increase = 2- to 3-fold increase. cGiven wide variation in indications and timing of initiation of renal replacement therapy (RRT), individuals who receive RRT are considered to have met the criteria for stage 3 irrespective of the stage they are in at the time of RRT.
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation & Coding Integrity
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, September 24, 2012 8:37 AM
To: Evans, Paul
Subject: [cdi_talk] Acute Renal Failure
We are going to have to revamp our query form for Acute Renal Failure and would like to include clinical indicators for ARF.
Do you include clinical indicators on your ARF query? If so, do you use RIFLE criteria or AKIN criteria?
Thanks,
Dorie Douthit
ddouthit@stmarysathens.org
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http://www.kdigo.org/
There have been changes in the definitions, understanding and guidelines with AKI.
http://www.kdigo.org/clinical_practice_guidelines/AKI.php
Don
>>> "CDI Talk" 9/24/2012 11:37 AM >>>
We are going to have to revamp our query form for Acute Renal Failure and would like to include clinical indicators for ARF.
Do you include clinical indicators on your ARF query? If so, do you use RIFLE criteria or AKIN criteria?
Thanks,
Dorie Douthit
ddouthit@stmarysathens.org
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PRACTICE is to have a definition developed and agreed to by the
appropriate physician interest group and then organizationally adopted.
This is really a clinically focused and clinical side, but CDI can be
key involvement toward this goal.
Not to say that there is a single RIGHT answer, but that your
organization is consistent & deliberate.
Not my idea -- one of the advocates has been Dr Trey La Charité.
I know this has also been discussed on CDI Talk before also and the
idea supported by several.
Additionally, be aware of how RAC etc. approach these type of
questions. They are deciding that certain things don't meet clinical
criteria or definitions and thus taking away codes, etc.
Don
>>> "CDI Talk" 9/24/2012 11:50 AM >>>
We tend to go with KDIGO -- Kidney Disease: Improving Global Outcomes
(KDIGO)
http://www.kdigo.org/
There have been changes in the definitions, understanding and
guidelines with AKI.
http://www.kdigo.org/clinical_practice_guidelines/AKI.php
Don
>>> "CDI Talk" 9/24/2012 11:37 AM >>>
We are going to have to revamp our query form for Acute Renal Failure
and would like to include clinical indicators for ARF.
Do you include clinical indicators on your ARF query? If so, do you use
RIFLE criteria or AKIN criteria?
Thanks,
Dorie Douthit
ddouthit@stmarysathens.org
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2.1.1: AKI is defined as any of the following (Not Graded):
Increase in SCr by X0.3 mg/dl (X26.5 lmol/l) within 48 hours; or
Increase in SCr toX1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; or
Urine volume 0.5 ml/kg/h for 6 hours.
There are more details in the official source one should review. We reviewed the KDIGO definition and found it consistent with the definition used on our query form. Despite this definition published in KDIGO, we have RAC denials for 584.9 even when the term is documented clearly and the clinical parameters have been met or exceeded.
Specificity of ARF is so important because it helps with understanding the patient’s overall clinical picture. Like ARF d/t hypertension --- do they also have Hypertensive Heart Disease? If a patient is hypotensive for greater than 30 minutes, then not only did they possibly have shock, but their ARF/AKI is likely ATN. What about ARK d/t toxicity…. I can go on and on…
Kindest Regards,
Mark
Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP
Clinical Documentation Excellence
Sr. Clinical Documentation Improvement Specialist
Sibley Memorial Hospital
Information Technology
5255 Loughboro Rd NW
Washington DC, 20016-2695
W: 202.660.6782
F: 202.537.4477
mdominesey@sibley.org
[cid:image001.gif@01CD9A4C.3A7A0680]
http://www.sibley.org
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, September 24, 2012 11:44
To: Dominesey, Mark N.
Subject: RE: [cdi_talk] Acute Renal Failure
We use this definition:
· Acute Kidney Injury/Acute Renal Failure– A complex disorder for which currently there is no accepted definition. The term Acute Kidney Injury is proposed to represent the entire spectrum of acute renal failure. Diagnostic criteria/staging system are proposed based on acute alterations in serum creatinine or urine output. (Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. R. Mehta, et al, Critical Care 2007)
(Only one criterion (creatinine or urine output) has to be fulfilled to qualify for a stage)
Stage
Serum Creatinine Criteria*
Urine Output Criteria
1
Increase in serum creatinine of more than or equal to 0.3 mg/dl (≥ 26.4 μmol/l) or increase to more than or equal to 150% to 200% (1.5- to 2-fold) from baseline
Less than 0.5 ml/kg per hour for more than 6 hours
2b
Increase in serum creatinine to more than 200% to 300% (> 2- to 3-fold) from baseline
Less than 0.5 ml/kg per hour for more than 12 hours
3c
Increase in serum creatinine to more than 300% (> 3-fold) from baseline (or serum creatinine of more than or equal to 4.0 mg/dl [≥ 354 μmol/l] with an acute increase of at least 0.5 mg/dl [44 μmol/l])
Less than 0.3 ml/kg per hour for 24 hours or anuria for 12 hours
*Modified from RIFLE (Risk, Injury, Failure, Loss, and End-stage kidney disease) criteria. Only one criterion (creatinine or urine output) has to be fulfilled to qualify for a stage. b200% to 300% increase = 2- to 3-fold increase. cGiven wide variation in indications and timing of initiation of renal replacement therapy (RRT), individuals who receive RRT are considered to have met the criteria for stage 3 irrespective of the stage they are in at the time of RRT.
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation & Coding Integrity
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, September 24, 2012 8:37 AM
To: Evans, Paul
Subject: [cdi_talk] Acute Renal Failure
We are going to have to revamp our query form for Acute Renal Failure and would like to include clinical indicators for ARF.
Do you include clinical indicators on your ARF query? If so, do you use RIFLE criteria or AKIN criteria?
Thanks,
Dorie Douthit
ddouthit@stmarysathens.org
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________________________________
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We have run into the denial situation, we have received 2 denials now for patients who "do not clinically meet criteria for ARF" and are denial is quoting RIFLE criteria. We are in the process of meeting with our nephrology chair to revise our ARF query.
Dorie Douthit, RHIT,CCS
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Monday, September 24, 2012 11:58 AM
To: Douthit, Dorie
Subject: Re: [cdi_talk] Acute Renal Failure
An additional point that I should interject -- seems to me that BEST
PRACTICE is to have a definition developed and agreed to by the
appropriate physician interest group and then organizationally adopted.
This is really a clinically focused and clinical side, but CDI can be
key involvement toward this goal.
Not to say that there is a single RIGHT answer, but that your
organization is consistent & deliberate.
Not my idea -- one of the advocates has been Dr Trey La Charité.
I know this has also been discussed on CDI Talk before also and the
idea supported by several.
Additionally, be aware of how RAC etc. approach these type of
questions. They are deciding that certain things don't meet clinical
criteria or definitions and thus taking away codes, etc.
Don
>>> "CDI Talk" 9/24/2012 11:50 AM >>>
We tend to go with KDIGO -- Kidney Disease: Improving Global Outcomes
(KDIGO)
http://www.kdigo.org/
There have been changes in the definitions, understanding and
guidelines with AKI.
http://www.kdigo.org/clinical_practice_guidelines/AKI.php
Don
>>> "CDI Talk" 9/24/2012 11:37 AM >>>
We are going to have to revamp our query form for Acute Renal Failure
and would like to include clinical indicators for ARF.
Do you include clinical indicators on your ARF query? If so, do you use
RIFLE criteria or AKIN criteria?
Thanks,
Dorie Douthit
ddouthit@stmarysathens.org
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