Credit for Queries

Trying to get a sense of how others do this.

If you query for Acute Respiratory Failure and it is returned positive, and lets say the patient also has Metabolic Encephalopathy that did not require a query, do you take credit for the MCC increase in reimbursement? Or just for adding an MCC?

Thanks.

Comments

  • Greetings, we count that as a severity query and not an MCC. We all know the more MCCs, the better with DRG downgrades increasing across the nation.

  • Ok, how do you show that impact in reports?

  • The software system we have (CDE One-Nuance) has the analytics to help us capture that. So not only can we show DRG impact per case, we can also show SOI and ROM score changes.

    Prior to upgrading to this software, it was difficult to get this level of data. What system are you currently using?

  • We are using 3M 360, it seems to us like the reports are inconsistent. We are trying to use their new "Impact Review" tab, but it feels like there are a lot of bugs still.

  • I understand as I needed to complete my due diligence before trusting the analytics. I applaud you trying to sort that out as it does take time. I would reach out to the vendor and let them know what your concerns and questions are. They should be able to assist you with your requests.

  • That depends on what was a determined baseline. If when you initially looked at the documentation, metabolic encephalopathy was not clinically indicated/documented at that time. Then, yes I would take credit for it. Your baseline documentation of present cc's and mcc's is what determines your impact even if additional cc's or mcc's are added afterwards. This holds true even if the DRG changes. If there were no MCC's at time of baseline and you query and get Acute Respiratory Failure added, you should take the credit.

  • Totally, I agree with you Lori, we just don't have a way to capture with our software. I have been told by 3M they're working on it, but we'll see. Thanks for your input!

  • As far as FINANCIAL credit I disagree with what is pasted ....’we ‘take credit’ for an MCC based on the charting ‘at the time’’ of the initial CDI review.


    CDI only ‘takes credit’ for financial impact if/when CDI review results in a different payment. If I query for acute respiratory failure and it is an MCC and the patient later develops another MCC, my reconciliation would reflect no financial impact, but it would reflect a Severity Impact. I would suggest if anyone is struggling with the Byzantine nature of reconciliation that the check with a trusted coding professional when determining impact.


    Paul Evans, RHIA, CCDS

  • Thank you Paul. I agree 100%.

  • Thank you. To repeat, there are different types of credit, and there are very narrow ways for CDI to report FINANCIAL impact. If we do not report the true financial impact of our work, we are producing false data.

  • I'm just a little confused on how your initial post is worded Paul. So I understand you're saying you wouldn't take credit for financial impact if at discharge there would have been no changes, but you would take credit for severity even if there was no change in severity on discharge?

    Example (not real numbers)

    Initial Review - $8000 SOI - 2 ROM - 2

    Post query Diagnosis - $10000 SOI - 3 ROM - 2

    On Discharge (patient developed septic shock) $13000 SOI - 4 ROM - 4

    So on the above example you would take credit for the 2 to 3 SOI change but not the financial? Or you would take credit for neither?

  • ROM is not the same as MSDRG - and severity credit is not the same as ‘financial credit’ unless you are reimbursed under an APR-DRG system rather than an MS-DRG system. I can’t explain the complexities in this forum. I suggest you contact a coding manager so that they can explain the concept.


    The earlier post you copied implying we ‘take financial credit’ for an MCC even when multiple MCCs are present is incorrect.


    With Respect..Paul

  • edited September 2020

    I understand severity of illness is not the same as financial credit, that's not what I was asking. There is no SOI in the MSDRG system either, which is why I don't understand what you're referencing.

    Would somebody else like to attempt to explain what is meant?


    Paul - I didn't copy any posts so I'm not sure to what you're referring.

  • I would take credit for the ROM or SOI, but not the financial, if the query alone, at the final analysis, move my SOI or ROM. I would not take credit for financial.

    Hope that helps.


    Some people always tabulate a credit for Severity, however, because they may work only in an MS-DRG environment. They do so when CDI work has no financial impact, but CDI work does strengthen the documentation. They do so because there is no other way to show ‘impact’, unless you build other types of reports. This is really a decision and workflow for CDI management .


    PE

  • Ok so yes, you're describing what we currently do, which is we take the final codeset, remove the diagnoses we queried for and take credit only for those differences.

    I'm trying to find ways to show our impact and purpose of querying concurrently when the "financial impact" (all we're being judged on currently) can be wiped out later in the stay or not matter when only one of the diagnoses may need queried.

    Thanks for your help.

  • The reality is that most CDI work does not impact the case financially because often there are multiple CC/MCC on most cases. When this happens, the reality is there is no financial impact to report. The other option would be change in principal diagnosis. I am addressing your last paragraph, specifically.


    I have to go...charts awaiting.

  • This is a topic close to my heart so weighing in a bit.  There are a lot of moving parts but if there is already a "naturally occurring MCC" it would not be acccurate to take credit for financial impact.  SOI/ROM impact, preventing a HAC through  accurate documentation, and/or impacting quality metrics are other considerations.  In my prevoius position, the CDI team claimed financial impact by moving the PDX and changing the DRG.  I was able to note CDI impact using the 3M reports by reviewing what DRG w/ SOI/ROM we started with and what the final coded DRG SOI/ROM was.  A well run reconciliation process allows the CDI team to assess their impact and also builds great team work between coder and CDI.  a Win Win for everyone!

    Good luck and hope this helps,

    Patti

  • Hi Patti,

    As I had mentioned in one of my previous posts, that is what my team does. I was bringing this up because 3M is adding an "incremental impact" to their reports, so for them to put so much effort into that I assumed there must be a decent percentage of programs taking credit for this "incremental impact".

Sign In or Register to comment.