Request for Examples of CDIS/Coder Reconciliation Processes

jekmcjekmc
in CDI Management

Hello everyone,

I’m looking for feedback regarding CDIS/Coder reconciliation workflows and would love to hear how other facilities handle this process. Specifically:

  • How do you structure your reconciliation between CDIS and coding teams?
  • What tools or reports do you use to track discrepancies?
  • How often is reconciliation performed (daily, weekly, monthly)?
  • Who is responsible for initiating and resolving variances?
  • Any best practices or lessons learned you can share?

If you have a policy and procedure you could share, that would be great as well.

Thank you!

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Comments

  • deanne.wilk@hcpro.comdeanne.wilk@hcpro.com

    Hi Jekmc,

    I will try to provide some input into your question based on what we see within the industry.

    • How do you structure your reconciliation between CDIS and coding teams? Many facilities will either have a designated individual or team that handles reconciliations. They may work 1:1 with the coding team to resolve or they may reach out directly between coder and CDI specialist to resolve. If it is handled at the coder level then they will usually reach out directly to the CDI specialist. If there is still disagreement then it escalates to another individual or leader. Most often the coding department has final say.
    • What tools or reports do you use to track discrepancies? Most often it is the coding/CDI software that provides reporting to identify discrepancies.
    • How often is reconciliation performed (daily, weekly, monthly)? Daily most often as charts are being held post discharge/pre-bill which is impacting the DNFB.
    • Who is responsible for initiating and resolving variances? Usually this falls to the coding department as they are the team to identify the final DRG and in contrast to the working DRG that was given by CDI.
    • Any best practices or lessons learned you can share? Develop a detailed procedure that clearly outlines how and when discrepancies will be handled. It may be that one day stays/weekends/and procedures or cases that were not reviewed by the CDI team initially or subsequently are not held for resolution. It is clear why there would be a DRG variance. In addition, ensure that education is being performed around discrepancies with all team members for improvement efforts.

    Hope that helps. Deanne Wilk

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