by Glenn Krauss, BBA, RHIA, CCS,CCS-P, CPUR, FCS, PCS, C-CDIS, CCDS The No. 1 struggle most CDI specialists face is getting physicians engaged in CDI, to provide accurate, specific, consistent documentation in the record. Unfortunately, unless healthcare is reformed to the point...Read More »
by Trey La Charité, MD Sadly, there are patients who will not survive their current level of illness regardless of the best efforts of their physicians and their medical facility. The providers caring for these patients are often at risk of underreporting those patients’ severity of...Read More »
Editor’s Note: The following questions were submitted for the ACDIS quarterly conference call of February 14, 2013, and were answered by Donna Wilson, RHIA, CCS, CCDS, Robert Gold, MD, Sylvia Hoffman, RN, CCDS, CCDI, CDIP, and Donald Butler, RN, BSN, of the ACDIS...Read More »
AHA Coding Clinic for ICD-9-CM released its second round of ICD-10 coding guidance in its First Quarter 2013 issue. The following is a recap of the issue with an eye toward what it means for CDI specialists.Read More »
Nearly 200 people lost their lives. More than 300,000 either lost their homes completely or suffered significant damage. In the floods that came with Hurricane Sandy, New Jersey ACDIS Chapter leader Deborah Gardner-Brown lost the first floor of her home to significant water damage.
“Documentation can be greatly improved by a properly functioning query process,” AHIMA says in its 2008 “Managing an Effective Query Process” practice brief. But how can you tell whether your query process works? Peer-to-peer review of query practices and outcomes may provide a low-cost,...Read More »
The phrase “sepsis syndrome” is starting to appear in medical records these days, but unfortunately it’s a term that requires further clarification. When it’s used, CDI staff/coders should query the physician to clarify the condition being treated. That’s the latest guidance from AHA’s Coding...Read More »