Book excerpt: Unexpected CDI effects

By Trey La Charité, MD, FACP, SFHM, CCDS

No new hospital initiative operates in a vacuum. And there is no way to anticipate every consequence of your CDI program. Even with the best intentions, there will be downstream consequences to navigate.

Let’s start with the first place your program’s effects will be noticed: the medical records department. If you didn’t know, your medical records department maintained a Discharged Not Final Billed (DNFB) or Discharged Not Final Coded (DNFC) list before the advent of your CDI program.

The DNFB is a list of all of the charts that cannot be final coded and submitted for reimbursement until missing documentation has been secured and reviewed. (In my facility, it is called the Waiting On Documentation or WOD file.) Generally, your DNFB file size is fairly consistent month after month, missing the same procedure notes, operative reports, and discharge summaries from the same group of doctors.

When the size of your DNFB list suddenly increases, it won’t go unnoticed. And, rest assured, your CDI program will increase the size of your hospital’s DNFB list. Why?

Because unanswered concurrent queries mean information vital to accurately capturing your patients’ severity of illness is still missing, and you are obligated to convert those concurrent queries to post-discharge queries. Can the coding of a record that has an outstanding query be completed? No. Therefore, you just increased the number of records on your hospital’s DNFB list.

Did I mention all the additional post-discharge queries your coders need to send due to the implementation of ICD-10? That’s certainly added to the number of DNFB cases. Since your director of medical records typically gets called on to explain such matters, he or she isn’t going to be happy with your CDI department. Congratulations! You’ve just alienated the person who should have been your first colleague, the medical records director.

Editor’s note: This excerpt was taken from the CDI Companion for Physician Advisors: Notes from the Field by Trey La Charité, MD, FACP, SFHM, CCDS.