Guest post: Maintain your passion while keeping your cool—BE CALM
by Kami Stufflebeam, MHA, BSN, RN, CCDS
Passion is a funny thing. As passion grows for a particular subject or person, so does the desire to defend it at all costs. I love true crime podcasts and listen to one nearly every day. Inevitably, there are always people that continue to defend the perpetrator, even when faced with overwhelming evidence of guilt. These people are blinded by their love for the individual. I find it frightening that we can lose sight of logic as our desire to defend grows. Can you think of an area in CDI where you might respond based on emotion because of your passion?
I am passionate about clinical documentation. It took me seven years in nursing to find my niche and, when I did, it was love at first sight. My hunger for knowledge as a baby CDI specialist built a solid foundation for my practice. I attended online boot camps, studied at home, and went through many months of orientation. I felt confident in my knowledge and in my ability to utilize references by the end of my orientation.
That confidence, however, was shaken when I started to receive mismatches with coders. I devoted countless hours to learning my profession, had years of clinical experience, and now someone is telling me I’m wrong? DRG mismatches definitely bring out my passion-beast and the desire to defend my work at all costs. My desire to defend is short-lived, however. Instead, I assume the stance of innocence until proven guilty. I assume I am incorrect and go on a mission to prove otherwise. If I come up empty handed and the coder is correct, that’s OK! That outcome serves as a reminder that I don’t know everything and fuels my passion for CDI even more.
“Innocent until proven guilty” is a great foundation, but the actual communication process between coding staff and CDI specialists should be formalized to remove bias and emotions. Our profession is about the clinical truth, not how a mismatch made us feel. The acronym BE CALM is a very useful tool to address the mismatch in a rationale, respectful manner.
No matter how you receive notice of mismatches, take a moment to breathe and check in with your emotions. If your child came home sick, you still have 10 more initial charts to review, and you have a provider emailing you about how CDI is only out for money, this may not be the best time to address the mismatch. After deciding you are emotionally ready, ensure that you have enough time to devote to a thorough review. Rushing through can result in misinterpretation of a coder’s message to you and of associated references.
Now that you know you’re stable and have time to objectively review, educate yourself. There are certain things in CDI that we assume we know. We do this job for hours every day and it becomes second nature at some point. We don’t know it all, however, and should check in with our knowledge base on every mismatch. This is the perfect time to grow! Perhaps you know that you cannot capture encephalopathy due to a post ictal state. That’s a great start, but don’t stop there. Pull up the Coding Clinic and read it. Review your references on every mismatch to ensure a solid understanding of the issue.
You get to create your response. How you choose to convey your thoughts can make or break your credibility and relationship with coding. The response should include:
- An introduction of the issue (“DRG mismatch due to X”)
- Rationale for your code set: Use the actual reference when speaking with coders (Official Guidelines for Coding and Reporting, Coding Clinic, etc.). I prefer to copy and paste the reference. This provides a non-biased view of the issue at hand.
- Proactive language: Never say “I think” or “I feel.” Instead, state “I coded X based on reference Y” (and then provide the actual reference, not your interpretation of it).
A: Acknowledge and appreciate
Acknowledge that coders are experts in their realm and always state that you appreciate their time. A great way to convey this is to provide supporting resources for your code set and then ask the coder to share their thoughts. This approach uses open communication and is in stark contrast to demanding a change. It will foster a collaborative relationship built on mutual respect and, who knows, you may even learn something!
Review what you wrote. We email coders in my current role, and I read it at least five times before I send it. Look at the overall tone, grammar, and spelling. As you read, ask yourself what your supervisor would think of you if they read this message. You want to come off as concise, logical, and respectful. Be sure your words reflect your intention.
It’s time to mail it! You are finally ready to send your response and begin a conversation founded in respect and research.
The BE CALM acronym can really help you keep your cool and maintain your passion when faced with a DRG mismatch. While it does feel good to be right on mismatches, this is not the only preferable outcome. If you can’t be right, you can still learn something new through respectful collaboration with coding staff.
Editor’s note: Stufflebeam is a CDI specialist at CorroHealth in New Windsor, New York. Contact her at email@example.com. Opinions expressed are those of the author and do not necessarily reflect those of ACDIS, HCPro, or any of its subsidiaries.