Meet a Member: CDI specialists as record detectives
Rachel Mack, RN, MSN, CCDS, CDIP, CCS, CRC, is the consulting director of CDI at Vizient, Inc., based in Littleton, Colorado. She is the current leader of the Colorado chapter of ACDIS and has been in the CDI field since 2012.
ACDIS: What did you do before entering CDI?
Mack: I was a registered nurse in the CVICU and ICU, I travel nursed, and I worked in home health.
ACDIS: Why did you get into this line of work?
Mack: I completely stumbled into it! I was initially hired to be a utilization review (UR) nurse, and UR, case management, and CDI were all housed under case management. Shortly after I started, there was a revamp of the entire department, and they asked for volunteers to do CDI. I had never heard of it! I researched it briefly and volunteered. One month later I was sitting in new-CDI training and have loved it ever since.
ACDIS: What has been your biggest challenge?
Mack: Honestly, my challenges in CDI wax and wane. When I first started, the biggest challenge was just figuring out CDI! I think everyone knows what I mean by that; it’s a lot to take in the first few months.
The next challenge was physician education. Me and my partner-in-crime CDI specialist even showed up at an outpatient clinic at 6 a.m. to do some physician education once!
Then there was the challenge of flipping from ICD-9 to ICD-10, which went smoother than expected. As I advanced in my career and became a CDI educator and auditor, the challenges changed again. This time it was how I could best support our CDI staff to make them become the best version of their CDI selves—and how I would do this in a supportive and positive manner and not a punitive manner, and make it all about education.
Now that I’m a CDI consultant, the challenges are different. I want to do everything and help everyone! It’s tough sometimes trying to rein in all of the different directions my CDI brain wants to go. But I love overcoming challenges; it makes it all worth it.
ACDIS: What has been your biggest reward?
Mack: My biggest reward is seeing CDI specialists have a “lightbulb moment” that I helped create, whether it be learning a new product or software, or focusing/learning a new query topic, or taking a naysayer physician and making them into a new best friend. I love watching people click with CDI!
ACDIS: How has the field changed since you began working in CDI?
Mack: I think one of the most positive changes I’ve seen across the country when it comes to CDI is CDI and coder communications and interactions. When I first started, that was very rare. Nowadays most CDI teams communicate and work cohesively with coding to assign the best DRG, severity of illness, risk of mortality, PCS codes, and present on admission status of codes for patients. I absolutely love it. Coders have so much knowledge to offer, and it’s so great to have not just one but two smart minds on each case.
ACDIS: Can you mention a few of the “gold nuggets” of information you’ve received from colleagues on The Forum or through ACDIS?
Mack: So many gold nuggets! I have truly enjoyed and gotten a lot of knowledge from every single ACDIS conference I have attended. The blogs and articles are also helpful and remind me that I’m not alone out there—we are all experiencing similar struggles.
ACDIS: If you have attended, how many ACDIS conferences have you been to? What are your favorite memories?
Mack: I am fortunate enough to have attended five ACDIS conferences (and have presented at two)! My favorite memories revolve around networking. Many of us work with people remotely, and getting to meet those people in person for the first time is so fun (especially when you’ve been phone buddies for months, or even years). I also love meeting new CDI specialists and getting the chance to have fun with like-minded people.
ACDIS: What piece of advice would you offer to a new CDI specialist?
Mack: Stick with it. It’s a lot! When CDI specialists start doing this job, they don’t know what they don’t know. Every time you review a record, you essentially are adding to your CDI toolbelt of knowledge. Take notes; keep track of really great query examples (even if they are not yours). Play around in your encoder.
My biggest piece of advice is to remind new CDI specialists that you are a record detective and are looking for things that are NOT there, or at least not obviously stated or documented. We are not just reviewing records and assuming everything will code out OK. Never assume, and aggressively search for the clinical truth of each record.
ACDIS: If you could have any other job, what would it be?
Mack: Career counselor/life coach/life organizer. I love helping people and assisting them in doing what they do BEST and being successful at it. I would also work at a vet clinic and/or animal rescue if I won the lottery.
ACDIS: What was your first job?
Mack: I had two high school jobs. I have danced my entire life and taught dance to little kids at my studio starting in high school. Drumroll for weirdest job ever: I also worked at the Music Valley Wax Museum in Nashville, Tennessee. It was a very strange job, and I hated vacuuming at the end of the day because the wax figures scared me at night!
ACDIS: Can you tell us about a few of your favorite things?
- Vacation spots: Zermatt, Switzerland; Copenhagen, Denmark; and any of the Hawaiian Islands (I’ve almost been to all of them).
- Hobbies: Biking, hiking, skiing, camping.
- Non-alcoholic beverage: COFFEE.
- Foods: Mexican food. Mexican food. Mexican food. Also, cake.
- Activities: Hanging with my husband and dog, relaxing at the house.
ACDIS: Tell us about your family and how you like to spend your time away from CDI.
Mack: I have a small family—just me and my husband and our rescue dog, Cheech, and I love it. Prior to COVID, we travelled internationally (and domestically!) a lot, and I can’t wait to get back to that after the COVID crisis is over. I truly enjoy the company of close friends and my tiny family and doing anything with them at any time.
ACDIS: Is there anything else you’d like to add?
Mack: Just the obvious: Anyone that knows me knows what a huge nerd I am for CDI.