CDI Strategies - Volume 4, Issue 17

Tool: Alternative staff schedules offer CDI opportunities

August 19, 2010
CDI Management

When the University of Medicine and Dentistry of New Jersey (UMDNJ) hired Melanie Halpern, RN-BC, MBA, CCDS, CCRA, to implement a clinical documentation and coding integrity (CDCI) program, administration allotted three full-time positions to staff the 550-bed academic medical center....Read More »
CDI Strategies - Volume 4, Issue 17

Tip: Raise awareness of ICD-10 implications

August 19, 2010
Clinical & Coding

It may be too early to start intensive ICD-10-CM training for your coding and CDI team, but now is a good time to at least become familiar with features of the new system. 

During CMS’ Basic Introduction to ICD-10-CM National Provider Call held earlier this year, Sue...Read More »
CDI Strategies - Volume 4, Issue 17

Q&A: Don't discharge the discharge summary

August 19, 2010
Ask ACDIS

Q: Should coders wait for the discharge summary before coding?

A: The answer is complicated because coders generally are held accountable to both the compliance and finance...Read More »
CDI Blog - Volume 4, Issue 16

Q&A: Searching for the principal diagnosis

March 16, 2011
Ask ACDIS, Clinical & Coding

Q: We had a patient come in for back pain and treatment for a possible neurological impingement. However, after a five-day stay, the physician documents neck mass and for the remainder of the stay the resources appear to have been focused on that treatment. How do I discern the principal...Read More »
CDI Strategies - Volume 4, Issue 16

News: IPPS Final Rule confirms DCA adjustment, kidney injury designated CC

August 5, 2010
News

On July 30, CMS issued the inpatient prospective payment system (IPPS) final rule to update policies and rates for fiscal year (FY) 2011, which maintains long-standing CMS policy...Read More »
CDI Strategies - Volume 4, Issue 16

News: CERT report points to documentation insufficiencies

August 5, 2010
News

Three types of mistakes—insufficient documentation, miscoded claims, and medically unnecessary services and supplies—accounted for nearly 98% of errors common across six different provider types, according to the July 14 report ...Read More »
CDI Strategies - Volume 4, Issue 16

News: Survey regarding CDI program structure garners 400 responses

August 5, 2010
News, ACDIS Guidance

In response to a 30-question survey, 482 CDI professionals provided data about the number of staff they employ, the number of queries they generate, and the number of chart reviews their staff perform. They offered information on the focus of their CDI programs and to whom their CDI specialists...Read More »
CDI Strategies - Volume 4, Issue 16

Tip: Query for type, underlying causes, and/or stage of heart failure and CKD

August 5, 2010
Physician Queries, Clinical & Coding

It’s not enough to know whether heart failure is systolic or diastolic. Congestive heart failure (CHF), for example, isn’t an inherent component of systolic and diastolic heart failure, according to Coding Clinic, fourth quarter 2004. That means CHF, when present, requires a second code...Read More »

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