Note from the ACDIS Instructor: Autumn means changes for CDI—meet them by actively participating in your professional growth

by Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC

A confession for you: I don’t like pumpkin spice lattes. I am not a fan of that popular spice in my drinks, although I did just find a recipe for a pumpkin spice white Russian that I may just have to try.

That said, I do love autumn. The crunch of the leaves when hiking, the crispness of the air, Friday night football games and coming home to a house smelling of a slow cooked pork roast surrounded by apples, onions, and garlic. It’s my favorite season. I love the changing leaves, the promise of renewal and the transitioning world. I have always enjoyed change.

My love of change has likely fueled my professional choices and certainly has influenced my landing in CDI. I know that not everyone feels change is a good thing. Sure, there is something comfortable about entering a room or a situation and knowing exactly where the furniture sits, exactly the rules of engagement and exactly what is expected of you. This level of familiarity allows you to relax and complete the task at hand with little thought or stress.

Fortunately, (or unfortunately, depending on your point of view), the worlds of CDI and coding are of change and an evolution. Consider the annual changes. Thursday, September 30^th can be considered New Year’s Eve!—what with October 1 being the beginning of the new fiscal year. This brings updates to the Official Guidelines for Coding and Reporting, as well as new codes, and new rules governing code assignment, as prescribed in the inpatient prospective payment system. These changes can affect quality reporting, reimbursement methodologies, diagnosis assignment, physician education focus, etc.

Additionally, every three months we receive new instructions from AHA’s Coding Clinic for ICD-10-CM/PCS. Sometimes the editorial board’s answers to industry submitted questions really rocks our world. I actually remember what I was doing the day they finally told us “HFrEF” could be reported as systolic heart failure. That was a great day, but the best was when we were told that documentation of “flash pulmonary edema” could be reported as acute pulmonary edema. That day rates right up there with the birth of my children.

It’s not just the rules that change. Depending on the whim of your payer mix, those diagnoses vulnerable to denial may change. The clinical or diagnostic guidelines for certain diagnoses may change. The focus of your department may change related to the setting of care, new attention to quality measures, payment methodology or purpose of record review. To successfully roll with those changes, you need to grab every opportunity to learn. 

If you worked in CDI for as many years as myself, you have experienced many changes. Remember the “good ole’ days” of pink sheets with handwritten queries, a complete focus on DRG optimization? We didn’t talk about denials, clinical validation, risk adjustment, or quality measures. Again, I like change and I dare say if we were still in the “good ole’ days” I likely would be in a different job. I would have moved on to another challenge. But the profession of CDI and its ever-changing challenges draws me back every time.

So, you may ask what is the point of my ramblings? My point is that to stay relevant and successful, you need to embrace change. You need to actively seek new guidance. Look forward to the release of new guidelines, be aware of the recent Coding Clinic releases, read medical journals and learn about the latest and greatest diagnostic guidelines related to the conditions you review in your records. Stretch and learn every day.

It can be overwhelming so here are a few pointers:

1. When someone provides you with information/guidance, ask for their source. Check it for yourself and confirm you are receiving correct guidance. Don’t depend on someone to provide you the answers to questions; go to the source. You never know if this individual is quoting the latest and greatest or is giving you instructions from five years ago.
2. Take some time each day or each week to self-educate. There are many subscription services that provide weekly industry updates such as ACDIS’ CDI Strategies (which is free to subscribe to by the way), medical journals, podcasts, listservs, and discussion groups that can provide you with current information on trends, changes, and activities within our industry.
3. Be aware of when new regulatory information is released, and then read it.
4. Offer to be that point person at your organization that works to inform the staff of any changes or newly released clinical criteria or consensus statements. (Second confession of the day: I learn by teaching!).

I describe CDI as a profession, and one element of a profession is its body of knowledge. We all contribute to this body of knowledge, and it is our professional duty to keep ourselves up to date, well informed, and embrace the changes that come down the road. If you are not actively participating in your self-education, you are not living up to your potential. You cannot always depend upon your employer to provide you with everything you need, you must seek out the information yourself. You must be an active participant in your professional growth.

In closing, when I say embrace change, I really mean learn to enjoy navigating the ever-changing environment. Knowledge is power. Don’t be the ostrich with your head in the sand. Lift it up and listen to the crunching leaves, and smell the pumpkin spice candles burning, cheer the quarterback’s new play and anticipate seeing it executed in the next game, don’t wait for someone to bring you the pumpkin spice white Russian… make the drink for yourself.

1. Mix pumpkin pie spice (1 teaspoon), sugar (1 teaspoon) and crushed graham crackers (3 tablespoons) on a plate. Dip the rim of your glass in water and then into the crumb mix to coat.
2. For the drink, add vodka (2 ounces), pumpkin spice creamer (2 ounces) and Kahlua (1 ounce) into a shaker filled with ice. Shake it!
3. Pour into your glass, top with whipped cream and pumpkin spice. Share with a friend.

Cheers my friends, and Happy Fiscal New Year! May Fiscal 2022 be the best ever!

Editor’s note: Prescott is the CDI education director at HCPro in Middleton, Massachusetts. Contact her at lprescott@hcpro.com. For information regarding CDI Boot Camps, click here.