Q: We have a new CDI program with a huge learning curve. I am an RN in a CDI position. There are many things to ask, but the present issue is the re-querying done by the coders, which results in a large number of charts being held up. Has this been a familiar problem that others have had to deal with, and what have they done to cut down on the numbers? I appreciate any help you can offer.
Colleen Garry: I understand completely. When beginning a new program you have to be very clear and your staff needs to hold each other to consistent timelines pertaining to the query close out. Closing out a query is an art form. I suspect that the CDS nurses are not being efficient in their closeouts or are meeting significant resistance (this is normal with new programs) and the unanswered queries may be causing frustration for the coders (understandably). Query response and turnaround time is a must have to a successful program. One can educate and place queries all day long, but at the end of the day it’s all about impact.
Gloryanne Bryant: When you start a program you will undergo a learning curve. You should anticipate some mentoring and shadowing on the floors with your CDIS staff. I recommend you start with focusing on 10-12 diagnoses to start, then fold in others after 2-3 months.
Regarding charts being held, you can finalize the chart/bill and then rebill after you receive a reply for the query/clarification. Discuss this with your HIM director and coding staff. Also, your HIM department should include the query/clarification forms in the chart delinquency process and calculation as this helps to get the physician to respond.
Tamara Hicks: We continue to struggle with coders asking CDI staff to take charts back for further clarification. We have a policy in place that limits the amount of time that can be taken to have clarification added to a record, particularly if it impacts the DRG and the bill is being held open. But to address the issue of the numbers, you may need to look at whether the CDI staff is capturing all the opportunities concurrently to cut down on the back end follow up (also a problem we continue to struggle with after a number of years).
Robert Gold: What leads to this situation is the training provided by companies who concentrate on the reimbursement effect on the hospital of what they call a clinical documentation program. They lose the perspective that it’s a clinical analysis and not a coding analysis. When their trainees see 15-20 records a day, or the process is left to case managers who are quite busy with a different perspective of hospital function and just don’t have the time to devote to real CDI efforts, there will be enormous numbers of retrospective queries.
When dedicated team members are in sufficient volume and they get to review 40-60 records a day with ease, you’ll cut down enormously on AR time. If your training program is set up to direct education and experience to specific service lines over time, you’ll get good at each service line a lot quicker and be able to roll the initiative through the facility with more comfort and ease. If you get it all dumped in your lap in a short time, you’ll flounder for the first six months to a year.
Editor’s note: The ACDIS Advisory Board answered these questions in January 2009. Should you have any questions for the current advisory board, please email ACDIS Editor Linnea Archibald (larchibald@acdis.org).