Q&A: Inpatient psychiatric reviews
Q: Recently, our inpatient psychiatric facility has been asking if it would be beneficial to have CDI review their accounts. I researched this a few years back and learned from other programs that there was little benefit as most psych DRGs are single tier (possible only to improve severity of illness [SOI]/risk of mortality [ROM]) and psych accounts are billed as fee-for-service. I know things change, though, so I just wanted to put some feelers out for current information/trends.
Do you have any information on programs that are reviewing inpatient psych accounts? What are the pros and cons?
A: This is a common question and I do find most facilities do not review psychiatric admissions regularly. You are correct that the DRGs within this Major Diagnostic Category (MDC) are all flat, so capturing CC/MCCs is not going to influence direct reimbursement if the payer is a DRG-based payer. It might be helpful to better understand your private payer population and how they’re reimbursing for psychiatric care to understand if your intervention could offer a positive influence, financially. I have no doubt that your intervention would likely improve the SOI/ROM for this population as often these patients have a number of comorbidities.
I am unaware of any quality measure programs that are related to this population, but this might also be an area to investigate to identify what is being tracked, measured, and reported related to diagnoses from this MDC.
The CMS hierarchical condition category (HCC) risk adjustment program does incorporate diagnoses such as schizophrenia, psychoses, major depressive disorders, bipolar, and personality disorders into the methodology.
As an aside, I do try to teach new CDI professionals to identify specificity related to psychiatric disorders in their daily reviews for medical/surgical admissions. I think these diagnoses are often overlooked or not documented to the needed specificity by hospitalists and primary care providers, just as your psychiatric providers may not necessarily document their patient’s chronic medical conditions. There are many opportunities to capture increased severity within the psychiatric codes, if documented correctly. As a matter of fact, that’s why I chose this topic as my presentation at the ACDIS conference this year. My session is titled “Psych Me Out,” and I’ll be presenting on Day 2, 1:45-2:45 p.m., in Track 1.
I might suggest you perform a review of the providers’ documentation within the psychiatric facility to identify opportunities and offer the providers some education related to the deficiencies that you see. It may not be feasible to take on daily reviews of this population, but you may be able to influence better documentation in this setting which would support SOI/ROM, organizational risk adjustment efforts, and perhaps quality measures.
Editor’s Note: Laurie L. Prescott, RN, MSN, CCDS, CDIP, CRC, CDI education director at HCPro in Middleton, Massachusetts, answered this question. Contact her at firstname.lastname@example.org. For information regarding CDI Boot Camps, click here.