Summer Reading: A letter to new CDI staff

by Laurie L. Prescott, RN, MSN, CCDS, CDIP

Dear Clinical Documentation Improvement Specialist,

I remember my first day as a new CDI staff member very well. I had been through an extensive interview process—three interviews, a written test, and a meeting with the consulting firm that trained me. At the time, all I understood was that I was going review records and help medical staff meeting documentation needs. After more than 20 years of nursing experience, and time spent as a nursing school clinical instructor and in management, staff development, and healthcare compliance roles, I figured this would be an easy jump for me. It was a jump that felt like I had leapt right off a cliff.

I spent my first day training with two inpatient coders and the consultants. These two ladies were an interesting pair. One had been coding for more than 25 years, and I concluded she could diagnose most disease processes better than a number of physicians I knew. The second was new to the inpatient process, having coded in outpatient and clinic settings for a few years. We were implementing a new CDI program. Everyone looked to me to make this program a success. I soon understood this was much more of a challenge than I ever imagined.

Our instructor made several assumptions as she began instruction. She assumed the coders had a much better understanding of anatomy and pathophysiology then they did. She mentioned lab and diagnostic tests that one or both of the ladies found confusing. When she looked at me, she assumed a person with my experience understood the confusing world of hospital reimbursement.

The conversation fell to rules of reimbursement. I took a ton of notes, not knowing what was important and what was not. I watched my new coder friends and found they were doing much the same thing. We all felt lost.

We sat through two weeks of education. I still have those notes, although they make little sense. The consultants left town, and we were left to implement our new CDI program. Fortunately, for those now entering the CDI field, there are now a number of resources available for the new CDI specialist, including a national advocacy and education collaborative in ACDIS and more than 40 related local chapter networking groups, as well as books, webinars, annual conferences, and additional guidance from AHIMA.

A decade ago, however, I had little available, as CDI was not a common practice then. The coding resources were a bit intimidating, and there was no CDI program nearby that I could even go visit. The benefit of that struggle was that I grew close with the coding team; we taught each other and supported each other through the effort.

I also began to understand the skills and interpersonal qualities needed to succeed in the role when it came time to hire a new CDI for our growing department. The first lesson was to never assume. People enter the CDI specialty from many different avenues. Within the ACDIS ranks, there are HIM professionals, coders, quality staff, nurses from all specialties, and physicians. Each of these experiences brings different skills to the table, but rare is the CDI candidate who brings it all. So no matter which background you come from, there will still be a good deal of foundational knowledge you will need to successfully carry out your day-to-day functions in this role.

Later, when I hired my own new staff members, I did bring in consultants to provide formalized training, but not until after our existing coders and internal staff worked directly with the new employees mentoring and guiding them for several weeks. This allowed the new team member to see us in action, complete reading and anatomy assignments, and begin the process of record reviews. This preliminary work allowed them to take full advantage of the consultant’s education without the sense of overwhelming confusion I had experienced.

When I entered the specialty, I quickly knew that the learning curve for this role would be the steepest I ever experienced. Throughout my years in nursing, I had sought out a variety of roles and specialties, as I enjoyed new and challenging roles. I am so proud I stuck with it, as every day it offers me new challenges. It has allowed me to take those years of experience in those many different roles and meld those skills into a new and stronger knowledge base.

You will accomplish this, too; I promise.

Editor’s note: This excerpt was taken from The Clinical Documentation Improvement Specialist’s Complete Training Guide by Laurie L. Prescott, MSN, RN, CCDS, CDIP.