Tip: Form comprehensive query policies to govern both CDI and coding staff

In a recent ACDIS Blog post, Lynne Spryszak, RN, CCDS, CPC-A, CDI Education Director for HCPro, Inc., in Marblehead, MA, pointed to an ongoing conversation posted on CDI Talk. An ACDIS member had asked for ideas on how to talk to coding staff about a newly established CDI program. At least one person suggested that nurses in the CDI role need not abide by the same regulations coders must adhere to.

 

“As a practicing CDI specialist, I had been taught to espouse this philosophy by our consultants, too,” Spryszak wrote. “But 18 months after the initial implementation, our program was failing, and fast, due to the ‘us versus them’ mentality this viewpoint created. So, when I became manager of the program, my first order of business was to establish policies and procedures regarding the query process to ensure that the process was the same for both coders and nurses.”

 

Auditors, such as the recovery audit contractors or the Office of the Inspector General, Spryszak explained, do not care who authored the query. “What they do consider is whether a query is compliant, based on the available information contained within the medical record and available guidelines.”

 

The most current guidelines are those published by AHIMA, one of the four cooperating parties, along with the Centers for Medicare and Medicaid, the American Hospital Association and the National Center for Health Statistics (NCHS). These four parties govern revisions to ICD-9 codes, and are responsible for maintaining the integrity of the coding system.

 

According to the 2010 Physician Query Benchmarking Report (to be released later this month) 54% of the more than 300 respondents said they follow AHIMA’s guidance fully. Another 21% indicated they had read and incorporated portions of the guidance, while 7% indicated their facilities maintain separate policies for queries—one for the CDI staff and another for coding/HIM professionals. Furthermore, 12% said they did not know about or had not read AHIMA’s latest guidance.

 

“ACDIS,” wrote Spryszak, “believes that the guidelines published by AHIMA in Managing an Effective Query Process and Guidance for Clinical Documentation Programs provide clear recommendations for those involved in the physician query process, regardless of professional background. As one of the four cooperating parties, AHIMA is positioned as a governmental ‘expert’ regarding the coding and billing function, and their recommendations should be taken seriously.”

 

Editor's Note: To comment on this topic visit the ACDIS Blog.