As part of the sixteenth annual Clinical Documentation Integrity Week, ACDIS conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Coral F. Fernandez, RN, CCDS, CCS, the system CDI auditor/educator at Baptist Health System in Kentucky,...Read More »
Q:A patient was initially suspected of having a diagnosis in the history and physical (H&P) that drove the DRG. After review, and without any evidence based supporting clinical indicators noted, the CDI specialist issued a compliant query to clarify...Read More »
Q: A CDI specialist asked me if they could put a photo in a query. I’m used to noting in the query where in the chart the provider can find the photo, but I have never actually put a photo in the query itself. Is this allowed?
Q: If a provider answers a query and the response requires further clarification, is it compliant to contact the provider by phone or other outside query method, have a conversation with the provider, and then ask/encourage them to add to their note without documentation regarding...Read More »
A very happy New Year from the ACDIS team! Now that we’re done with celebrations and counting down the seconds until midnight, it’s time to reengage and kick off 2026 with only the best of what our publications have to offer. Since provider engagement remains one...Read More »
