2025 CDI Week Q&A preview: Productivity

As part of the fifteenth 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, answered these questions. Fernandez is a member of the ACDIS Furthering Education Committee and the ACDIS CDI Educators Networking Group. For questions about the committee or the Q&A, contact ACDIS Editor Jess Fluegel (jess.fluegel@hcpro.com).

Q: According to the 2025 CDI Week Industry Survey results, most respondents report that an average inpatient CDI specialist completes 6–10 patient new reviews per day (59.78%), followed by an average of 11–15 reviews (18.95%). In comparison, 53.36% are expected to complete 6–10 new reviews by their department, while 23% are expected to complete 11–15 reviews. How does your CDI program handle chart review expectations with its staff? Do you think a specific goal can be helpful, and/or are there other metrics helpful to track? Why or why not?

A: Having a specific goal for productivity is extremely important. It is vital that reviewers know that working a couple of encounters per hour is not sufficient. That said, some reviews naturally take longer than others. That must be taken into account when measuring, interpreting, and reporting productivity and metrics. It is better to view overall productivity on average over a specified time period rather than, say, daily. Comparing one CDI specialist’s productivity to another or to the group can be helpful, especially if each CDI specialist has the same resources (e.g., review software, electronic health records, and reference materials) and the same challenges in using those resources.

Productivity expectations as reported from the CDI Week Industry Survey results may reflect differences in availability and/or user friendliness of these resources across the industry. It’s difficult to compare apples to oranges—or to compare a Red Delicious to a Granny Smith. There are other metrics of equal or greater value than productivity: query compliance rates, concurrent vs. retrospective query rates, DRG/principal diagnosis assignment accuracy, and missed opportunities for queries.

Q: Survey results showed 31%–40% was the most common personal average query rate (i.e., the percentage of charts that have at least one query opportunity found during CDI review) reported by respondents, followed by 21%–30%, though results otherwise were spread evenly across the board. Can tracking your personal average query rate be beneficial? Why or why not? What other ways can CDI professionals personally measure success?

A: Yes, tracking your personal average query rate can be beneficial, especially when comparing it to other CDI specialists in your facility/system. When reviewing encounters, I find there are many which have potential query opportunities, but not all will have a meaningful impact on that documentation.

“Measuring success” has long been a subject of much discussion in CDI, both from an individual standpoint and for a group. As an educator, I think that query compliance is an underrated metric. Query compliance rate is measurable and “addressable = educable.” Anyone who writes CDI queries will occasionally write a noncompliant query. Providing continuing education regarding query compliance means giving concrete feedback to individual CDI specialists as well as to a group. If queries are noncompliant, does it matter what the query rate is? That said, there should be some feedback to the individual regarding compliant queries as well—no one benefits from only hearing about what was done incorrectly.

Q: According to survey results, 21%–30% was the most common query rate goal of CDI departments, though many free responses stated that their department doesn’t have a set expectation. Does your CDI program have a specific goal and if so, how was that number decided on? What other strategies can a CDI program use to encourage personal accountability and best query practices?

A: Our query rate is more of a goal set for the program and is not limited to individual CDI specialists. It is shared with each facility and education is geared toward information which helps to decrease the query rate by improving documentation.

Continuing education and feedback regarding query compliance can, in my opinion, encourage professional accountability and best query practices, both for individual CDI specialists and for the team. As advised in the ACDIS/AHIMA Guidelines for Achieving a Compliant Query Practice—2022 Update, my organization used this document as a prime resource to write our system policy regarding CDI queries.

CDI practice aligns very well with the practice of nursing. You wouldn’t enter a patient’s room with a urinary catheter kit planning to use the kit without knowing the clinical rationale behind what you are doing and being able to explain it. Likewise, a CDI specialist should understand the rationale behind the need for a query prior to sending that query.

According to the Guidelines, “Queries are not necessary for every discrepancy or unaddressed documentation issue.” Understanding the “why” as well as the “why not” can help the individual CDI specialist decide whether a query is necessary or not. Maintaining a good working relationship with the coding department can also be very helpful, as discussion with coders can help CDI specialists see clinical documentation from another point of view.

Q: The majority of respondents (62.75%) reported a 91%–100% physician query response rate, which was also the most common goal response rate for CDI departments. What do you think these departments are doing to achieve or reach above their goals? Do you have any advice on query wording, policies, collaboration, etc., to help CDI professionals construct effective queries?

A: Make the most of the time you’re given out of a provider’s day. This is often less than a minute or two—so make it count.

Make your queries concise as advised in the Guidelines. There is no need to include anything in the query that is not directly pertinent to the specific question being asked. No one wants to read an encyclopedia. At the same time, include enough information in the query that the provider understands why it was sent. A carefully worded CDI query can be an effective tool for provider education.

CDI queries sent prior to or shortly after discharge should garner more accurate responses from providers. If you were a floor nurse before, you could tell me everything there was to know about a patient you took care of yesterday. A week from now, however, that will probably not be the case. Additionally, queries sent prior to or shortly after discharge align better with a provider’s work schedule and will have a better chance of getting answered in a timely manner.

Construct queries in an easy-to-read manner. For example, list pertinent information in a column, rather than as a part of a paragraph. Below, Example A is not as easy to read as Example B.

Example A:

“H&P and progress notes dated 12/7 through 12/9 include diagnosis of acute renal insufficiency. H&P includes, “no history of chronic kidney disease.” Patient’s creatinine levels during this encounter include 12/6 – 2.3, 12/7 - 2.5, 12/8 – 1.9, 12/9 – 2.2, 12/10 – 1.89, 12/11 – 0.80”

Example B:

“H&P and progress notes dated 12/7 through 12/9 include diagnosis of acute renal insufficiency. H&P includes, “no history of chronic kidney disease.” Patient’s creatinine levels during this encounter include:

12/6 – 2.3

12/7 - 2.5

12/8 – 1.9

12/9 – 2.2

12/10 – 1.89

12/11 – 0.80”

The CDI department at Baptist Health System engages physician leadership and facility executives to encourage participation and improve provider engagement.

Q: Of respondents whose organization tracks physician query agree rate, 56.3% reported a 91%–100% agree rate, 33.82% reported an 81%–90% agree rate, and 6.51% reported a 71%–80% agree rate. What efforts has your CDI program made, if any, to have a higher physician query agree rate? Do you have any advice on query wording, organization, policies, etc., to help CDI professionals construct effective queries?

A: I once heard that the best CDI queries are the ones that you already know the answer to before you send them. Know what clinical indicators are pertinent to the question being asked and include them in your query. Know the most commonly accepted criteria for a particular diagnosis or condition. My best query writing advice is to include what you would have written down if you were going to call a provider at three o’clock in the morning. Be concise. Write and submit queries in an easy-to-understand format. Don’t fish. Do the right thing.

Share particularly well-written queries with the team as an educational experience. Sharing not-so-well-written queries can also be helpful, perhaps presenting them with a review of the encounter as a case study. Take care to not single out any particular CDI specialist in a group setting—this is not helpful to anyone.

Educate providers about query composition and why queries are necessary in the first place. When appropriate, we educate physicians that while inpatient CDI impacts hospital billing, improved physician documentation also helps support physician billing.

Q: When asked if their organization has an escalation policy or other policy requiring physicians to respond to queries/CDI clarifications, 89.2% of respondents said they do. Also, those with an escalation policy reported a higher physician response rate than those who did not (64.74% vs. 51.22%). Does your CDI program have a query escalation policy, and if so, what have been your struggles and successes while using it? What advice would you give a CDI program wanting to improve or create such a policy?

A: CDI queries are a part of the legal medical record at Baptist Health System. As such, CDI queries are subject to HIM policies for chart completion. This includes suspension for incomplete records.

Q: This year, the most-used CDI software solution by respondents was electronic grouper software (78.25%), surpassing chart prioritization (77.47%) and electronic querying (77.31%), with computer-assisted coding (CAC) close behind (76.83%). What kind of software solutions would you say have become common practice to use by CDI departments, and which, if any, have you noticed growing in popularity over the last few years? What types have you found helpful for your own team, and how have they impacted your productivity?

A: The electronic medical record, electronic grouper software, and software used for CDI practice have been game changers. Software has undoubtedly had an impact on productivity but also on job satisfaction among CDI specialists. Being able to see and understand the implications of query responses can give a CDI specialist a deeper understanding of the CDI process. Being able to see and read provider responses to queries can help the CDI specialist consider alternative ways to pose the same question in the future, potentially in a more concise and easier to read manner.

Q: As the CDI profession grows, the way that departments measure productivity is changing with it. How have expectations evolved since you started in CDI and/or your program began? Now that CDI is better known at most organizations, how do you think productivity and measurements for success will evolve in the future?

A: When I started in CDI, dinosaurs roamed the earth. The number of encounters I reviewed daily was self-reported. I printed a patient list every morning and visited different nursing units. I pulled charts from a chart rack and reviewed paper documentation, checking encounters off my list as I went along. The number of queries I wrote in a given day was also self-reported. The source I used for DRG assignment and for specific codes was an abbreviated version of “the code book.”

When the CDI department was given access to electronic grouper software, it was a game changer. We in the CDI department could see the difference made with provider responses to CDI queries. How exactly productivity and measurements for success will evolve in the future, I do not know. What I do know is that there is never a dull moment in CDI!