Clinical Documentation Improvement Program
Inpatient Setting
Our Implementation Journey
Linda Dubiel, RHIA, Coding Director
Mayo Clinic Health System – NW WI Region WHIMA Conference May 2013
Clinical Documentation Improvement
CDI h b d i th
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CDI programs have been around since the 1990’s•
Concurrent Coding model•
We tried concurrent coding in 1990’s but went back to post discharge due to the time required of the coder on the floors in addition tofinalization after discharge.
MS-DRG
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Effective 10/1/2007 CMS implemented MS-DRGs Add d dditi l l l f it t•
Added an additional level of severity to differentiate patients with additionalcomorbidities/complications (CC) requiring greater resource consumption.
Improvement
Inpatient Coders
• Hired an external physician consultant to provide education for inpatient coders to ens re the acc rac of coded data for inpatient coders to ensure the accuracy of coded data.
• 12 month project
• Retrospective physician query process with
standardized query forms
• Enhanced coders’ clinical knowledge of
pathophysiology and various disease processes.
• Physician education of the IPPS payment system, y p y y , severity adjusted DRG’s and present on admission (POA)
• Assignment & training of a physician liaison for coders
• Assignment & training of coding auditors (2 Inpatient Coders)
Success!
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The project proved to be a success.•
Physician documentation improved – morePhysician documentation improved more specificity representing a more accurate picture of the patient’s level of severity and moreappropriate reimbursement.
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Coders’ clinical knowledge enhanced - more appropriate queries when documentation needs clarification•
Decrease in number of queries coders send to providers post discharge•
Case Mix increasedRetrospective Documentation Review
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While project was successful, retrospective review wasn’t idealreview wasn t ideal
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Attempts to clarify documentation were problematic -patient was discharged & physician not always familiar with case anymore.Inpatient CDI Focus
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Inpatient CDI focus changed fromreimbursement optimization to accurate
f f f
representation of severity of illness and risk of mortality.
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Benefits of concurrent documentation review versus retrospective became more apparent•
Documentation specialist could haveface-to-face discussions with providers & obtain face discussions with providers & obtain clarification at point of care, minimizing
clarification requests needed by coders after discharge.
Mayo Clinic and Mayo Clinic Health System The Power of Collaboration
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Inpatient CDI program in place at Mayo Clinic’s three group practices in Minnesota, Florida and A iArizona
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Revenue Cycle houses the CDI program for Rochester which has been in place for approximately 3 years.•
As the plan for ICD-10 implementation began to be discussed, a decision was made to use the CDIi li t t d t i ti t id b t th specialists to educate inpatient providers about the increased specificity required for ICD-10.
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CDI programs would be implemented in all hospitals in the Mayo Clinic Health System.Clinical Documentation Improvement
Mayo Clinic Health System – NW WI Region
• DCBA, Inc. is consultant hired throughout the Mayo system to
implement a concurrent documentation review program and train CDI specialists
• We created a CDI specialist job description for our NW WI region oQualifications and education required
Active Wisconsin RN license or ability to practice professional nursing in the state of Wisconsin
Bachelors of Science – Nursing (BSN) degree from an accredited university
Masters preparation and/or advanced course work preferred Five years working experience as a Registered Nurse in acute
care setting preferably in CCU Med/Surg ED care setting, preferably in CCU, Med/Surg, ED
Must obtain or be willing to obtain advanced training and certification in clinical documentation improvement within 24 months (CCDS).
Utilization Review/Case Management or ICD coding experience preferred
How we got started
• 4 CDI RN FTE’s approved for NW WI Region (One 230 bed PPS hospital and 4 CAH sites)
PPS hospital and 4 CAH sites)
• Support from administration and Medical Director
• Communication about the program with providers and department directors from Medical Director
New CDIP Program
• CDI nurses review documentation on floor – paper progress notes
• Paper clarification forms. Not a permanent part of medical record. Documentation is amended
Documentation is amended.
• Midas CDI module (software that tracks, manages and reports data) -still working on building our reports
• CDI nurses enter cases into Midas as well as scan their clarification forms and save them in Midas.
• Coders save their retrospective queries in Midas and have access to the CDI info and CDI nurses have access to the coders’ queries.
• CDI nurses work closely with inpatient coders and meet monthly to
di y y
discuss cases
• CDI nurses are developing relationships with case managers and core measure abstracters in Quality
• Monthly conference calls with Mayo enterprise CDI nurses
• CDI nurses are members of WI ACDIS and attend monthly conference calls
Inpatient CDIP Future
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CDI nurses continue to learn more about documentation review and coding guidelines documentation review and coding guidelines•
Develop relationships with providers and otherdepartments
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Measure and track physician compliance, CDI productivity, SOI (severity of illness) and ROM (risk of mortality)(risk of mortality)
Questions?
Linda Dubiel, RHIA
