Updated on: October 14, 2019

Breaking down the silos with education

Original story posted on: October 11, 2019

Expanding clinical conversations to involve all players can only benefit the entire organization.

EDITOR’S NOTE: This article is based upon Dr. Erica Remer’s remarks during a recent live Talk Ten Tuesdays Internet broadcast.

A while back, I told readers about a fun activity I do with one of my clients. In order to give their clinical documentation integrity specialists (CDISs) regular education, we regularly hold a half-hour conference call about a topic of their choice.

Their analyst prepares the presentation, and I serve, as I affectionately call it, as the color commentator. For those of you who don’t watch sports on television, a color commentator is a chatty co-host who assists the play-by-play commentator, filling in when play is not in progress.

I add the clinical perspective. I expand on the CDI topic. I mention some coding nuances. I go off on some tangent.

I wanted to share something we did a few weeks ago, because I think you could try doing it at your facility.

Their acting physician advisor had contacted me for my opinion on a medical necessity case that was fascinating and multi-faceted. It was a patient with an abscess and cellulitis from injecting an illicit substance. The ED personnel was unable to perform an incision and drainage in the emergency department.

The first question was what the appropriate status determination was, but there were numerous other points to address the coding and the clinical documentation.

What was really exciting was that we invited the utilization review/case management team and the coders to participate in the call. We usually have about 35 participants, and that day we had 99 callers. We knocked down the silos and had a fascinating interdisciplinary discussion about how to support the clinical providers’ documentation.

The medical necessity aspect was eye-opening to the CDISs, who didn’t realize that their efforts in making each patient look as sick and complex as they really also support the utilization management (UM) folks. If a patient is placed in the wrong status and it is not resolved prior to discharge, serious financial repercussions can ensue.

The UR/CM folks don’t always know what the CDISs can do to help support them, or how getting complications and co-morbidities (CCs) and major CCs (MCCs) change the DRG tier and affect reimbursement.

Also, coders always appreciate being included in clinical discussions, because it helps them more deeply understand the medical issues and allows them to bring their coding expertise to the table.

I have to confess that I am prejudiced. I think that institutions should always invite the clinical documentation team to participate in all their ventures. When I was a physician advisor, our system started setting up best-practice, high-reliability medicine groups for different conditions and specialties. The first one I was invited to be a member of was the colorectal group because the chair was a strong proponent of clinical documentation. In fact, in the first meeting, he made me blush when he announced that he thought I was going to be the most important team member present. What he was trying to convey was that he thought once they had ironed out the wrinkles in standardizing excellent patient care, we needed to ensure that the documentation accurately represented it.

Documentation can’t fix bad medicine. But good medicine without good documentation will go unrecognized. Knockdown the silos and spread the good clinical documentation word around.


Programming Note: 

Listen to Dr. Erica Remer each Tuesday on Talk Ten Tuesday, 10-10:30 a.m. EST.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Erica E. Remer, MD, CCDS

Erica Remer, MD, CCDS has a unique perspective as a practicing emergency physician for 25 years, with extensive coding, CDI, and ICD-10 expertise. She was a physician advisor of a large multi-hospital system for four years before transitioning to independent consulting in July 2016. Her passion is educating CDI specialists, coders, and healthcare providers with engaging, case-based presentations on documentation, CDI, and denials management topics. She has written numerous articles and serves as the co-host of Talk Ten Tuesdays, a weekly national podcast. Dr. Remer is a member of the ICD10monitor editorial board, a former member of the ACDIS Advisory Board, and the board of directors of the American College of Physician Advisors.

Related Stories

  • Supporting the Next Wave of CDI Professionals
    We often overlook the human component of metrics within our profession. I recently received some feedback on an article I wrote about the metrics used to measure clinical documentation improvement (CDI) performance. It reminded me that we often overlook the…
  • Some Risk-Adjustment HCC Basics for HIM Coding and CDI Professionals
    Compliance is a big part of the risk adjustment HCC. Everyone is welcoming the New Year, and I am among them. This is a good time to take a look at some basics that make up the Medicare Advantage (MA)…
  • Applying the Toyota Way Principles to CDI
    The principles focus on continuous improvement. There have been numerous articles and other materials written promoting the material benefits of implementing some if not all of Toyota’s 14 principles, first outlined by the auto manufacturer in The Toyota Way, published…