Updated on: October 16, 2018

CDI: Documenting the Need to Generate Compliant and Meaningful Queries

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Original story posted on: October 15, 2018

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New program for live CDI education is gaining traction.

Last week, I shared details about a new activity I have been doing with a client that I think is extremely beneficial, and suggested that perhaps others could implement a similar program in their own practices. I was asked to lay it out in an article, so here it is.

When consulting, I find that organizations are keen on having me educate providers, which I agree is critical. But the benefit is short-lived unless you have a good clinical documentation integrity (CDI) program to reinforce the education. Therefore, it is my opinion that ensuring that CDI staff and coders are knowledgeable and up to date is just as (if not more) important.

Our fledgling program grew out of a desire to ensure that the CDI staff was generating worthy and compliant queries. We had instituted a CDI analyst role, and one of her key tasks is performing query quality assurance. My philosophy is that knowledge gaps are rarely individual issues, but more likely systemic. To that end, I believe that continuous feedback and dissemination of information to the entire team is a best practice.

Most organizations can’t afford to send all their CDI staffers to annual national or regional conferences, but it is indisputable that ongoing education is vital to any program. To address that need, as our analyst finds faulty query composition or recurring topics that bring up important teaching points, we share them with the whole group, so everyone can learn from each opportunity.

The program we have implemented works as follows, and I must comment that one reason it is going so well is that the team I am working with is fantastic.

  • We meet on a weekly basis for a half-hour at a time. The format is a webinar (conference call plus screen-sharing) involving the entire remote CDI staff. Periodically, we plan to gather in person.

  • The analyst usually discusses two cases, often linked by a common theme. For instance, one week she found opportunity in encephalopathy queries; another week we discussed the Glasgow Coma Scale; the following week she had several shock cases to review. Sometimes we talk about coding updates and important Coding Clinic opinions.

  • The moderator prepares a short slide deck, usually no more than 12 slides, for the entire 30-minute session.

  • She summarizes the clinical scenario in a few sentences and presents the query. There is often a chance to educate on both query structure and content, to improve queries, and then move on to clinical points.

  • My role is to interject and add details. I provide a clinician’s perspective and also give input regarding ICD-10 and coding. I don’t prepare a formal presentation – the discussion triggers my additions to the dialogue.

  • We leave time for questions at the end.

  • We try to stick strictly to the half-hour time frame.

The feedback from participants has been overwhelmingly positive. They feel like they are being nurtured and think the sessions are extremely helpful. They comment that the information is the right amount to absorb, and that they feel they are growing professionally.

You can easily establish a similar program in your organization. If you don’t have an analyst, your group can teach each other. If you don’t have a formal quality assurance process, choose queries that have elicited complaints from providers, such as those that created situations in which they didn’t understand why they were being queried or what the question was.

Consider expanding the program to include CDI specialists (CDISs) and coders together. It is helpful to have the staff share their perspectives and be given the same information.

You should also have a physician advisor participate. The service could be provided by a vendor, if you don’t have a physician advisor. Build it into your contract. I know I would be happy to help your team if you don’t have any alternative – I think it is one of the most intellectually challenging and fun activities I engage in.

MedLearnMedia and I are considering partnering to offer such services to hospitals or systems that do not have the resources or inclination to institute them. We would structure it similarly, with the responsibility for preparation rotating between facilities. I would provide the physician advisor support.  Would your hospital or organization be interested in participating? Let us know – send us an email at .


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Erica E. Remer, MD, FACEP, CCDS

Erica Remer, MD, FACEP, CCDS has a unique perspective as a practicing emergency physician for 25 years, with extensive coding, clinical documentation improvement (CDI), and ICD-10 expertise. As a physician advisor for University Hospitals Health System in Cleveland, Ohio for four years, she has trained 2,700 providers in ICD-10, closed hundreds of queries, fought numerous DRG clinical determination and medical necessity denials, and educated CDI specialists and healthcare providers with engaging, case-based presentations. She transitioned to independent consulting in July 2016. Dr. Remer is a member of the ICD10monitor editorial board and the co-host of Talk Ten Tuesdays. She is also on the board of directors of the American College of Physician Advisors.

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