A reader says that coders, not CDISs, are querying physicians. Across the archipelago of the Internet came a timid yelp to be heard one recent Thursday morning – and it has renewed a tsunami of interest and passion regarding the roles of coders and clinical documentation integrity specialists (CDISs). A…
To query or not query that is the question. Querying is the lifeline of clinical documentation integrity (CDI) professionals and many coding professionals. In fact, the CDI profession has many key performance indicators (KPIs) based on querying – so isn’t it funny that, as an industry, there is so much…
There are certain key elements of consideration during CDI review of COVID-19 patients.  Understanding how to clinically validate sepsis and differentiate between sepsis and septicemia is not easy, and requires a lot of time and effort. Sepsis is an overwhelming non-homeostatic response of the immune system to infection causing organ…
In many ways, CDI is the perpetuator of self-inflicted denials through the query process.  Unprecedented times require unprecedented actions, with all hospitals and health systems currently facing undue financial stress related to the ongoing (and raging) COVID-19 pandemic. The American Hospital Association (AHA), in its report issued June 30, indicated…
The practice of medicine takes clinical criteria into consideration, but clinical judgment can override criteria. As I was deleting emails one morning, I saw a picture of Cynthia Tang, as in Pinson & Tang, authors of the annually updated CDI Pocket Guide. I had never met her, so I was…
I'm making a pitch for reciprocal education. EDITOR’S NOTE: Dr. Erica Remer reported this story live during a recent edition of Talk Ten Tuesday. The following is an edited transcript of her reporting. To set the stage, I am currently engaged in a really fun, intellectually challenging ongoing project. I compose…
EDITOR’S NOTE: Dr. Erica Remer reported this story live during a recent edition of Talk Ten Tuesdays. The following is an edited transcript of her reporting. When I was a new physician advisor, the chief quality officer at my facility instructed me to not talk about money when discussing clinical documentation…
Case study proves the need for physicians to be members of the CDI team. Having a strong denials management team is critical for facilities. If providers do not leverage proper resources to generate strong appeal letters, the third-party payers will uphold their decisions to remove or change diagnosis or procedure…
Where CDI went awry: missing an opportunity for safety. In last week’s ICD10monitor news edition, I authored an article titled “How a Texas Health System Beat a $61.8 Million Billing Fraud Case.” The dismissal of the case was based upon a citation of previous language the Centers for Medicare &…
The allegations in the case focused on CCs and MCCs. A Texas federal judge recently dismissed a False Claims Act lawsuit alleging that Dallas-based Baylor Scott & White Health overbilled Medicare by improperly upcoding claims. The whistleblower lawsuit, filed in 2017, alleged that the health system submitted more than $61.8…