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Welcome
TO THE DIGITAL EDITION OF THE
JOURNAL AHIMA
OF
Two experts give their best advice on CDI prep for ICD-10.
Reinvigorating
YOUR CDI PROGRAM
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Cover
18
Presidents Message
The New Frontier of Clinical
Documentation Improvement
10
Bulletin Board
pg. 24
Features
24
By Kristen Geissler, MS, MBA, CPHQ, and Joni Dion, RHIA, CDIP,
CCDS, CPC
28
32
14
17
Inside Look
Linking the Right Info and the Right
Person at the Right Time
60
Calendar
61
Keep Informed
62
Volunteer Leaders
65
68
Addendum
Battle of the Century:
Watson vs. Big Data
36
42
40
Standards Strategies
Clinical Definition Standards
Case Study
44
Quality Care
The New CDI Challenge:
Adjusting to Quality, Not Quantity
By Brian Murphy, CPC
Coding Notes
Quizzes
52
By Danita Arrowood, RHIT, CCDS, CCS; Laurie M. Johnson, MS, RHIA, FAHIMA;
and Michelle Wieczorek, RN, RHIT, CPHQ
56
27
35
Practice Brief
59
46
http://journal.ahima.org
Time to Focus on 10
Coders at Baystate Health
have ditched dual coding and
one day a week code records
in only ICD-10 as part of
their training. Read how this
readiness process is achieved
without impacting revenue,
and its benefits.
tinyurl.com/AHIMALinkedInGroup
twitter.com/ahimaresources
youtube.com/AHIMAonDemand
feeds.feedburner.com/JournalOfAhima
AHIMA CEO
EDITORIAL DIRECTOR
EDITOR-IN-CHIEF
ASSISTANT EDITOR/
ADVERTISING COORDINATOR Sarah Sheber
ASSOCIATE EDITOR
Mary Butler
CONTRIBUTING EDITORS
Sue Bowman, MJ, RHIA, CCS, FAHIMA
Patricia Buttner, RHIA, CDIP, CCS
`
Angie Comfort, RHIA, CDIP, CCS
Crystal Clack, MS, RHIA, CCS
Julie Dooling, RHIA, CHDA
Melanie Endicott, MBA/HCM, RHIA, CCS, CCS-P, CDIP,
FAHIMA
Katherine Downing, MA, RHIA, CHP, PMP
Deborah Green, MBA, RHIA
Jewelle Hicks
Lesley Kadlec, MA, RHIA
Carol Maimone, RHIT, CCS
Paula Mauro
Anna Orlova, PhD
Kim Osborne, RHIA, PMP
Harry Rhodes, MBA, RHIA, CHPS, CDIP, CPHIMS, FAHIMA
Angela Rose, MHA, RHIA, CHPS, FAHIMA
Donna Rugg, RHIT, CCS
Maria Ward, MEd, RHIT, CCS-P
Diana Warner, MS, RHIA, CHPS, FAHIMA
Lydia Washington, MS, RHIA
Lou Ann Wiedemann, MS, RHIA, CHDA, CDIP, CPEHR,
FAHIMA
ADVERTISING REPRESENTATIVES
Network Media Partners
Jeff Rhodes
Phone: (410) 584-1940
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Phone: (410) 584-1941
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JOURNAL OF AHIMA MISSION
The Journal of AHIMA serves as a professional development tool
for health information managers. It keeps its readers current on
issues that affect the practice of health information management.
Furthermore, the Journal contributes to the field by publishing work
that disseminates best practices and presents new knowledge.
Articles are grounded in experience or applied research, and they
represent the diversity of health information management roles and
healthcare settings. Finally, the Journal contains news on the work
of the American Health Information Management Association.
EDUCATIONAL PROGRAMS
The Commission on Accreditation for Health Informatics and
Information Management Education (www.cahiim.org) accredits
degree-granting programs at the associate, baccalaureate, and
masters degree levels.
AHIMA recognizes coding certificate programs approved by the
Approval Committee for Certificate Programs. For a complete list of
AHIMA-approved coding programs and HIM career pathways go to
www.hicareers.com.
Journal of AHIMA (ISSN 1060-5487) is published monthly, except for the combined issue of November/December, by the American Health Information Management Association, 233 North Michigan
Avenue, 21st Floor, Chicago, IL 60601-5800. Subscription Rates: Included in AHIMA membership dues is a subscription to the Journal. The annual member subscription rate is $22.00 for active and
graduate members, and $10.00 for student members. Subscription for nonmembers is $100 (domestic), $110 (Canada), $120 (all other outside the U.S.). Postmaster: Send address changes to Journal
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Periodicals postage is paid in Chicago, IL, and additional mailing offices.
Notice of Policy
Editorialviews expressed in articles contributed to the Journal of AHIMA are those of the author(s) and do not necessarily reflect the policies and opinions of the Association, editorial review
board, or staff. Articles are not to be construed as endorsing any particular product or service. Advertisingproducts, services, and educational institutions advertised in the Journal do not imply
endorsement by the Association.
Copyright 2015 American Health Information Management Association Reg. US Pat. Off.
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A study from the RAND corporation, published in the Journal of the
American Medical Association, found
that clinical decision support tools
led to an increase in the number of
ordered advanced imaging tests rated
as appropriate. The full report based
on the study, submitted by RAND to
Congress, outlines a series of improvements to decision support tools that
could lead to further reductions in
unnecessary tests.
QUALITEST ICD-10 SURVEY RESULTS
APRIL 2015
www.qualitestgroup.com/resources/
document/qualitest-icd-10-surveyresults-april-2015/?doc=eyJyaWQiOj
YxMDMsImRpZCI6NjEwMywiZmlkIjo2
MTA0fQ=
A survey from software testing company QualiTest finds that the vast
majority of responding organizations
over 80 percentbelieve that ICD-10
will not experience further delays.
According to the survey, 28 percent of
responding hospitals have conducted
ICD-10 revenue impact testing with
payers and 67 percent have conducted
testing with clearinghouses.
12/Journal of AHIMA July 15
A year ago the Health IT Policy Committee recommendedand the US Department of Health and Human Services (HHS) endorsedvoluntary testing
of systems that placed metadata tags
on health records containing sensitive
information.
Extra protection is required for health
records containing details about federally funded substance abuse treatments and behavioral health issues.
Metadata tags enable providers to
share the records with other providers
without a patients written consent.
In March, ONC issued a proposed
rule that included a DS4P testing rule.
Most of the proposed provisions will
not be implemented until 2018, according to Modern Healthcare. According
to a chairwoman quoted in the article,
new committee appointees objected to
the prior recommendations.
informed perspective on which patients need to be seen and how quickly. E-consulting has also allowed more
patients to get necessary testing done
ahead of time, leading to more efficient
appointments with specialists.
Three years after implementation,
the program has helped to alleviate
some of the bottleneck for Los Angeles
County patients. While theres still a line
to see the specialist, the program has
helped to alleviate some of the burden
and has even determined that about 30
percent of patients referred dont actually need an in-person appointment
consultation and continued care with a
primary physician can suffice.
Electronic consultation by itself
cant resolve the access problem for
poor patients, said Nwando Olayiwola, MD, associate director of UC San
Franciscos Center for Excellence in
Primary Care, in the article. It solves a
huge part of the problem but it doesnt
solve all of it.
THIS PAST SPRING, the HIM profession saw many important regulatory
changes. For starters, on March 20 the
Department of Health and Human Services (HHS) announced a notice of proposed rulemaking (NPRM) for stage 3 of
the meaningful use EHR Incentive Program. At the same time, the Office of the
National Coordinator for Health Information Technology (ONC) also released its
proposed 2015 edition for EHR certification criteria. On April 10, HHS released a
proposed rule to revise meaningful use
in 2015 through 2017.
Join fellow healthcare professionals at the health information event of the year!
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Inside Look
WITH ITS ROOTS in DRGs, the prospective payment system, and value-based
purchasing, clinical documentation improvement (CDI) can seem like a practical administrative task. The process of
ensuring accurate clinical documentation islike so many HIM functionsoften done in the background rather than
the spotlight.
But its important to remember that CDI
is a vital link in the chain that gets the
right information to the right person at the
right time. In fact, in a white paper published by AHIMA following last years CDI
Summit, CDI was identified as a priority
for organizations and providers.
Top priorities during the next 12 months
include identifying documentation gaps,
achieving documentation excellence,
and providing ongoing education to clinical providers, the paper says. Accurate
documentation of patient encounters is
the foundation for telling the patients story, appropriate reimbursement, and quality reporting. As healthcare reform moves
quickly towards quality-driven reimbursement, organizations and providers will
have to continue to justify care plans and
treatment options as well as successfully demonstrate quality outcomes and
patient safety. Consistent, complete, and
accurate documentation is the key to the
economic health of the organization and a
key indicator of physician quality.1
HIM professionals have long known that
improving clinical documentation has a
direct effect on patient care. Now, as the
role of CDI specialist becomes increasingly prevalent in our organizations, more
of us can start telling that story as well.
The articles in this months Journal give
us additional material.
In our cover story, Preventing Healthcares Top Four Documentation Disasters, Mary Butler talks to CDI professionals about the top documentation
errors theyve seen repeatedly committed in healthcare facilities. The article looks at why these documentation
mistakes are made in the first place
and the best ways for CDI specialists
to identify and fix them. Joseph Gurrieri, RHIA, CHP, Cassie Milligan, RHIT,
CCS, and Paul Strafer, RHIA, CCS, describe how coding and CDI programs
should connect to an organizations
quality improvement efforts in Closing the Loop on Quality and CDI. And
Kristen Geissler, MS, MBA, CPHQ, and
Joni Dion, RHIA, CDIP, CCDS, CPC, offer tips to launch or relaunch an effective CDI program that features strong
leadership practices and focuses on improving the quality of the health record
in Reinvigorating Your CDI Program.
Finally, in this issue AHIMA releases the results of its latest workforce
study. Ryan Sandefer, MA, CPHIT, David Marc, MBS, CHDA, Desla Mancilla,
DHA, RHIA, and Debra Hamada, MA,
RHIA, discuss the current state of the
HIM workforce, what we hope the future
state will be, and how education and
training will fill the gap in Survey Predicts Future HIM Workforce Shifts.
If youre looking for still more on CDI,
AHIMAs annual CDI Summit takes place
August 6 to August 7 in Alexandria, VA.
Join us as we continue the journey to improve clinical documentation.
Note
1. Buttner, Patty et al. Leading the
Documentation Journey: A Report from the AHIMA 2014 Clinical
Documentation Improvement Summit. 2014. http://perspectives.
ahima.org/leading-the-documentation-journey-a-report-from-theahima-2014-clinical-documentation-improvement-summit/#.
VUzevpMVZj8.
Journal of AHIMA July 15/17
breviate things that only they know what they really mean. So
that hampers documentation, adds Susan Wallace, MEd, RHIA,
CCS, CDIP, CCDS, FAHIMA, director of compliance at Administrative Consultant Service. She says another frequent shortcut
is physicians who document multi-organ failure rather than
citing the specific organs, which can fail to reflect the severity of
an illness, thereby impeding accurate reimbursement and appropriate patient care.
this neonate, for head trauma the whole time. But they werent.
And that was because of copy and paste and lazy documentation, Burgess says.
Wallace says that one time she observed a case where for a
whole week, the patient appeared to be on post-operative day
three because the entire note was just copied forward, copied
forward, including the heading [on the chart], when that clearly
was not the case. That kind of mistake implies that a patient has
made no progress from their surgical procedure when in fact
they have.
Elion, however, notes that there are two specific circumstances under which physicians can use copy and paste to win the appreciation of coders and CDI teams. The first is when documenting the findings of a radiology report in a progress note. Since
you cant code from a radiology report, Elion says, the doctor
should copy the whole note, paste it into the progress note, and
then add a line or two that says Ive personally reviewed the Xray and discussed the findings with the radiologist. I agree with
his description of the location and nature of the fracture. Doing
this will make a coder fall in love with you, he says.
Ditto with anatomic pathology. How many times do we see
the note that says brochial biopsy was positive. Ill schedule oncology to see the patient as an outpatient? Thats useless. You
cant code from that. Copy and paste the anatomic pathology
report, document stage 2 bronchial carcinoma, whatever it is.
Those kinds of things are very important, Elion says.
Not only can copy and paste perpetuate errors, it can add pages upon pages to a patients record which can slow down any
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physicians to do it: due to or manifested by. With reimbursement changes and ICD-10 on the way, writing due to instantly
forces the documenter to add the needed specificity. You cant
just say anemia and GI bleed, you have to say the anemia is
due to a GI bleed. You cant just say GI bleed, you have to say
the GI bleed is due to a bleeding gastric ulcer, Elion says. Due
to is really a game changer in the way doctors approach documentation. Its more complex and comprehensive than thatif
you can get the doctors to use those two words, the notes just got
massively better.
The phrase manifested by offers similar improvement. For
example, rather than generically saying a patient has diabetesrelated problems, a better note would say the patient has complicated diabetes manifested by neuropathy and nephropathy,
and retinopathy, according to Elion.
Getting physicians to make these changes requires communication with CDI teams, says Cortnie Simmons, MHA, RHIA,
CCS, CDIP, managing director of education services at himagine
solutions inc.
You have a lot of physicians that code, whether they run a
practice or even at hospitals theyre assigning codes through the
EHR systems, and you want to make sure their job is more about
the documentation and less about the coding, and be available
to them, Simmons says.
She says the best way to do this is to sit down with physicians
and show them examples of where theyre struggling. CDI specialists also need to be willing to match their own communication style with the physician. Because, usually, theres been
pushback from docs on queries, we have to find new ways to
jump in front of physicians, Simmons says.
on a prior visit, but because the problem list listed CVA (cerebrovascular accident), they thought it was a current condition.
Conflicting information is often a side effect of having a large
care team collaborating on the same patient, which is the case
in hospitals that have a lot of hospitalists. When each one updates a chart, they might use different terminology to explain
the same condition. For example, one physician might document that a patient has acute renal failure, and the physician
who does the discharge summary might write that the patient
has acute renal insufficiency.
Thats a huge issue because it affects how you code it, how
you get paid, and it affects what condition is going to be the
principal diagnosis in some instances, Wallace says.
Note
1. Lerner, Barron H. A Case That Shook Medicine.
Washington Post. November 28, 2006. www.washingtonpost.com/w p-dy n/content/art icle/2006/11/24/
AR2006112400985.html.
Mary Butler (mary.butler@ahima.org) is associate editor at the Journal of
AHIMA.
Read More
More CDI Tips Online
www.ahima.org
Reinvigorating
YOUR CDI PROGRAM
By Kristen Geissler, MS, MBA, CPHQ, and Joni Dion, RHIA, CDIP, CCDS, CPC
Reinvigorating Your
CDI Program
LONG GONE ARE the days of grab and go coding, finding the
CC/MCC to push reimbursement to the next level and then moving
on to the next record. Today, in addition to reimbursement, clinical data drives quality initiatives, hospital and physician profiles,
and medical necessity. Clinical documentation is the cornerstone
of clinical data management. It also represents resources used and
patient care rendered when reviewed by external auditors. Another key factor impacting clinical documentation is the adoption of
ICD-10-CM/PCS, scheduled for October 1, 2015. Greater specificity in clinical documentation has never been more important.
Since clinical documentation is vital to the success of any
healthcare organization, now is the time to step up clinical
documentation improvement (CDI) programs. Whether kickstarting a CDI program or reinvigorating one, you will want to
build a strong foundation for sustainable success.
Reinvigorating Your
CDI Program
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26/Journal of AHIMA July 15
Reinvigorating Your
CDI Program
pursue. Review the OIG Work Plan to understand the hospitalrelated policies and procedures and the areas targeted for review. Then, implement an internal data mining process to identify areas of vulnerability included in the OIG plan and develop
a corrective action plan.
The importance of collaboration cannot be overstated. The
CDS has valuable insight into the clinical documentation
beneficial to the revenue cycle team. CDI staff should consider participating on the denials team to understand what
is being denied due to documentation and how to proactively assist with documentation up-front. Is the revenue cycle
team holding claims due to unanswered queries? Having a
good rapport with the medical staff helps facilitate a prompt
response to queries. There are many quality initiatives that
depend on clinical documentation and the CDS needs to stay
informed in order to understand the impact documentation
has on quality initiatives.
Partner with coders to build and strengthen the CDI program.
Monthly team meetings to review rules and regulations that
govern coding, query development and compliance, and record
reviews foster team building and provide opportunities to share
knowledge and skills. Evaluate which queries are being generated retrospectively and review to determine if the queries can
be generated concurrently.
Contribute to the development of query templates and review
queries generated to promote compliance. Also, CDS and coding team members can collaborate on data mining projects to
identify accounts that may be included in the PEPPER or OIG
Work Plan focus. Assess the documentation and the final coding to confirm complete and accurate information. If a trend is
identified, it may be beneficial to proactively review vulnerable
accounts before the final coding is submitted.
A second-level review by a coder and a clinical documentation
specialist can decrease denials. Accounts with HACs should also
be referred to the quality department for review prior to the final
coding in order to determine if the condition was present on ad-
mission or hospital-acquired. In addition, the review should include clinical evidence to support the validity of the diagnosis. A
solid CDI program is one that moves out of a silo and develops a
team-based approach, promoting efficiency and accuracy.
The CDS must take the responsibility to review every record
from a holistic perspective, including for POA and clinical validation. When the patient goes home the record must stand on
its own. CDS professionals should ask themselves, Does this
record clearly and accurately reflect the condition of the patient
and services rendered? If the answer is yes, then congratulations on a job well done.
References
AHIMA. Clinical Documentation Improvement Toolkit. Chicago,
IL: AHIMA Press, 2014. http://library.ahima.org/xpedio/
groups/secure/documents/ahima/bok1_050585.pdf.
Centers for Medicare and Medicaid Services. HospitalAcquired Conditions and Present on Admission Indicator
Reporting Provision. Medicare Learning Network.
September 2014. www.cms.gov/Outreach-and-Education/
Med ic a re-L ea r n i ng-Net work-M L N/M L N P roduc t s/
downloads/wPOAFactSheet.pdf.
Russo, Ruthann. Clinical Documentation Improvement:
Achieving Excellence. Chicago, IL: AHIMA Press, 2010.
TMF Health Quality Institute. PEPPER: Short-term Acute
Care Program for Evaluating Payment Patterns Electronic
Report, Users Guide, Sixteenth Edition. 2014. www.
pepperresources.org/Portals/0/Documents/PEPPER/ST/
STPEPPERUsersGuide_Edition16.pdf.
US Department of Health and Human Services Office of Inspector
General. Work Plan Fiscal Year 2015. http://oig.hhs.gov/reportsand-publications/archives/workplan/2015/FY15-Work-Plan.pdf.
Kristen Geissler (KGeissler@thinkbrg.com) is managing director and Joni
Dion (jdion@thinkbrg.com) is associate director and an AHIMA-approved
ICD-10-CM/PCS trainer at Berkeley Research Group, in Hunt Valley, MD.
CLOSING THE
LOOP ON
QUALITY
AND CDI
REFOCUSING PROGRAMS TO
ENSURE AN ACCURATE PICTURE
OF CLINICAL CARE
By Joseph J. Gurrieri, RHIA, CHP; Cassie Milligan, RHIT, CCS;
and Paul Strafer, RHIA, CCS
Consumer Comparisons
CMS Hospital Compare is a website where consumers can
shop around to select healthcare providers online. The website presents easily accessible provider information on 27 inpatient quality measures, including 24 clinical processes of care
measures and three clinical outcome measures. If hospitals
dont capture these measures via quality documentation and
accurately coded data, the information portrayed to consumers
is erroneous.
For example, one process of care quality measure pertains to
aspirin at arrival. Patients who present with an acute myocardial
infarction must receive an aspirin within 24 hours before or after hospital arrival, assuming there are no aspirin contraindications. If this measure isnt performed, documented, and coded,
then it may appear as though the hospital doesnt comply with
safety protocols.
CDI specialists can ensure documentation reflects the fact
that aspirin was prescribed within this timeframe. Doing so enhances the data on which measures, outcomes, and public profiles are based.
Safety Indicators
Outcomes measures are driven, in part, by Agency for Healthcare Research and Quality (AHRQ) patient safety indicators
(PSIs). In particular, PSI 04 (death among surgical inpatients
with serious treatable complications) and PSI 90 (complication/
patient safety for selected indicators) play an important role in
the data used to generate information on consumer comparison websites.
CDI specialists can play a key role in the capture of PSIs. The
Leapfrog Group uses 28 national performance measuresmany
of which are drawn from CMS datato assign a single composite safety score that denotes a hospitals overall performance in
keeping patients safe from preventable harm and medical error.
Healthgrades relies on similar data, including data from AHRQ,
to recognize hospitals for excellent performance in safeguarding patients from potentially preventable conditions during
hospital stays.
Many CDI programs begin with a focus on recovery audit contractor (RAC) and other auditor findings. Although this is an
effective way to ensure an immediate return on investment
and target high-risk areas of compliance, programs canand
shouldexpand beyond this scope to include:
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These indicators denote whether a condition was POA or developed during the hospital stay. If the POA is not documented
and/or coded correctly, a hospitals patient safety indicators
rate could be improperly inflated. Its not realistic for CDI specialists to focus on reviewing POA accuracy for every diagnosis. Instead, they should focus on capturing the correct POA for
infectious diseases, hospital-acquired conditions, and cases in
which patients are transferred from another facility.
Outpatient/Emergency Documentation
Many organizations are turning their attention toward outpatient documentation as it directly impacts medical necessity
justification for inpatient care. With emergency medicine documentation, CDI specialists can ensure that residents and others
provide a thorough history of present illness as well as documentation to support the POA indicator.
Note
1. Centers for Medicare and Medicaid Services. EHR Incentive Program: Active Registrations. March 2015. www.
cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/March2015_SummaryReport.pdf.
Joseph J. Gurrieri (joe.gurrieri@himoncall.com) is vice president and chief
operations officer, Cassie Milligan (cassie.milligan@himoncall.com) is
manager of coding quality improvement, and Paul Strafer (paul.strafer@
himoncall.com) is coding and education manager at H.I.M. On Call.
Journal of AHIMA July 15/31
Survey Predicts
Future HIM
Workforce Shifts
HIM INDUSTRY ESTIMATES THE JOB ROLES, SKILLS
NEEDED IN THE NEAR FUTURE
By Ryan Sandefer, MA, CPHIT; David Marc, MBS, CHDA; Desla Mancilla, DHA, RHIA; and Debra Hamada, MA, RHIA
THE AMERICAN HEALTH Information Management Association (AHIMA) conducted a study to assess the future needs
of the health information workforce. The study was intended
to define the current reality of HIM within the healthcare industry, how the market is shifting to meet future needs, and
what knowledge, skills, education, and credentials will be
necessary to perform successfully as an HIM practitioner in
the future. The study consisted of a survey of HIM and related
stakeholders and multiple focus groups. This article summarizes key findings from the survey.
was sent to 59,029 health information management (HIM) professionals and related stakeholders, yielding 6,475 survey views,
of which 3,370 responses were included in the final analysis. A
total of 58 percent of the respondents were HIM professionals,
with the remainder consisting of employers, healthcare professionals, students, educators, and other related groups. AHIMA
members made up 89 percent of respondents, 75 percent of respondents were over the age of 45, and 91 percent were female.
A total of 60 percent of respondents worked in an acute care
setting, with the percentage of respondents from each of the
other settings under 10 percent. Approximately 35 percent of
respondents had an RHIT credential, 28 percent had an RHIA
credential, and 23 percent had a CCS credential.1
-6
-4
-2
0
2
Mean Differences in Responses
the most important skill for the profession today and agreed
that its importance will diminish in the future.Globally, the
study revealed strong agreement between employers and HIM
professionals regarding current and future skill prevalence
and importance. The harmony between employers and HIM
professionals reinforces the recognition of the changing professional landscape.
Journal of AHIMA July 15/33
Current
Future
EHR Management
Data Integrity
Critical Thinking
Problem Solving
Communication
Quality Assurance
Data Analysis
Informatics
Leadership
Fraud
CDI
Interoperability
HIM Standards
Efficiency
IT Support
IG
Coding
System Development
Project Management
Data Mining
Auditing
Med Term/Pharma
Big Data Analysis
IT Networking
Risk Management
IT/Programming
Pt/Clinician Ed
Statistics
Compliance/VBP
Change Management
Assess Processes
Admin
Design/Innovation
Financial Management
Records Processing
Consumer Engagement
Negotiation
Business Analytics
Research
4.0
4.5
Average Response
Analytical Thinking
3.5
5.0
0.4
Notes
1. AHIMA. Results of the AHIMA 2014 Workforce Study.
March 2015. http://bok.ahima.org/doc?oid=300801#.
VV4b7k2UBGE.
2. Cohasset Associates and AHIMA. 2014 Information Governance in Healthcare: Benchmarking White Paper. 2014.
www.ahima.org/~/media/AHIMA/Files/HIM-Trends/
IG_Benchmarking.ashx.
Ryan Sandefer (rsandefe@css.edu) is chair and assistant professor in the
department of health informatics and information management and David Marc (dmarc@css.edu) is assistant professor of health informatics and
graduate program director at the College of St. Scholastica. Desla Mancilla
(desla.mancilla@ahimafoundation.org) is senior director of academic affairs at the AHIMA Foundation. Debra Hamada (dhamada@llu.edu) is
chair of health informatics and information management and assistant
professor, program director of the health informatics masters program at
Loma Linda University.
ONC Targets
Information
Blocking
By Kathy Downing, MA, RHIA, CHPS, PMP, and Jessica Mason
A NEW REPORT to Congress from the Office of the National Coordinator for Health IT (ONC), released in April, has put information blocking in the spotlight.1 The ONC report comes out on
the heels of a recent article written by five US senators titled,
Where Is HITECHs $35 Billion Dollar Investment Going?2
That article questioned the current state of the program and
ONCs Roadmap to Interoperability.3
The senators wrote that there was inconclusive evidence that
the program [HITECH] has achieved its goals of increasing efficiency, reducing costs, and improving the quality of care.
The senators singled out interoperability as the key factor in restraining success. They argued that the ONC Roadmap lacked
specifics for how to achieve true interoperability and sustain
meaningful use of electronic health records (EHRs).
In a HealthIT.gov blog post on April 10, 2015, ONC Director
Karen DeSalvo, MD, MPH, MSc, and Jodi Daniel, director of the
ONC Office of Policy, announced the release of the Report to
Congress on Health Information Blocking.4
In the post they wrote that The secure, appropriate, and efficient sharing of electronic health information is the foundation
of an interoperable learning health system and that information blocking hinders progress toward that goal. The report was
compiled at the request of Congress as outlined in the Consolidated and Further Continuing Appropriations Act of 2015,
signed by the President on December 16, 2014.
The legislation required a detailed report from ONC regarding the extent of the information-blocking problem, including
an estimate of the number of vendors or eligible hospitals or
providers who block information. The act further required a
comprehensive strategy on how to address the information
blocking issue.
36/Journal of AHIMA July 15
readily apparent that some providers and developers are engaging in information blocking.
In 2014, ONC received approximately 60 unsolicited complaints regarding information blocking. ONC also reviewed
documented incidences, interviewed a variety of stakeholders,
and conducted in-person discussions and phone calls related
to the issue.
On the whole, most complaints of information blocking were
directed at health IT developers. These complaints largely centered on developer fees. Developers are accused of charging
prohibitive fees to:
Send, receive, or export electronic health information
stored in EHRs
Establish interfaces that enable such information to be exchanged with other providers, persons, or entities
Send, receive, or query a patients electronic health information
Establish certain common types of interfaces
E xtract data from EHR systems or move to a different EHR
technology 6
The report acknowledges concerns about wide variation in developer fees. Though fee variation may reflect differences in developer technology and services, it cannot adequately explain all
the variation in prices reported to ONC. The report considers that
The report examines concerns that may lie beyond the scope of
ONC. The discovery of information blocking practices requires
direct access to potentially sensitive documentation. ONC notes
in the report that it has no authority to demand the production
of relevant documentation or access to information. The agency
does note that there are, however, avenues open to Congress
that could effectively address information blocking practices.
Notes
1. Office of the National Coordinator for Health IT. Report
on Health Information Blocking. April 2015. http://healthit.gov/sites/default/files/reports/info_blocking_040915.
pdf.
2. Thune, John et al. Where Is HITECHs $35 Billion Dollar
Investment Going? Health Affairs. March 4, 2015. http://
healthaffairs.org/blog/2015/03/04/where-is-hitechs35-billion-dollar-investment-going/.
3. Office of the National Coordinator for Health IT. Connecting Health and Care for the Nation: A Shared Nationwide
Interoperability Roadmap. 2015. www.healthit.gov/sites/
default/files/nationwide-interoperability-roadmap-draftversion-1.0.pdf.
4. DeSalvo, Karen B. and Jodi G. Daniel. Blocking of health
information undermines health system interoperability
and delivery reform. Health IT Buzz. April 10, 2015. www.
healthit.gov/buzz-blog/from-the-onc-desk/health-information-blocking-undermines-interoperability-deliveryreform/.
5. Office of the National Coordinator for Health IT. Report
on Health Information Blocking.
6. Ibid.
7. Ibid.
8. Ibid.
Kathy Downing (Kathy.Downing@ahima.org) is a director of HIM practice excellence at AHIMA. Jessica Mason (jessicamason.chicago@gmail.
com) is a recent graduate of the University of Illinois at Chicago.
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Clinical Documentation
Improvements Main Ingredient:
Physicians First
By Lou Ann Wiedemann, MS, RHIA, CDIP, CHDA, FAHIMA
WHATS THE MAIN ingredient in your clinical documentation improvement (CDI) program? CDI programs are not new
to healthcare, and depending on the organization they can
look different from facility to facility. Over the past 10 years
CDI programs have increased in size and scope due to changes in reimbursement, increased scrutiny by third party payers,
and fraud and abuse activities.
Physicians are not taught documentation in medical school,
and in most cases physicians remain uniformed about why
CDI is important. In a competitive healthcare environment,
with acronyms such as DRG, MCC, CC, and POA, a physicians
place in the recipe for a successful CDI program can become
lost. When mixing up healthcares veritable alphabet soup of
ingredients to bake a CDI program, consider placing physicians as the main ingredient.
mentation used to support patient care. Great CDI programs consider the EHR as an active member of the healthcare team rather
than the passive recipient seen previously in paper records.
PJ &A
References
Bresnick, Jennifer. Clinical Documentation Improvement,
Quality Combine for Revenue. Health IT Analytics. March
30,
2015.
http://healthitanalytics.com/news/clinicaldocumentation-improvement-quality-combine-for-revenue.
Dimick, Chris. Shadowing Physicians for Documentation
Improvement. Journal of AHIMA. September 1, 2009. http://
journal.ahima.org/2009/09/01/shadowing-physicians-fordocumentation-improvement/.
Towers, Adele L. Clinical Documentation ImprovementA
Physicians Perspective: Insider Tips for Getting Physician
Participation in CDI Programs. Journal of AHIMA 84, no. 7
(July 2013): 34-41.
Clinical Documentation.net. The Advantage of Modern
Day Clinical Documentation. July 31, 2014. http://
clinica ldocumentat ion.net/advantage-modern-dayclinical-documentation/.
Lou Ann Wiedemann (lou-ann.wiedemann@ahima.org) is vice president
of HIM practice excellence at AHIMA.
1-800-803-6330
www.pjats.com
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Malnutrition Diagnoses
replicated in other areas by defining standards in the clinical
diagnoses of obesity, anemia, respiratory failure, heart failure,
sepsis, epilepsy, asthma, and renal failure. Because clinical
definition standards are an accepted practice in the medical
community, the process was endorsed by the medical staff.
Its also clear that the value of streamlining clinical communication with a succinct, standard definition has been well
received.
Finally, as an added financial bonus, this process ensures
the provider and the hospital are accurately represented with
patient acuity.
Katherine Lusk (Katherine.Lusk@childrens.com) is chief health information management and exchange officer at Childrens Health System
of Texas.
diana.warner@ahima.org
ment, these two staffers are focused on improving quality outcomes for the hospital as well as physician report cards by reviewing elements of patient safety indicators such as deep vein
thromboses, pulmonary embolisms, iatrogenic pneumothorax
cases, and accidental punctures and lacerations.
Yale New Haven has had a CDI program in place for 12 years,
and prior to implementing this new role had been focused on
a review of principal diagnoses and complications and comorbidities (CC) and major complications and comorbidities
(MCC) capture. It also transitioned from reviewing Medicare
patients only to all-payer review.
Many CDI departments are looking for the next step, i.e., how
to expand the impact of CDI beyond DRG validation and leverage the expertise many CDIs possess, particularly those with a
clinical background, says Cheryl Ericson, MS, RN, CCDS, CDIP,
CDI education director for HCPro, Inc. and associate director
of education for the Association of Clinical Documentation Improvement Specialists (ACDIS). CMS quality metrics are an
ideal fit with CDI because it encourages physician engagement,
[as physicians] are often more concerned with profiling than reimbursement, and [CMS metrics] incorporates the patient care
aspect of documentation.
An example of this emerging CDI-quality connection and its
relationship to clinical care is the 1,069-bed NYU Langone Medical Center in New York City, NY. A few years ago NYU created
hard stops for coders on hospital-acquired conditions (HAC)
cases, meaning that if a condition triggers a HAC, the case is
flagged and the coder cannot release the bill. Instead, the case is
referred to a coding manager for a second review. If additional
clarification is needed, CDI is engaged. If CDI determines that
the case is a HAC, it is then sent to the department of clinical
8. Identify other patient safety indicators beyond or in addition to PSI 90 and their impact as a quality measure
9. Identify coded data elements that can impact the reporting of patient safety indicators in regards to Medicare
claims
10. Compare and contrast hospital-acquired infections (HAI)
from documentation that supports the assignment of a
complication code
PRACTICE BRIEF
practice guidelines for managing health information
Practice Brief
of their job tasks will promote understanding of program efficacy, the impact of documentation changes, and trends on the
reporting of patient outcomes as well as how these trends impact organizational efforts. The CDS must be able to review the
data, looking for trends or patterns over time as well as any variances that require further investigation. DRG shifts are reflected
in the documentation of comorbid conditions and complications that could move a diagnosis into a higher paying DRG. CDI
programs must be constantly vigilant in tracking and trending
program data to be aware of these payment patterns.
Practice Brief
most important of all, improved patient care. CDI has the potential
to enhance a hospitals compliance efforts, as better documentation reduces future exposure to external audits and reduces risk.
A recent Healthcare Financial Management Association (HFMA)
executive study identified improved clinical documentation accuracy as the greatest opportunity for financial improvement.
Healthcare organizations are moving aggressively to implement
CDI programs and technology solutions. The need for clinical documentation accuracy is driving these CDI initiatives toward their
goals of widespread clinician adoption, improved quality of care,
enhanced financial results, optimizing an organizations EHR investment, and improvement and accuracy in case mix index (CMI).
One of the initial motivators for adopting CDI solutions is the
proven, demonstrable, and sustainable improvement in CMI,
resulting in increased revenues and the best possible utilization of high-value specialists. CDI solutions are instrumental
in ensuring full and timely reimbursement from payers, while
avoiding the costly penalties of non-compliance. The appropriate capture of severity of illness and risk of mortality indicators
contributes to the development of risk-adjusted outcome profiles, improved performance in provider and facility quality profiles, and appropriate payments for hospitals and physicians.
The CDI manager must regularly review and utilize data from
internal (i.e., discharge data) and external sources (i.e., Medicare Provider Analysis and Review (MEDPAR), and Program for
Evaluating Payment Patterns Electronic Report (PEPPER)). By
applying this data, the following metrics should be tracked on
a monthly basis and measured at least quarterly to understand
the financial impact of the CDI program:
1. Case Mix Index (CMI). A measure of the relative complexity and severity of patients treated in a hospital. CMI serves
as the basis for payment methodologies administered by
CMS as well as other third-party payers. A number of factors
can affect a hospitals CMI, including volume changes in
certain DRGs and documentation/coding improvements.
CDI leadership should understand CMI fluctuations and
declines in CMI. Through proper measurement and analysis, providers can identify ways to improve a stagnant or
declining CMI. To understand a hospitals total CMI, the
following five metrics are calculated as follows:
Overall CMI. Add the relative weights of all DRGs and
divide by the total inpatient population, excluding psychiatric and rehabilitation patients.
Medical CMI. Add the relative weights of all medical
DRGs and divide by the total medical inpatient population, excluding psychiatric and rehabilitation patients.
Surgical CMI. Add the relative weights of all surgical
DRGs and divide by the total surgical inpatient population, excluding psychiatric and rehabilitation patients.
Adjusted CMI. Remove all high-weighted DRGs that are
not typically influenced by coding and/or clinical documentation improvements from the inpatient population, such as tracheotomies and transplants (MS-DRGs
1-17 and 652), excluding psychiatric and rehabilitation
patients. Remove this volume from the overall population before repeating the calculation for total CMI
48/Journal of AHIMA July 15
2.
3.
4.
5.
outlined above. Some facilities may also eliminate lowweighted, high-volume DRGs (i.e., normal newborns).
Medical/surgical mix and volume-adjusted CMI.
This calculation can help you determine the percentage by which CMI has changed over two equal quarterly periods (i.e., the first quarter of 2014 to the first quarter of 2015) and the resulting change in reimbursement
for the designated time period.
-- Calculate medical/surgical mix and compare
volumes from the two equal time periods
-- Adjust the CMI to equalize these two components by freezing one period and adjusting
the mix distribution and volume of the other
period to match the frozen period
-- Compare medical/surgical mix of the periods
Overall CMI, Medical CMI, and Surgical CMI. Separately
determining the medical CMI and the surgical CMI will identify underlying problems masked in the overall CMI. Average
medical CMI weights range from 1.0 to 1.15. A low end overall
medical CMI may indicate symptom DRGs and the need for
a more specific principal diagnosis or missing complications
and comorbidities (CCs) that should have been captured. Low
medical CMIs may be heavily influenced by incorrectly documented and/or sequenced principal diagnoses.
Adjusted CMI. Remove all tracheotomies/transplants (MSDRGs 1-17 and 652), which are very high-weighted DRGs
and have geometric mean length of stay (GMLOS) and average length of stay (ALOS) impact, without documentation improvement potential. This allows focus on DRGs that
will most likely be influenced by CDI efforts. Analysis of the
adjusted CMI enables you to target underlying coding or
documentation issues that need to be addressed.
Comparative Medical and Surgical Case Mix. Compare
the volume of all inpatient cases in two comparable time
periods, as well as the percentage of cases that are medical versus surgical, by calculating the medical/surgical mix
and volume-adjusted CMI. Be sure to note losses and gains
that may indicate the need for further investigation:
Look at volume loss or medical/surgical mix change to
determine if you are losing market share to competitors.
Review the case types to see if they are moving to a different level of service (inpatient to ambulatory surgery
or to observation).
Review the CMI by service line to identify focus areas and
break it down further by DRGs to see if CC capture rates
or key DRG pairs are in the optimal DRG assignments.
Track and trend the following calculations:
Percentage of one- to two-day length of stays in both
periods. An increase in short-stay cases may be causing
a decline in CMI. Consider benchmarking your length of
stay against other hospitals to uncover any major differences. Understand the impact of CMS Final Rule 1599,
known as the Two Midnight Rule, which affects patient
level of care while in the hospital.
CMI by each service line or by major diagnostic category. Perform this calculation for comparable time
Practice Brief
W
ere there any conditions or procedures added that impact
the complexity or severity of the case (SOI and ROM levels)?
Were any conditions clarified or averted based on lack
of supporting or clarifying documentation (HACs, Core
Measure conditions, PSIs, HCCs)?
A critical focus of a CDI program is to identify deficiencies in
clinical documentation and develop processes to ensure the
complete and accurate picture of a patients clinical encounter.
Outcomes reporting should be monitored to measure the overall impact of the CDI program and track areas of opportunity
and success. A CDI program goal is to develop specific case examples as education for physicians, clinicians, and administrators, highlighting impacts as applicable.
Practice Brief
www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/
AcuteInpatientPPS/FY-2014-IPPS-Final-Rule-Home-PageItems/FY-2014-IPPS-Final-Rule-CMS-1599-F-Regulations.html.
Centers for Medicare and Medicaid Services. Evaluation of the
CMS-HCC Risk Adjustment Model. March 2011. www.cms.
gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/
Downloads/Evaluation_Risk_Adj_Model_2011.pdf.
Garrison, Garri. Understanding a Declining CMI: A Step-byStep Analysis. HFMAs Revenue Cycle Forum. July/August
2013.
http://multimedia.3m.com/mws/media/902718O/
hfma-reprint-understanding-a-declining-cmi-09-13.pdf.
Haas, Dianne L. Clinical Documentation Improvement:
What Executives Need to Know and the Financial Impact
of Neglect. Beckers Hospital Review. February 12, 2013.
w w w.beckershospita l rev iew.com/f i na nce/cl i n ica ldocumentation-improvement-what-executives-need-toknow-and-the-financial-impact-of-neglect.html.
Healthcare Financial Management Association. HFMAs
Executive Survey: Clinical Documentation Meets Financial
Performance. HFMAs Executive Survey and Education Report.
November 2013. http://engage.nuance.com/hfmasite.
Orr, Jeremy and Allen Kamer. Accurate coding: the foundation
of accountable care. Optum white paper. https://
w w w.optum.com/content/dam/optum/CMOSpark%20
Hub%20Resources/White%20Papers/Optum%20One%20
WhitePaper_Accurate-Coding%20FINAL.pdf.
Prepared By
References
Acknowledgements
Appendix
CDI Summit:
Leading the
Documentation
Journey
August 67, 2015
Alexandria, VA
Prepare for the future, gain an edge on the latest documentation strategies, and move
forward with best practices.
Premier
Sponsor
Supporting
Sponsors:
Coding Notes
Clinical Documentation
Improvement in the
Outpatient Setting
By Danita Arrowood, RHIT, CCDS, CCS; Laurie M. Johnson, MS, RHIA, FAHIMA; and Michelle Wieczorek, RN, RHIT, CPHQ
CLINICAL DOCUMENTATION IMPROVEMENT (CDI) programs have proven their worth with over a decade of success
and continued role expansion in the inpatient setting. As the
healthcare industry prepares for new initiatives such as value-based purchasing, electronic health records (EHRs), and
ICD-10-CM/PCS implementation, clinical documentation
improvement has become a focus for organizations that do
not yet have a well established program in place.
Facility-based outpatient services and physician practices acknowledge there are benefits to a CDI program in
the outpatient setting. Outpatient needs for clinical documentation improvement are much different than inpatient
needs. As outpatient federal incentive programs grow,
so too does the need for accurate, concise, and reliable
documentation. A widely-accepted pathway to analyze,
develop, implement, and monitor an outpatient-focused
CDI program has not been defined. The question becomes,
Where do we begin?
The physician office setting has a different approach and focus than the facility-based setting. Whether facility-based or
physician practice-based, its best to begin by determining the
scope and focus of the program. If claim denials are an area of
focus, drill down into the denials to conduct an analysis of audit findings and medical necessity reviews. Are denials due to
misleading, inadequate, and/or poor clinical documentation?
Many problem-prone areas have well defined expectations on
how to minimize denial risk and avoid intensified reviews,
such as National Coverage Determinations (NCDs) and Local
Coverage Determinations (LCDs).
Are claims denied repeatedly for similar documentation issues, such as inadequate documentation to support medical
necessity or previously treated conditions from the problem
list being reported as current conditions? Is nursing documentation falling short on logging infusion times? In addition
to identifying areas with recurring issues, CDI professionals
should also investigate whether the provider documentation
is capturing all the acute and chronic conditions that are being evaluated and treated.
A successful outpatient CDI program begins by developing
tools to analyze where clinical documentation in the outpatient arena falls short in providing the necessary documentation to establish medical decision making, justify services
rendered, promote continuity of care, and support proper reimbursement. Establishing procedures to address identified
issues and monitor outcomes will help ensure the success of
an outpatient CDI program.
Coding Notes
move forward and address specific issues. Increased attention occurs by limiting the focus to a specific procedure(s). For
example, a focus could be the resolution of claim denials for
orthopedic procedures. This approach will also remediate the
volume issue.
After determining the focus and completing the data review, the next step is to evaluate a claim sample with clinical
documentation and a detailed bill. The clarity, completeness,
and reliability of documentation should be considered for the
sample. Processes may be evaluated for the data capture. Electronic health record (EHR) templates may be revised to promote data accuracy.
The facility benefits of an outpatient CDI program include:
1. Increased documentation specificity
2. Decreased additional documentation requests
3. Decreased claim denials/rejections
4. Reduced barriers to reimbursement
5. Increased quality of care
6. Increased compliance to billing and coding regulations/
principals
Coding Notes
Note
1. Orr, Jeremy and Allen Kamer. Accurate coding: the foundation of accountable care. Optum white paper. December 1, 2014. www.optum.com/content/dam/optum/
CMOSpark%20Hub%20Resources/White%20Papers/
Optum%20One%20WhitePaper_Accurate-Coding%20
FINAL.pdf.
References
Collins, Corliss. How to Fast Track Your Outpatient
Clinical Documentation Program. Hayes Management
Consulting Blog. December 17, 2014. http://meetings.
hayesmanagement.com/blog/fast-track-your-outpatientclinical-documentation-program.
Johnson, Laurine. The Implementation of an Outpatient
Clinical Documentation Program. Ingenix white paper.
2008. https://etg.optum.com/~/media/Ingenix/Resources/
White%20Papers/Ingenix_OutpatientCDI_WP_1001055.pdf.
Linnander, Robert. CDI in outpatient settings: Are
you ready for the challenge? The Advisory Board
Companys At the Margins Blog. October 14, 2014. www.
advisor y.com/research/financial-leadership-council/
at-the-margins/2014/10/how-to-create-outpatient-cdiprogram.
Danita Arrowood (darrowood@precyse.com) is healthcare education
developer at Precyse. Laurie M. Johnson (ljohnson@panaceainc.com) is
director of HIM consulting services at Panacea Healthcare Solutions. Michelle Wieczorek (mwieczorek@e4-services.com) is general manager, coding and CDI practice at e4 Services.
Online Education
AHIMA learning opportunities with CEUs include:
ICD-10 A&P Focus Courses and Assessments
ICD-10 Coding Practice Cases
ICD-10-CM Collection
ICD-10-PCS Collection
ICD-10 Coding Proficiency Assessments
ICD-10 Readiness and Post-Training Assessments
Clinical Documentation for ICD-10 by Specialty:
Principles & Practice
For more information, visit ahima.org/education/onlineed.
Webinars
10IC
D-1
0IC
-10
D-1
ICD
0IC
D-1
10IC
ICD
0IC
D-1
-10
D0
MX11260
Publications
ICD-10-PCS Code Book ,
2015 Draft
Consulting Editor
Anne B. Casto, RHIA, CCS
Prod. No. AC222014
Price: $115
Member Price: $94.95
Downloadable Resources
2015 Edition
ICD-10-PCS
An Applied Approach
2015
Basic
ICD-10-CM/PCS
and ICD-9-CM
Coding
-10ICD-10ICD-10ICD-10ICD-10ICD-10ICD
10ICD-10ICD-10ICD-10ICD-10ICD-10ICD-
Leverage
AHIMAs wellestablished
expertise and
knowledge!
Coding Notes
PRIOR TO THE October 1, 2015 implementation of ICD-10CM/PCS, every hospital must examine how the new code
set will impact MS-DRG reimbursement. A recent Centers
for Medicare and Medicaid Services (CMS) analysis indicates the overall effect of the transition to ICD-10 on hospital reimbursement will be negligible. However, the effect on
any individual hospital may vary due to that facilitys case
mix or coding accuracy.1 In order to assess the impact on
their facility, coding managers need to be familiar with how
the ICD-9 and ICD-10 classification systems differ and how
these differences are addressed in the MS-DRG grouper
logic for ICD-10.
Coding Notes
themselves include:
D57.21, Sickle-cell/Hb-C disease with acute chest syndrome
K50.114, Crohns disease of large intestine with abscess
Operational Assessments
Temporary HIM Management
Coding Validation Audits and Coding Support
Scanning and Transcription Analyses
Scanning Software & Project Operations
Management
CAC Guidance & RFP Management
CAC Implementation Management
ICD-10 Coder and Physician Education
ICD-10 DRG Shift/Documentation Analysis
800-274-1214
www.FirstClassSolutions.com
www.Cortrak.com
Journal of AHIMA July 15/57
Coding Notes
as the principal diagnosis. This guideline difference will result in a legitimate change in DRG when the case is coded in
ICD-9 versus ICD-10.
Focus On
Missed Revenue
HA
RT
is a pr
o
by
pr ietary softwar e developed
1.866.427.7828
W W W. H C S S TAT. CO M
58/Journal of AHIMA July 15
HC S
Coding Notes
Notes
Correction
An additional reference should be noted for the June 2015 Coding
Notes article Injection and Infusion Coding Offers High Stakes:
Rubinowitz, Andrea Clark. Infusion Confusion Whats Your Solution!! 2008
Jokers Wild Edition. Presentation at the Association for Healthcare
Internal Auditors 2008 Annual Conference. www.resourcenter.net/
images/AHIA/Files/2008/AnnMtg/Handouts/TrackF6.pdf.
Calendar
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
10
11
Leadership Symposium,
Chicago, IL
WEBINAR:
Physician
Engagement
for Clinical
Documentation
Improvement
12
13
14
20
16
17
18
CSA MEETING:
FLORIDA, Orlando, FL
19
15
21
22
23
24
25
WEBINAR:
CSA MEETING:
SOUTH CAROLINA, Columbia, SC
26
27
28
29
30
31
A Look Ahead
Keep Informed
AUGUST
4-5
5-7
6-7
12-14
12-14
13
16-17
19-21
26-28
26-28
31-Sept. 2
September
9-11
September
9-11
September
10
September
14-15
September
16-18
September
26-27
Clinical
documentation
improvement
(CDI)
programs, along with clinical care providers and
senior management, contribute to organizational
success by ensuring the right information is
available at the right time. To keep up with the
healthcare industrys ever-changing demands and
initiatives, clinical documentation programs and
professionals must constantly evolve and adapt.
The AHIMA CDI Academy provides participants
with the information necessary to keep up with a
complex and growing industry.
For more information and to register, visit ahima.
org/events.
Nominating Committee
Jill A. Finkelstein, MBA, RHIA, CHTS-TR
(954) 418-0938
jfinkelstein@browardhealth.org
Fellowship Committee
Mona Y. Calhoun, MEd, MS, RHIA, FAHIMA
(301) 352-0304
mcalhoun@coppin.edu
Envisioning Collaborative
Laura W. Pait, RHIA, CDIP, CCS
Chief Operating Officer, Health Information
Management Shared Service Center, Parallon
Business Performance Group, Atlanta Shared
Service Center
Norcross, GA
(678) 421-7681
laura.pait@parallon.com
House Leadership
Elizabeth A. Delahoussaye, RHIA, CHPS
(865) 659-5059
edelahoussaye@iodincorporated.com
AHIMA volunteers also make valuable contributions as facilitators for Engage Online Communities. To locate the facilitator(s), go to a particular community, click on the Members tab, then click on the
community administrator link.
Indiana
Deborah Grider, CDIP, CCS-P
McCordsville, IN
(317) 908-5992
deborahgrider@mac.com
Nevada
Gregory Schultz, RHIA
North Las Vegas, NV
(702) 526-8361
gschultz00@aol.com
South Dakota
Sheila Hargens, MSHI, CMT
Parkston, SD
(605) 928-3741
sheila.hargens@avera.org
Alaska
Janie Batres, RHIA, CDIP
Anchorage, AK
(907) 252-7228
janieleigh44@hotmail.com
Iowa
Mari Beth Schneider Lane, MS, RHIA
Sheldon, IA
(712) 324-5061
mlane@nwicc.edu
New Hampshire
Jean Wolf, RHIT, CHP
Gorham, NH
(603) 466-5406
jean.wolf@avhnh.org
Tennessee
Lela McFerrin, RHIA
Chattanooga, TN
(423) 493-1637
lela.mcferrin@hcahealthcare.com
Arizona
Christine Steigerwald, RHIA
Gilbert, AZ
(480) 292-8293
Christine.Steigerwald@bannerhealth.com
Kansas
Julie Hatesohl, RHIA
Junction City, KS
(785) 210-3498
phoebehat@cox.net
New Jersey
Carolyn Magnotta, RHIA
New Egypt, NJ
(609) 758-8890
magnottac@deborah.org
Texas
Terri Frnka, RHIT
Bryan, TX
terrifrnka@yahoo.com
Arkansas
Marilynn Frazier, RHIA, CHPS
Ozark, AR
(479) 667-5153
mfrazier@ftsm.mercy.net
Kentucky
Diba Thakali, RHIA
Lexington, KY
(859) 979-3049
diba.thakali@bhsi.com
New Mexico
Vicki Delgado, RHIT
Albuquerque, NM
(505) 948-6711
vicki.delgado@kindredhealthcare.com
California
Shirley Lewis, DPA, RHIA, CCS, CPHQ
Upland, CA
(909) 608-7657
shirley.lewis5@verizon.net
Louisiana
Lisa Delhomme, MHA, RHIA
Rayne, LA
(337) 277-5544
delhomme@louisiana.edu
New York
Sandra Macica, RHIA
Saratoga Springs, NY
(518) 584-0389
s.macica@elsevier.com
Colorado
Melinda Patten, CDIP, CHPS
Aurora, CO
(720) 777-6657
melinda.patten@childrenscolorado.org
Maine
Nora Brennen, RHIT
Topsham, ME
(207) 751-1853
Nora.Brennen@va.gov
North Carolina
Jolene Jarrell, RHIA, CCS
Apex, NC
jolene@drgreview.com
Connecticut
Elizabeth A. Taylor, MS, RHIT
East Hartford, CT
(860) 364-4417
liz.taylor@sharonhospital.com
Maryland
Sarah Allinson, RHIA
Baltimore, MD
(410) 499-7281
sarahballinson@gmail.com
Delaware
Marion Gentul, RHIA, CCS
Lewes, DE
(302) 827-1098
mgs60mga@yahoo.com
Massachusetts
Walter Houlihan, MBA, RHIA, CCS
Springfield, MA
(413) 322-4309
Walter.Houlihan@bhs.org
District of Columbia
Jeanne Mansell, RHIT, CHTS-CP, CHTS-PW,
CHTS-IM, CHTS-IS, CHTS-TS, CHTS-TR
Washington, DC
(202) 421-5172
jeanne87@hotmail.com
Michigan
Thomas Hunt, RHIA
Owosso, MI
(989) 725-8279
thunt@davenport.edu
Florida
Anita Doupnik, RHIA
Tampa, FL
(813) 907-9380
anita.doupnik@nuance.com
Minnesota
Jean MacDonell, RHIA
Grand Rapids, MN
(612) 719-3697
jean.macdonell@granditasca.org
Georgia
Allyson Welsh, MHA/INF
Decatur, GA
Allysonwelsh@gmail.com
Mississippi
Phyllis Spiers, RHIT
Carriere, MS
(601) 347-6318
pspiers@forrestgeneral.com
Hawaii
Marlisa Coloso, RHIA, CCS
Wailuku, HI
(808) 442-5509
mcoloso@hhsc.org
Missouri
Angela Talton, RHIA, CCS
Florissant, MO
(314) 276-4180
afranks@swbell.net
Idaho
Mona P. Doan, RHIT, CCS-P
Boise, ID
(208) 484-7076
monadoan@hotmail.com
Montana
Vicki Willcut, RHIA
Kalispell, MT
(406) 756-4758
vwillcut@krmc.org
Illinois
Teresa Phillips, RHIA
Effingham, IL
(217) 347-2806
teri.phillips@hshs.org
Nebraska
Shirley Carmichael, RHIT
Fairbury, NE
(402) 729-6854
shirley.carmichael@jchc.us
Utah
Vickie Griffin, RHIT, CCS
Bountiful, UT
vickie.griffin@Parallon.com
Vermont
Charmaine S. Vinton, RHIT, CCS, CPC
West Chesterfield, NH
(603) 357-0170
cvinto@bmhvt.org
Virginia
Darcell Campbell, RHIA
Hampton, VA
(757) 788-0052
DACampbell@cox.net
North Dakota
Tracey Regimbal, RHIT
Grand Forks, ND
traceyregimbal@hotmail.com
Washington
Sheryl Rose, RHIT
Spokane, WA
(509) 624-4109
sherylrose622@hotmail.com
Ohio
Pamela Greenstone, MEd, RHIA
Mason, OH
(513) 403-9014
Pamela.Greenstone@uc.edu
West Virgnia
Kathy Johnson, RHIA
Sinks Grove, WV
(304) 772-5312
kjohnson@care-communications.com
Oklahoma
Christy Hileman, MBA, RHIA, CCS
Mustang, OK
(405) 954-2824
christy.hileman@faa.gov
Wisconsin
Susan Casperson, RHIT
Cecil, WI
(715) 853-1370
susan.casperson@thedacare.org
Oregon
William Watkins, RHIA
Oregon City, OR
(503) 867-5173
william.w.watkins@kp.org
Wyoming
Kimberle Johnson, RHIA
Gillette, WY
(307) 682-1251
kim.johnson@ccmh.net
Pennsylvania
Laurine Johnson, MS, RHIA, FAHIMA
Sarver, PA
(724) 295-9429
ljohnson@peakhs.com
Puerto Rico
Brunilda Velazquez, RHIA, CCS
Guayanilla, PR
(787) 505-1433
Rhode Island
Patti Nenna, RHIT
Bristol, RI
(401) 253-1686
pnenna@cox.net
South Carolina
Karen B. Farmer, RHIT
Greenville, SC
(864) 277-1982
kfarmer@ghs.org
Advertising Index
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American Medical Association.......................................39
Amphion Medical Solutions.............................. back cover
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QualCode, Inc.SM
Medical Coding & Reimbursement
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ADREIMA
The nations largest revenue
cycle services organization
has immediate openings for
experienced remote coders.
Adreima partners with over
600 hospitals and our benefits
include competitive pay with
full benefits.
www.adreima.com/careers/
Advertise in the
AHIMA Career
Center!
Coding Validators
Staten Island University Hospital is a 714-bed,
specialized teaching hospital located in New York
Citys 5th and fastest-growing borough. Founded in
1861, Staten Island University Hospital today is a
member of the North Shore-LIJ Health System, and
enjoys numerous academic and clinical afliations and
accreditations. We are now seeking Coding Validators
for multiple openings within our Health Information
Management team.
In this role, you will plan, organize and manage the
Health Information Management Department in the
area of coding and DRG assignment.
Qualied candidates must have a Bachelors Degree
in Health Care Administration, Nursing, or a related
eld; along with RHIA, RHIT or RN, CCS certication/
licensure. At least two years of inpatient coding
experience is also required.
We offer competitive salaries and excellent benets.
To apply, please visit nslijcareers.com and search for
Requisition ID STA0000UD. You may also e-mail
your resume to: Jsada@NSHS.edu.
We are an equal opportunity employer with a smoke
free work environment.
Call 410-584-1961
Exclusively Specializing
in HIM for
almost 25 years!
We assist both
job seekers and employers
in the following specialties:
Executive Level | Consultants
Coders | Auditors | CDI
Directors | Managers | Vendors
Contact us in confidence:
Doug Ellie or
Perry Ellie, MA, RHIA, Fellow AHIMA
Careers@HIMjobs.com
800-248-6989
Journal of
of AHIMA
AHIMA July
July 15/65
15 / 65
Journal
WeareseekingaqualifiedPhysicianCoderwithbroadlevel
experienceinboththehospitalandmultiphysicianspecialties
tosupplementourCodingandComplianceServicesTeam.
Variety of work
Cross training in all aspects of the revenue cycle
Opportunity for growth, development,
expansion, and upward mobility
Flexibility, work from home and flexible hours
Requirementsfortheroleare:
Benefits Plan:
Auditingclientengagementactivitiesandreportpreparation.
Workingknowledgeinhospitalorhealthcaresettingssuchas
revenuecycle,clinicalexperience,chargedescriptionmaster,
coding(hospitaloutpatientcoding,physicianpractice
coding),reimbursementandhealthinsurancepractices.
CodingexpertisewithICD9,CPT/HCPCS,E&Mcodingand
billing.
Educational reimbursement
Accreditation reimbursement
Office Setup, computer, monitor, phone
Great Benefits: 401K, medical, dental, vision, and
more
Contact Jena Ford, our dedicated recruiter
to learn more at jena.ford@adreima.com
Strongcriticalthinkingskillswiththeabilitytointeractwith
bothinternal&externalclients
Strongoralandwrittencommunicationskillscoupledwith
provenorganizational,auditinganddetailorientationskills.
JobTitle:MedicalRecordsTechnician(Coder)
Department:DepartmentOfVeteransAffairs
Agency:VeteransAffairs,VeteransHealthAdministration
SalaryRange:$49,045.00to$63,987.00/PerYear
OpenPeriod:Monday,June1,2015toFriday,July10,2015
PositionInformation:FullTimeExceptedServicePermanent
DutyLocation:2vacanciesinthefollowinglocation(s):
EastOrange,NJ
Lyons,NJ
Duties:TheMedicalRecordTechnician/Coderisastaff
positionlocatedundertheHealthInformationManagement
sectionoftheBusinessOfficeattheVANewJerseyHealthcare
System(VANJHCS).Thispositionisresponsibleformaintaining
thequalityofpatientrecords,assigningtheappropriate
InternationalClassificationofDiseases9thRevisionClinical
Modification(ICD9CM),and/orInternationalClassificationof
Diseases10thRevisionClinicalModification(ICD10CM),
InternationalClassificationofDiseases10thRevisionProcedure
CodingSystem(ICD10CM),CurrentProceduralTerminology
(CPT4),andHealthcareCommonProcedureCodingSystem
(HCPCScodes).
Minimum35+years(hospitalinpatient,outpatientand
physiciancoding/billing).Relatedbusinessexperienceinthe
healthcarefieldmayalsobesubstituted.
ComputerproficiencywithknowledgeofMicrosoftOffice
softwareincludingWordandExcel.
Knowledgeofmedicalandgeneralindustryterminologywith
workingknowledgeofindustryregulatoryrequirements.
StrongknowledgeofMedicareandMedicarepayorshighly
desirable
Remoteworkflexibilitywith25%travelexpected.
EDUCATION:
Bachelorsdegreeinhealthcare,businessorrelatedfield
preferred.Appropriatecodingcertificationshighlydesirable.
(CPC,CPCH,CCS)
Interestedcandidatesshouldforwardtheirresume,coverletter
andsalaryrequirementstoHumanResourcesat
nmarsden@besler.com.
ApplyonlineatUSAJOBS.GOV
66/Journal
15
66
/ Journal of AHIMA July 1
5
company of
excellence
top notch
individuals
dedicated to
clients and
HIM industry
Journal
Journal of
of AHIMA
AHIMA July
July 15/67
15 / 67
Join today at
www.acdis.org
or call us at
800-650-6787.