‘Superstar’ tip: CDI is a piece of (cup)cake

by Jane Hoyt, BSN, RN, CCDS

CDI is the frosting on the cupcake. Frosting makes the cupcake complete and perfect. Consider this scenario:

Utilization management (through no fault of their own) perform back-end solutions such as not billing for observation services and re-reviewing two-day inpatient stays post discharge to ensure they met medical necessity.

If the UM nurse doesn’t think the cases meet medical necessity, the records are billed only with ancillary charges and not for inpatient admission.  UM sees what is written; what was written.

CDI sees what could be written.  In this case, we frost cupcakes that get thrown out!

CDI programs needs to be in the emergency room to ensure that what is written in the progress notes is complete and accurate so that UM can do their jobs effectively.

If these kinds of practices are not implemented, we’ll never be on the same page. In this case, putting a CDI in the ED is a sound front-end solution.

Let’s put medical decision-making for inpatient vs. outpatient status back in the hands of the physicians with the correct tools to document this decision.

We need to work together.

Editor’s Note: Hoyt, at the time of this article’s original release, was manager, Clinical Documentation Integrity/Health Information Management for Denver Health and Hospital Authority, in Colorado.

Editor’s Note: This ‘superstar’ story was written by Jane Hoyt, BSN, RN, CCDS, manager, Clinical Documentation Integrity/Health Information Management for Denver Health and Hospital Authority, in Colorado. Contact her at Jane.Hoyt@dhha.org.