The AHIMA CDI practice brief: A Q&A discussion with co-chair Gloryanne Bryant

A CDI Work Group run by the American Health Information Management Association (AHIMA) has been meeting for more than a year to address and develop CDI resources and tools. One of the primary objectives of the AHIMA CDI Work Group was the development of a CDI practice brief. The CDI practice brief is expected to provide additional support and enhancements to the previously published practice brief titled Managing an Effective Query Process, which serves as a recommended industry best practice for CDI programs.

ACDIS Advisory Board member Gloryanne Bryant, RHIA, CCS, CCDS, Regional Managing Director of HIM (NCAL Revenue Cycle) for Kaiser Foundation Health Plan Inc & Hospitals in Oakland, CA, was co-chair of AHIMA CDI Work Group. She recently talked with ACDIS Director Brian Murphy about this important project. Below is a transcript of their Q&A session.

Question 1: Does this AHIMA CDI practice brief change or replace the prior practice brief Managing an Effective Query Process? CDI professionals still have questions regarding verbal queries vs. written, retaining query forms as part of the permanent medical record, etc.

Answer: No, it does not replace the October 2008 practice brief, Managing an Effective Query Process. In fact, it is in addition to, and enhances the practice brief. It addresses CDI specific issues and provides more guidance for those who work in the CDI area, whether they are an HIM professional or not. We’ve also tackled some query questions that have persisted since the October 2008 practice brief to try to address those and articulate them better. For example, leading vs. non-leading is an area where a lot of questions remain, so we’ve outlined some more detailed examples of those.

Question 2: How long has AHIMA been working on the CDI practice brief and what is the makeup of the professionals on this work group?

Answer: The practice brief stems from a larger group called the AHIMA CDI Work Group, which has been together for a little over a year. The CDI Work Group has subgroups, and the CDI practice brief was generated as a focused subgroup. It has been working around five to six months on the practice brief.

Gail Garrett, RHIT, assistant vice president of coding compliance REGS for HCA Healthcare Company in Nashville and myself are the two co-chairs of the CDI Work Group and served on the practice brief subgroup. Kathryn DeVault, RHIA, CCS, CCS-P of AHIMA is our practice management advisor. The subgroup that just focused on the practice brief had one physician, two RNs, and three HIM professionals. The larger CDI Work Group had 30 professionals, including many physicians, RNs, and HIM professionals. They were volunteers and AHIMA brought the group together to come up with standards for the industry, including query forms, job descriptions, and a CDI ethics standard.

Question 3: Were there ACDIS members included on the Work Group?

Answer: Yes, we had four advisory board members from ACDIS: Dr. William Haik, Robin Holmes, Gail Marini, and myself [Bryant, Haik, and Holmes served on the practice brief sub-committee]. Another member of ACDIS also served on the practice brief sub-committee. (Note: The complete list of members who served on the CDI Work Group are included below).

Question 4: Can you share with me the key elements or sections that the practice brief covers? Does it address CDI staffing models and competencies, for example? Does it mention a CDI quality assurance (QA) process or policy for conducting verbal queries?

Answer: Yes, it does describe a CDI QA process and how important this is. We outlined and looked at staffing models and competencies, physician advisor/champion roles, query retention, verbal vs. non-verbal queries, leading vs. non-leading queries, with examples, and we also have appendices with additional information. Verbal queries are handled similar to written queries; certain situations have to be presented in a delicate matter so that you are not suggesting a diagnosis to the physician.

Question 5: Does the practice brief offer recommendations on who should perform the CDI function?

Answer: We looked at several CDI staffing models and addressed the levels of competencies, knowledge, and skill-sets these individuals bring to the table. These include an all physician model and a multi-disciplinary model that includes physicians, RN, and HIM professionals. We do advocate that HIM professionals can do this role and should have the opportunity to perform this function. I believe that strongly myself as well. But we do not say that one particular structure is the ideal model. We present all the models so that facilities can make a determination which one is best for their needs.

Question 6: Can you also give an example of more specific guidance that this practice brief provides and that the prior practice brief did not?

Answer: We went into some detail into leading vs. non-leading queries with examples. We solicited our physicians to present their perspectives. We called out that the CDI role is not limited to one profession. We also called out retention of query forms/clarification forms, whether they are written or electronic, so that you can reproduce how you asked the question, if you need to validate how you run your program for auditors. We address the retention of the CDI clarification/query forms both for those hospitals who maintain queries as a permanent part of the medical record and those who keep their forms separately. We suggest that a best practice is for hospitals to have some retention process for their physician clarification or query forms, whether it is part of the medical record itself, or outside.

Question 7: Does the AHIMA CDI practice brief differentiate between clinical (i.e., nurse and/or physician) and HIM/coding queries?

Answer: Yes and no, we discuss the concurrent query process and querying at the coding level (prebill and retrospective). But no, it does not differentiate if one individual is better than another. Regardless of whether you are an RN, MD, PA, HIM, or CCS, if you are functioning in the role of a CDI specialist we believe this practice brief should be followed and that it applies to you. A query is a query and a clarification is a clarification (which is the same as a physician ‘query’). This also applies to RNs and MDs who were caregivers, but no longer serve in that role and are now CDI specialists or staff.

Question 8: Will there be any period for providers, industry professionals, or AHIMA members to comment on the CDI practice brief before it is finalized?

Answer: We’ve already done this. The CDI Work Group is a multi-disciplinary team of 30-plus members both internal to AHIMA and external. There is a practice counsel of AHIMA which has been given the brief to review. There also is a professional practice group of AHIMA which has been given the brief as well. We have strong representation of the industry, including RNs, MDs, and HIM.

Question 9: When will the CDI practice brief be published?

Answer: The CDI practice brief will be published in the May 2010 AHIMA Journal. It is currently going through the editorial review process at AHIMA.

Editor’s note: Gloryanne Bryant, RHIA, CCS, CCDS, is a member of the ACDIS Advisory Board and serves on the Certified Clinical Documentation Specialist (CCDS) certification board.

The AHIMA CDI Work Group consists of the following individuals. Those marked with an asterisk served on the CDI practice brief subcommittee:

Maria Alizondo, BBA-HA, RHIT
Rhonda Anderson, RHIA
Danita Arrowood, RHIT, CCS
Sheila Bowlds, MBA, RHIA
Elizabeth Brady, RHIT, CCS
Gloryanne Bryant, RHIA, CCS, CCDS*
Christine Catalan-Butvich, RN
Kathy DeVault, RHIA, CCS, CCS-P
Michelle Dragut, MD, CCS
Rose Dunn, RHIA, CPA, FACHE
Cheryl Ericson, MS, RN*
MaryAnn Filer, RHIA, CTR
Paula Frost, RN, CTR
Gail Garrett, RHIA*
Susan Garrison, CHCA, CHC, CCS-P
Chad Guidry, RHIA, CCS
Bill Haik, MD, FCCP*
Robin Holmes, MSN, RN*
Marilyn Jones, MBA, MN, RN, CCS
Jenna Jordan, RHIA
Christine Karaman-Meacham, MAS, RHIA
Collette LaClair, RN, CPC
Stephen Levinson, MD
Eve-Ellen Mandler, RHIA, MS, CCS*
Gail Marini, MM, RN, CCS
Carol Osborn, PhD, RHIA
Sheila Peterson, RHIA, RN, CPC
Richard Pinson, MD, FACP, CCS
Chuck Terzian, MD, MPH, MJ
Kathleen Wall, MS, RHIA
Susan Wallace, MEd, RHIA, CCS
MeChelle Walker