Guest Post: Have you had a CDI check-up lately?

by Kelli Estes, RN, CCDS

A large number of hospitals across the country have some version of a CDI program in place. With ICD-10 implementation on our heels, it is recommended by AHIMA that all hospitals have a “mature” CDI program in place by October 1, 2014.

In October 2013, I attended the AHIMA pre-conference coding meeting in Atlanta. An informal polling of the audience led to some interesting revelations regarding CDI program maintenance and growth through audits. Most everyone in the room professed to having an internal and external audit process in place for coding, but only a few hands went up when asked about having a CDI-specific audit process. Additionally, recommendations were made to have outside auditors assess CDI programs currently operating under ICD-9 to leverage their stability during the transition to ICD-10.

A thorough, CDI-specific audit can illustrate how viable any CDI program will be come ICD-10, particularly considering projections of a 25% decrease in productivity as a result of ICD-10. Let’s face it!  If you have CDI problems with ICD-9, you will have those same problems with ICD-10. So don’t delay  developing policies and procedures for CDI audit processes including conducting your own internal audits and hiring an external audit team.

What should should you audit for? Good question. Here are some of the items we recommend:

• CDI specialists’ query writing skill/compliance
• Missed opportunities to capture MCCs/CCs as well as further severity of illness and risk of mortality
• Query trends to identify educational opportunities for physicians
• Productivity when reviewing patient records

Most models of CDI look similar on the surface, but when assessing the detail in the various moving parts you will find differences that could cost your organization big in the long run. You want to make sure you are working smarter, not harder. You also need to identify process improvement needs such as collaboration with other healthcare team members involved in the care of the patient  (i.e., nutrition, wound care, care management, core measures). The only way to capture this type of information best is by reviewing a random selection of CDI cases and overall processes.

Editor's note: Estes, at the time of this article's original release, was a CDI consultant with DCBA Inc., in Atlanta.