Guest Post: Seven smart strategies of highly effective CDI specialists

by Karen Newhouser, RN, BSN, CCM, CCDS

I’ve seen a lot of changes in the eight years I have been in the world of CDI.  As the value of CDI programs, and the worth of CDI specialists, gain recognition by the executive leadership, additional opportunities for improvement nevertheless become evident.

In thinking about the initiatives swirling around, I realize that CDI specialists can become quite confused by all the fairly recent developments as they attempt to juggle the increased workload.  Core measures, present on admission, patient safety indicators, hospital acquired conditions, quality improvement are some of the initiatives that, while necessary, are nonetheless time intensive. Even with the added tasks, it is imperative to remember that the goal is a complete and consistent record that precisely reflects the patient encounter.

So, how does the CDI specialist handle everything? With apologies to Stephen Covey, here is my take on seven strategies to help you balance the work day and maintain maxim productivity.

1. Abide by the standards of the American Health Information Management Association (AHIMA), as well as the ethics of the Association of Clinical Documentation Improvement Specialists (ACDIS). The CDI specialists should be familiar with the coding guidelines, and keep up to date on AHA Coding Clinic for ICD-9-CM.  Read (or re-read) both guidance papers from AHIMA, Managing an Effective Query Process, and Guidance for Clinical Documentation Improvement Programs.  
   Knowing these basic, integral elements of the CDI specialist’s role will help you maintain your professional integrity as you adjust to the multiple responsibilities of the job.
2. The success of a CDI program depends on provider engagement. So, be visible to the provider. Show how important their documentation is to their metrics, to public reporting, and to the patients that they serve. Establish and develop those congruent relationships.
3. Organize your daily workflow. Take advantage tools that maximize your productivity. For example, if the work list is electronically generated, having appropriate fields to minimize the amount of handwritten carryover information is important. Also, make sure that you are prioritizing your own workflow. For example, are there queries to be closed?  Are there any unopened cases that are older than two days?  Were there any transfers to the work list that could potentially have opportunities, i.e., into an intensive care unit with a working DRG without a CC and/or MCC. Those cases need to examined first.
4. There have been some great blogs on the ACDIS website on chart review, so I won’t dwell on this point. A couple to check out are Take 10 Steps to refresh your documentation review process,and Helping the physician and the hospital through proactive denials management.  No matter how a CDI specialist performs the chart review, remember that the purpose is to recognize, not what the provider is saying, it’s what the provider is not saying.
5. Be aware of the number of potential queries in one record and balance the number of potential queries against the patient’s potential length of stay (LOS). Keep providers from becoming ‘query weary’ by limiting the number of queries according to the overall clarity of the record.
6. As the CDI specialist is busy, so is the provider. Remember this as you formulate your queries. Be sure to include only that information which will assist the provider to make a decision. Keep it simple and succinct.
7. Stay current. Become involved in ACDIS at the national and local levels. Keep up to date on CMS decisions. The CDI specialists profession is here to stay—and grow. Be an integral part of that growth. Look to the future – it looks bright!

Editor’s Note: Newhouser, at the time of this article's release, was a CDI consultant with MedPartners HIM. Her background in critical care nursing, case management, plus a certificate as a Medical Coding and Billing Specialist has given her the solid foundation to be successful with CDI since 2004. She finds great reward in sharing her expertise and imparting her knowledge through teaching.