Meet a Member: Thinking about ‘M.U.S.I.C.’ every day

Tracy Pitts, RN, BSN, CCDS, is a clinical documentation specialist at St. Luke's Hospital in Chesterfield, Missouri. She is also a member of the St. Louis ACDIS local chapter.

CDI Strategies: How long have you been in the CDI field?

Pitts: I have been in a full-time CDI specialist since October 1, 2007. I am one of an original two-person team.

CDI Strategies: What did you do before entering CDI?

Pitts: My early nursing career focused primarily in the area of oncology, first on an acute care hospital division, followed by oncology home health/palliative care. In 1999, I was an associate head nurse on the oncology division at St. Luke's Hospital. Before moving to documentation improvement, I worked as a floor based case manager (essentially utilization review).

CDI Strategies: Why did you get into this line of work?

Pitts: All floor-based case managers were introduced to documentation improvement on a gradual basis, completing training with J.A. Thomas and then initiating Medicare cases for documentation opportunities as time allowed. I soon found this to be my favorite and most interesting part of my day, and I tried to complete all my other duties as soon as possible so I could devote my attention to CDI. When I discovered my institution decided to devote two full-time positions to documentation, I jumped at the chance.

CDI Strategies: What has been your biggest challenge?  

Pitts: The Oncology Certified Nurse (ONC) test was truly the hardest exam I have ever taken, and I was proud to carry those credentials during my years as an oncology RN.

The CCDS exam wasn’t exactly a piece of cake either! As far as documentation improvement itself, I think the battle was moving from the notion of "upcoding" to the sincere, honest purpose of improving the integrity of the medical record that we all know we are here for.

CDI Strategies: What has been your biggest reward?

Pitts: I felt like I took a big risk when I entered documentation improvement almost 10 years ago, wondering if it would turn out to be nothing more than “the flavor of the day.” I am honestly thrilled to see how the field has grown and gained professional recognition, both within my own organization and across the country, and now provides its own sense of job security

CDI Strategies: How has the field changed since you began working in CDI?

Pitts: Anyone who has been in the field for any length of time I'm sure remembers the days of hunting and pecking for CCs and MCCs in Medicare charts. My day now consists of reviewing all payers in an inpatient status for correct assignment of the principal diagnosis/DRG and valid secondary diagnoses as well as at present on admission indicators, patient safety indicators, and quality issues. My role is to help capture the absolute best and accurate clinical picture of that patient for this particular inpatient stay, reminding myself that within reason any other person with clinical expertise should come away with a very similar impression.

CDI Strategies: Can you mention a few of the “gold nuggets” of information you’ve received from colleagues on The Forum or through ACDIS?

Pitts: While attending the 2016 ACDIS conference in Atlanta, I had the pleasure of speaking with James S. Kennedy, MD, CCS, CDIP, during one of the breaks. He shared with the table an acronym both useful and highly effective when performing a documentation review: for every documented diagnosis/symptom/problem think M.U.S.I.C.

M: Manifestations

U: Underlying pathology or cause

S: Severity or specificity

I: Instigating or precipitating cause

C: Complications or consequences

I was able to bring this home to my facility and share with several nurses new to the CDI role, who found it extremely helpful as well.

CDI Strategies: If you have attended, how many ACDIS conferences have you been to? What are your favorite memories?

Pitts: I have only had the opportunity to attend the Atlanta, Georgia conference in 2016. I honestly was incredibly impressed with the quality of the speakers and all of the breakout sessions I attended. One day, after I returned to work, the newer CDI nurses and I took lunch outside and spent time reviewing all of my notes and slides, and discussing different clinical scenarios along with references and Coding Clinics. It was a great afternoon for all of us.

It didn't hurt that my husband Mike and I turned this into a road trip, visiting the beautiful town of Helen, Georgia, on the Friday after the conference before returning home.

CDI Strategies: What piece of advice would you offer to a new CDI specialist?

Pitts: Use every possible minute of orientation. Explore the references available in your particular program, reviewing diagnoses, associated conditions/complications, decision trees and coding guidelines.

And never sell yourself short. Everyone, no matter how new, has something to bring to the table. It took a new dog (my co-worker, Samantha Knudtson) to teach an old dog (me) a different way of organizing and performing both new and concurrent reviews.

CDI Strategies: If you could have any other job, what would it be?

Pitts: At this point in my life I don't really think in terms of a new or different job. Oncology nursing was my passion, and despite the many difficulties and sadness at times, I never regretted one second of those years. I am happy and satisfied in my current role, and love the fact that I still learn something new every single day. When it comes time to retire I would love to explore being a hospice and/or Humane Society volunteer.

CDI Strategies: What was your first job (what you did while in high school)?

Pitts: Ugh. I was the queen of the local McDonald’s drive through!

CDI Strategies: Tell us about your family and how you like to spend your time away from CDI.

Pitts: My husband Mike and I have been married for 16 years. We recently built a new home and relocated from Florissant to Wentzville, Missouri. We love exploring and learning about this new part of St. Louis. Right now we are focused on  getting a fence for our pooch, landscaping, and meeting our new neighbors.

Between us we have three sons: Michael, 33, Andy, 31 (married to Melissa), and Daniel, 25. We recently welcomed and fell in love with our first grandson.

Here are a few of Tracy’s favorite things:

• Vacation spots: Any ocean, any beach. I'd have to say that so far the Pacific Northwest and beautiful Oregon coastline have been a favorite.
• Hobby: I’m a voracious reader and can’t get enough. I still prefer an old fashioned book in my hands. For the most part I read novels and fiction. More than reading, though, I’m a St. Louis Cardinals baseball fan.
• Non-alcoholic beverage: Water, water, water.
• Foods: Pasta is my best friend but I also adore fresh local seafood when on the coast.
• Activities: Zumba, beach combing, leisurely evening bike rides with my hubby, walking our wire-haired Dachshund, Franklin, always two or three new craft projects per year, and aggravating the heck out of friends and family with my camera!

Editor’s note: ACDIS is always on the lookout for the next Meet a Member. If you’re interested in being interviewed, email ACDIS Editor Linnea Archibald (larchibald@acdis.org).