News: Demystifying outpatient CDI efforts

Only 9% of CDI programs currently have a presence in the outpatient arena, according to a recent ACDIS membership poll. But 24% plan to expand to some level of outpatient record reviews within the next six to 12 months.

With the growth in outpatient focus, however, many in the CDI profession feel at a loss for detailed direction.

“Outpatient CDI requires a different mindset from inpatient CDI,” said James S. Kennedy, MD, CCS, CCDS, CDIP, president of CDIMD – Physician Champions in Smyrna, Tennessee, on the April 11 episode of the Talk 10 Tuesday podcast by the ICD10 Monitor. This episode of the podcast sought to clear some of the fog through a panel of experts, including Kennedy, Cynthia Keith, CPC, and Glenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FCS, C-CDAM.

While inpatient CDI programs have many different goals—financial, denial prevention, quality measures, general documentation improvement—outpatient should have one, according to Krauss.

“The goal of all your outpatient efforts should be documentation improvement,” he said. Additionally, the events taking place in the free-standing physician office directly affect any hospital outpatient services as many of those services require a referral from the general practitioner.

For hospitals, the referral can open them up to denials. This, according to Krauss, happens when the documentation from the physician’s office does not backup the necessity for that service. “Outpatient CDI really starts in the doctor’s office,” said Krauss.

One way to ensure the documentation stays up to snuff and audit proof is frequent self-audits. “Don’t just audit the documentation after claims are denied. Think of it as preventative medicine,” Keith said.

Since the coders use the progress notes to code the final bill rather than the superbill (an itemized form from the physician reflecting the services provided), the quality of the notes need frequent monitoring. “Physicians have to be more descriptive as to what they’re doing with their patients in the progress notes,” Kennedy said.

For CDI specialists coming from the inpatient side of the house, Kennedy warned that the outpatient world can be more complex. “An outpatient CDI specialist has a much broader focus. You have to look at things globally rather than in a discreet episode,” he said.

While inpatient documentation focuses on one particular incident, outpatient documentation and coding takes into account up to 12 months of care for that patient. Combined with the different payment methodologies, this broader focus can be quite daunting to the new outpatient CDI specialist.

To help clear up some of the mystery, Kennedy suggested opening communication with the individual payers. “Call them up and ask what they’re expecting,” he said. Facilities can also ask after their data collected by the payers to see where they need improving.

Though expanding into outpatient can be challenging and a bit scary, Krauss and Kennedy both suggested patience and education. “It takes a lot of time to educate and engage the physicians,” said Krauss.

Editor’s note: To listen to the complete Talk Ten Tuesday podcast, click here. To read a White Paper from the ACDIS Advisory Board about outpatient CDI, click here. To read an article about specificity in outpatient records, click here. To read a Q&A with one of the ACDIS 2017 conference speakers regarding outpatient CDI, click here.