Note from the Instructor: CDI and Risk Adjustment—a preconference primer

By Laurie L. Prescott, MSN, RN, CCDS, CDIP

Imagine the following scenario with me:

The discharge summary describes an admission for Mrs. Moody, 79 years old, living at home. She was admitted with chest pain and later diagnosed with an acute myocardial infarction (MI), angina pectoris. She has a history of chronic obstructive pulmonary disease (COPD) and renal failure and a right ankle sprain.

Mrs. Moody’s husband is a patient at Rolling Hills Nursing Facility. He is 85 years old with diabetes, chronic kidney disease, and a chronic ulcer of his left foot. He has left hemiparesis, a late effect of cerebrovascular accident (CVA). He became a bit agitated upon learning of his wife’s health issues: he choked his afternoon milkshake and developed an aspiration pneumonia and acute respiratory distress syndrome. He is now in the room next to his wife at the hospital.

This is just one of the examples, my co-instructor Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS, the director of HCPro’s coding and regulatory Boot Camps, and I have been reviewing in the Risk Adjustment Documentation and Coding Boot Camp pre-conference event yesterday and today.

While I love each of our CDI-related courses, this one if my absolute favorite course to teach as it covers so many angles of the CDI practice. Many look at risk adjustment as it relates to outpatient CDI practice. The concepts we discuss in class, however, cover both inpatient and outpatient encounters.

I also really love co-teaching with Shannon as she brings her robust knowledge of code assignment into the discussion as well. She and I designed this class to suit the needs of both CDI specialists and coders, so each can apply their expertise to the course content and lend their view on how to better capture appropriate risk scores.

I learn something new every time I teach this course.

When we began the course yesterday, we started at the beginning, of course, discussing the Official Guidelines for Coding and Reporting as applied to code assignment both in the inpatient and outpatient setting. We discuss the concept of reportable diagnoses and how often the support required to report a diagnosis proves murky.

We then dove into the what risk adjustment is, and how the CMS Hierarchical Condition Categories (HCC) are applied. We use scenarios in our teaching to better capture how our efforts in record review and querying can assist in ensuring accurate risk capture. Then, we move through each HCC to identify those diagnoses that contribute to a patient’s risk score. As we move through the HCCs, we discuss both coding rules and guidance and clinical indicators to support the code assignment. We’ll close the course with a discussion as to how to ensure records can be defended in audits and provide suggestions to improve documentation.

The two days are packed full of information, getting to share the process with my good friend and colleague along with an amazing crew of more than 80 students has been truly exciting. Our goal is for the attendees to leave with an increased knowledge, understanding, and a few tools to address risk adjustment in their documentation improvement efforts. In this case, what happens in Vegas should NOT stay in Vegas!

Editor’s note: Prescott is the CDI education director for ACDIS/HCPro. She is a frequent speaker and author of The Clinical Documentation Improvement Specialist’s Complete Training Guide. Contact her at lprescott@acdis.org. For information regarding CDI Boot Camps visit www.hcprobootcamps.com/courses/10040/overview.