Q&A: Credentialing for outpatient CDI

Q: I’ve heard lately that outpatient CDI specialists are less likely to be registered nurses. Is there a reason there may be more coders in this arena?

A: While many outpatient CDI specialists do hold an RN credential, there are good reasons for having coders fill the roll, says Allen Frady, RN, BSN, CCDS, CCS, CDI education specialist for HCPro in Middleton, Massachusetts.

“There are a lot of very specific documentation requirements for evaluation and management (E/M), observation codes, interventional radiology, etc., which RN CDI specialists don’t typically learn,” he says. Additionally, coders may already be comfortable working in a physician practice setting and have a familiarity with hierarchical condition categories (HCC).

The credentials represented within the outpatient CDI world, however, are perhaps as diverse as those in the inpatient world, says Laurie Prescott, RN, MSN, CCDS, CDIP, CDI education specialist for HCPro.

“Outpatient programs often hire licensed practical nurses (LPN) to work in the role as they are less expensive than RNs and coders. Ultimately, I think it depends on the goal or focus of the program,” Prescott says. “For example, if the outpatient program is working on charge capture activities, a coder or coding assistant can perform the role easily as they are counting minutes, defining infusions versus injections, etc.”

If, on the other hand, the program’s focus is broader, a more experienced individual will suit the role better, says Prescott. “For risk adjustment activities, I mainly see RNs or experienced coders in the rule as this function is looking to define vague or missing diagnoses.”

Editor’s note: Prescott and Frady answered this question jointly. To contact Prescott, email her at lprescott@blr.com. To contact Frady, email him at afrady@blr.com.