Q&A: SOI/ROM impact

Q: I am with a CDI program that is starting to explore the severity of illness/risk of mortality (SOI/ROM). I personally have been reviewing for SOI/ROM for quite a while. I usually designate the impact (MCC/CC/SOI/ROM) after the billing is done and see if what I queried for made a final impact, and only take credit for those that do.

I was told that regardless of the actual final impact on SOI/ROM we should be taking credit for any SOI/ROM clarification as SOI/ROM impact. Which is the most accurate, “correct” way to capture the CDI impact for these types of clarifications?

A: I very much agree with your practice of claiming those in which you see a change in SOI/ROM related to your query. I believe you are being encouraged to claim impact for any query that allows for an increase in SOI/ROM. So, for example, if you query for MCC capture, that would likely affect SOI/ROM and I would claim the impact for both MCC capture and SOI.

Say you have a patient that is admitted for COPD exacerbation with heart failure and diabetes. When you query to capture the MCC of the acute respiratory failure, and the physician responds appropriately, you would claim the credit for the MCC capture. But this query likely would also increase your SOI/ROM (I do not have access to an APR grouper but my guess is that it likely would).

I would think that although your goal in the query was not to increase SOI/ROM, if it did indeed do so, I would take the credit for this as well.

I would also suggest you seek out your peers on the ACDIS Forum as they likely could share with you how they analyze their metrics.

Editor’s note: Laurie L. Prescott, RN, MSN, CCDS, CDIP, AHIMA Approved ICD-10-CM/PCS Trainer, CDI Education Director at HCPro in Danvers, Massachusetts, answered this question. Contact her at lprescott@hcpro.com. For information regarding CDI Boot Camps visit http://hcmarketplace.com/clinical-doc-improvement-boot-camp-1.