Symposium spotlight: Chronic conditions and your CDI work

Editor’s note: Sharme Brodie, RN, CCDS, CCDS-O, will present “Clinically Speaking: Conditions Treated in the Outpatient Setting” on Day 1 of the ACDIS Symposium: Outpatient CDI, which takes place November 14-15 at the Hyatt Regency in Austin, Texas. Brodie is a CDI education specialist at HCPro, a Simplify Compliance brand, in Middleton, Massachusetts.

ACDIS: Why are CDI professionals traditionally less familiar with chronic conditions than they are with acute conditions?
Brodie: Chronic conditions generally do not meet medical necessity for an inpatient admission, so these conditions are usually treated in the primary care office. If the patient does decide to seek treatment at a hospital, they are seen and sent home from the emergency department or possibly placed in observation. Most CDI departments are just starting to review patients in observation units.

ACDIS: Is it more important in the outpatient setting than in the inpatient setting?
Brodie: Usually when a patient seeks treatment at an inpatient facility such as an emergency department it’s due to an acute condition such as a new injury or fracture or an acute exacerbation of chronic condition, such as congestive heart failure. Both types of condition can be captured in either setting, though.

In the inpatient setting, some chronic conditions will lead to the capture of MCCs and CCS which are used with the MS-DRG payment methodology, along with the calculation of someone’s severity of illness and risk of mortality. In the outpatient area, these conditions can be used for the risk adjustment payment methodologies.

ACDIS: What are the most commonly seen chronic conditions in the outpatient setting? Can you offer a word of documentation wisdom related to those conditions?
Brodie: Diabetes is probably one of the more common chronic conditions. We would want to make sure we are capturing any chronic complications associated with diabetes such as diabetic neuropathy along with any diabetic ulcers.

Another condition commonly seen in our population is obesity and/or morbid obesity. For this condition, we want to make sure we are capturing the correct level of severity.

Depression is another condition usually treated in the outpatient setting and making sure the correct information is documented is not only important for the encounter but also for future research and patient care.

Q: In your opinion, what’s the most successful physician education tactic when it comes to documenting chronic conditions?
Brodie: An oldie but a goody is explaining to a physician who is certain they’re taking care of much sicker patients than their peers how these patients present on paper. Most physicians are surprised how differently their patients look on paper.

ACDIS: Does the CDI review process change at all depending on whether you’re reviewing for chronic conditions versus acute conditions?
Brodie: It really shouldn’t. Our job is to make sure that all diagnoses are documented to their highest level of specificity for the patient during the encounter under review.

ACDIS: What’s your dream vacation, and why?
Brodie: Tropical beach vacation with white sands and beautiful water. I love to swim and pretty much every other activity that can be done in or around the water, including eating seafood.