Tip: Seven lessons for physician CDI education

Ensuring hospital revenue integrity requires three operational pillars—clinical coding, CDI, and physician education, according to Kalispell (Montana) Regional Medical Center’s (KRMC), director of CDI services and ICD-10 project manager Christine Seager, RN, BSN, CCDS.

“Accuracy is the single most important strategy to making sure that we are painting a clear clinical picture of our patients,” Seager says, in an article published in HIM Briefings.

KRMC, one of Becker’s Hospital Review “100 Great Community Hospitals,” had a mature CDI program in place and was already using computer-assisted coding, even prior to ICD-10-CM/PCS implementation. In the fall of 2015, the organization worked with external consultants to conduct a CDI audit and identify areas of improvement based on the recent code changes. About 14% of the cases revealed additional opportunities, which led the team to reassess opportunities particularly in relation to physician education and engagement.

Seager says the following lessons were learned at KRMC and proved in improving communication between physicians, CDI staff, and coders:

1. When changes are implemented, keep all three disciplines in the loop and remember they are all essential in making the process work.
2. Coach and train CDI staff on how best to present findings to physicians and what data sets to use.
3. Ask yourself what specific documentation changes you want coders and CDI specialists to communicate to physicians.
4. When presenting coding and documentation improvement requests to physicians, know the hot-button topics that get their attention (i.e., mortality rates, resource utilization, public reporting). Frame your conversation around these attention-getting topics.
5. Set up a specific time to meet with physicians—and make sure it’s not during rounds. Schedule a time when physicians won’t be distracted by other tasks and will be able to listen and understand why your request is important. Then give them time to absorb the information you’re passing along.
6. Show physicians two cases, with varying query outcomes, to demonstrate how a case can change with a positive physician response to a CDI or coder query. Quantify the impact of query responses on coding and public reporting in dollars and health grades.
7. Practice what you want to say to physicians and how best to say it.

Editor’s Note: This article is adapted from the original published in ACDIS’ sister publications HIM Briefings and Medicare Compliance Watch.