Book excerpt: Navigating CDI-coding relationships

By Johanne Brautigam, RN, BSN, CCDS and Mindy Davis, RHIT, CDIP, CCS, CCDS for ACDIS Blog

There are a few key strategies for communication between CDI and coding. Most important, communicate to coding leadership and the coding staff that having a strong working relationship between CDI and coding is a priority. Back this statement up with action.

The CDI team will not only need to rely upon coding for their expert knowledge of the Official Guidelines for Coding and Reporting and Coding Clinic, it will also need to work with coding to ensure the results of the CDI team’s hard work of improving documentation results in a properly and fully coded claim. Having a strong partnership with coding is a great way to ensure this happens.

Do not fall victim to being uninformed about the organization’s coding policies and procedures that could impact the overall CDI results. For example, an organization may have a coding policy dictating that secondary diagnoses must be documented on the discharge summary in order to be coded. In this case, CDI efforts could be in vain if queried diagnoses don’t make it onto the discharge summary.

The same is true for certain quality measures for which CDI is responsible. Without an understanding of how the coding team’s organization assigns present-on-admission (POA) status, CDI’s work in this area may again be in vain. For example, a CDI specialist’s thought process may cause him or her to think that a specific diagnosis was POA. However, what can appear as obvious to CDI may be anything but to coding, who could view the same POA status as a gray area. Don’t assume that diligent efforts in CDI are leading to measurable outcomes until there is a full understanding of how the organization’s coding department functions. It’s much better to conduct due diligence first than having any surprises down the road.

Out of all healthcare disciplines, coding is perhaps most focused on productivity. When coders take time out to discuss DRG assignment with CDI, participate in CDI meetings, or provide coding education of some fashion, this is likely affecting their productivity levels. Express gratitude for the time that is offered and make the most out of it.

Many coders work remotely to some extent, and this can sometimes create communication barriers. If the organization has recently expanded CDI or if the focus has somehow changed, ensure that coders are made aware of any changes and the reasons behind them. Coders who have been working remotely for many years may have somewhat lost touch with the CDI mission and focus.

Depending upon how CDI was first introduced to them, some coders may believe that CDI specialists should fix all documentation issues that lead to post-discharge queries or otherwise hold a chart for documentation clarification/completion. Again, this is where it is important that coders are educated on the CDI mission and scope. Educating coders on the fact that CDI specialist will likely only review a chart one or two times before discharge and therefore it is unlikely that CDI will catch a documentation issue that occurs near the end of the patient’s stay goes a long way in setting realistic expectations.

Also, some coders may expect CDI professionals to have coding knowledge at the same proficiency level as coders. Obviously, this is unrealistic for many reasons. The sooner that misconception can be clarified, the sooner everyone will have a mutual understanding of each other’s roles.

Appreciate the differences and similarities between CDI and coding and capitalize on each area’s strengths. It is important that each area understands the unique challenges of a concurrent review versus a post-discharge review. If there is conflict between CDI and coding, it is sometimes helpful to re-create a timeline of what existed in the documentation at each point the chart was reviewed. For example, if a DRG changes drastically after the last CDI review, it is helpful if both parties can review the documentation trajectory and understand what led to the change.

Finally, appreciate that coding has long been blamed for disappointing results such as a low case mix index, a high volume of unbilled accounts, or poor quality performance rankings, when very few of these other parties understand the coding guidelines and regulatory requirements that might lead to these issues. If coding initially is not overjoyed to partner with another entity such as CDI, who may appear to be questioning the accuracy of their work, remember that coding’s role is not easy. It is possible to overcome this initial adversity by showing a genuine commitment to fostering a productive and efficient working partnership where each role is valued and respected.