Guest post: CDI and reconciliation

By Cynthia Raymond, RN, MSN, CPC, COC, CCDS, ACM-RN for ACDIS CDI Blog

CDI specialist’s work can often be tapered down to two categories of work. One category is concurrent stay reviews where CDI makes efforts to ensure that the medical record is accurate and compliant before final coding. The second category of work is reconciliation.

Reconciliation is the activity performed by CDI specialists to compare the CDI-assigned DRG to the final coding DRG. Reconciliation allows for a last review of the code assignment, present on admission (POA) assignment, and DRG assignment to ensure that the patient’s clinical condition and care are accurately reported. “It takes a village” is a saying that should not only be applied to child rearing, but also in CDI as working as a team helps to ensure we make the most appropriate DRG and code assignments for our hospitals, providers, and patients.

Some hospital systems might consider only reviewing cases where CDI and coding DRGs do not match, while others may take a full-circle approach, taking the additional time to review the record one last time. Some hospitals may use this reconciliation process to review all mortalities that occurred during the inpatient stay regardless of the DRG assignment.

The reconciliation process allows for education for the CDI specialists—especially to learn coding guidelines, coding clinics–and can serve as an educational opportunity for the coding team. Reviewing the POA indicators ensures that conditions are appropriately assigned to reflect if the patient came in the hospital with the condition, or if the condition developed during the patient’s inpatient stay. This can be crucial when reporting quality metrics.

The reconciliation process is often missed as a possible key performance indicators of our CDI team. Itis important to show the work performed during this process to our quality and financial leaders as representation of the work that CDI does. More importantly, it shows the importance of the CDI reviews and reconciliation.

Performance indicators might include the number of accounts of where CDI and coding do not match DRGs, the number or percentage of accounts that are escalated to the coding team for review, the number of accounts that have DRG change due to this process, or the number of accounts that receive a coding change, be it aa code addition, revision, or deletion. For quality reporting and scoring process, it is important to show changes in severity of illness and risk mortality as well.

No matter what approach a hospital takes to the reconciliation process, having an extra review allows for one more chance to have any documentation opportunities cleared up and the most accurate DRG and code assignment for the record.