The Intersection of CDI and Coding: Part 3: CDI Challenges

Hosted by Libman Education
April 2018

Coding and CDI, both critically important to the success of our healthcare institutions, will continue to evolve in response to changes in technology, reimbursement, and workforce requirements. The relationship between CDIs and Coders is changing as the Revenue Cycle function requires a team approach that embraces all operational areas that impact revenue. We asked seven experts what they thought about the intersection of CDI and coding and what it means to them and their organization.

In the third installment of this discussion, several of the experts discuss CDI challenges that they’ve recently faced. (See the series in its entirety here.)

ERAMO: What’s the biggest challenge you’ve encountered in the last week? 

TROMBLEY: I’m in the process of learning more about E/M coding and CPT guidelines so I can help train and audit other outpatient CDI specialists. CDI has traditionally focused on inpatient only, so E/M coding isn’t something with which many CDI specialists have experience.

“Provider documentation is the biggest challenge—getting providers to buy into CDI and provide quality documentation. This was the same challenge ten years ago when I started in the profession.”

-Trey La Charite

LA CHARITE: Provider documentation is the biggest challenge—getting providers to buy into CDI and provide quality documentation. This was the same challenge ten years ago when I started in the profession. I don’t think this is something that CDI specialists can fix unfortunately. It’s more of an administration problem. Administrators must talk to the medical staff and convey the importance of documentation.

LAFRAMBOISE: Keeping up with the pace of change is the biggest challenge. RNs come from a profession that changes slowly. The human body doesn’t change. But CDI changes so rapidly. We have an opportunity to impact value-based payments and our ranking in U.S. News & World Report—so we keep pushing the envelope to do these things.


Lisa A. Eramo, MA, moderator and freelance writer




Leif Laframboise, RN, CCS, CDI professional with more than 20 years of healthcare experience who currently works for an academic medical center in the northeast



Nikki Miskowicz, RN, BSN, CCDS, manager of clinical documentation integrity at Stanford Children’s Health



Rayellen Kishbach, director of customer success at MediRegs, a division of Wolters Kluwer Law& Business



Tammy Trombley, RHIT, CDIP, CCDS, compliance manager at HCTec, a coding, auditing, and CDI service provider



Trey La Charite, MD, FACP, SFHM, CCS, CCDS, medical director of clinical documentation integrity and coding at the University of Tennessee Medical Center



Mary Beth York, CCS, CCS-P, CIC, senior associate at Barry Libman, Inc., a coding and auditing company




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About the Author

Libman Education
Libman Education Inc. is a leading provider of training for the health care workforce offering self-paced and instructor-led online courses designed and developed by leading industry experts in Health Information Management (HIM) and Medical Record Coding. Our courses are specifically designed to improve individual skills and increase the efficiencies and competencies of health care providers and institutions. At Libman Education, we understand the needs and challenges of a well-trained workforce and offer the right-mix of online education to ensure that the health care professionals are prepared to meet the challenges of the changing workplace.

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