The Intersection of CDI and Coding: Part 4: Additional research and education for CDI Staff

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 fourth installment of this discussion, two of the experts discuss a recent case example that required additional research and/or education for their CDI staff. (See the series in its entirety here.)

ERAMO: Can you provide a recent case example that required additional research and/or education for your CDI staff?

TROMBLEY: This happens all the time especially when you’re auditing. For example, I had to research an argon plasma coagulation procedure for bleeding arterial venous malformation. A CDI specialist and coder both coded it as ‘control’ of the bleed. But then I remembered there was an updated Coding Clinic about hemorrhage control stating that if the control moves to a more definitive root operation, you should assign the other more definitive root operation. In this case, it was destruction. Another example is COPD exacerbation with influenza and pneumonia. Influenza is the principal diagnosis based on sequencing. However, some CDI specialists will put the pneumonia first. Spinal procedures are also tough, and OB coding sometimes requires additional research because there are chapter-specific guidelines.

LAFRAMBOISE: We sometimes need to provide education about cases that move from outpatient to observation to inpatient. What qualifies as the principal diagnosis for admission? Another topic is symptom coding. For example, can we code weakness as a secondary diagnosis that holds value under risk-adjustment if the patient also has anemia?

 

Participants:


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

 

 


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

 

 

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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.

2 thoughts on “The Intersection of CDI and Coding: Part 4: Additional research and education for CDI Staff

  1. Wendy Rowe - June 28, 2018 at 1:57 pm

    LAFRAMBOISE: Another topic is symptom coding. For example, can we code weakness as a secondary diagnosis that holds value under risk-adjustment if the patient also has anemia?

    Looking for an answer to the issue above. I am an outpatient CDI with the ED we are experiencing documentation issues with rule out stroke in supporting the MRA. In situations where patient’s present with “eye droop”, balance issues, and fall they will work the patient up for a ” rule out stroke” in some cases after work up the final diagnosis is Migraine. How would we capture the medical necessity for the MRA. Is it appropriate to code R29.818 other signs and symptoms of the nervous system to support the balance issue, eye droop as additional code. I am being told no the final diagnosis is the only code that can be abstracted?

    • Libman Education - June 29, 2018 at 2:34 pm

      Wendy, You describe an outpatient visit for “eye droop”, balance issues, and fall with a final diagnosis of migraine. Consider the application of this coding guideline in these situations.

      ICD-10-CM Official Guidelines for Coding and Reporting, Section 1.C.18.b states:

      “Use of a symptom code with a definitive diagnosis code

      Codes for signs and symptoms may be reported in addition to a related definitive diagnosis when the sign or symptom is not routinely associated with that diagnosis, such as the various signs and symptoms associated with complex syndromes. The definitive diagnosis code should be sequenced before the symptom code.”

      The National Library of Medicine states that the most common symptoms of migraines are: temporary blind spots or colored spots, blurred vision, eye pain, seeing stars, zigzag lines, or flashing lights, and tunnel vision. It seems the symptoms you describe are not common for migraine and as a result, the application of this guideline may apply for these types of scenarios.

      Source: https://medlineplus.gov/ency/article/000709.htm

      — Sandy L. Macica, MS, RHIA, CCS, Director of Educational Content for Libman Education