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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?
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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