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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 eighth installment of this discussion, participants are asked for their experience in joint education for CDIs and coders. (See the series in its entirety here.)
ERAMO: What are 2-3 strategies that can help build a cooperative environment in which CDI specialists and coders work together to ensure data integrity?
MISKOWITZ: Discuss DRG mismatches. This is an opportune time to share knowledge. Coders can share information about coding that CDI specialists may not have been aware of and vice versa.
TROMBLEY: Ask a CDI specialist to shadow a coder for half a day and vice versa. Also, managers need to reiterate the importance of respectful and polite communications between coders and CDI specialists. I recently worked with a hospital where everyone was so nice when working through DRG mismatches. You don’t see this too often. When coders and CDI specialists can’t agree on a mismatch, create a process where there’s another layer or review and reconciliation. Ask a supervisor or CDI coordinator to serve in this role—someone who has more experience.
LACHARITE: CDI and coding need to be in the same department with the same set of leaders so everyone is on the same page. You can’t have CDI running out of finance and coding running out of HIM. That’s too siloed. You also need a process to resolve DRG mismatches. At our facility, when CDI finishes reviewing the chart, they assign a preliminary DRG. Then the coder assigns a final DRG. If there’s a mismatch, the two are required to talk about it. The nice thing about that is the CDI nurse learns from the coder and vice versa. That’s extremely productive. Mismatches occur weekly and can often be resolved after a conversation. If it can’t be resolved, we have an escalation process so a coding quality auditor reviews the case and makes the final decision. CDI specialists may not realize there’s a code first, code also, or combination code that takes precedence.
LAFRAMBOISE: Set up a buddy system. At our facility, each CDI specialist is assigned to a coder. If the CDI specialist has a question about coding, they call their coding buddy for clarification.
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
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
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