CDI to CDI · – To improve physician quality score ... • Strong focus on relationships, trust, and mutual ... • Coders able to view CDI coding and clarifications • Coding
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• A comprehensive healthcare network including one of the nation’s largest multispecialty group medical practices, regional community clinics, and hospitals
• Tertiary referral center
• Physician‐led, not‐for‐profit healthcare system
• Located throughout Western Wisconsin, Northeastern Iowa, and Southeastern Minnesota caring for patients in 19 counties
• 2014 – became first hospital “off the grid”
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Gundersen Health System
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Gundersen’s CDI Goals
• Accurately represent Gundersen Health System in administrative databases
• Capture the true “severity” of illness
• Demonstrate medical necessity and patient complexity
• 91‐year‐old admitted with acute diastolic heart failure
• Secondary diagnoses:
– HTN.
– CKD 3.
• Documented in medical record:
– BMI 41.7.
– “91‐year‐old female who comes in with respiratory distress, noted to have low sats in the 70s, placed on high‐flow oxygen. She is normally on home oxygen.”
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Case Example
• 91‐year‐old admitted with acute diastolic heart failure
• Secondary diagnoses:
– HTN.
– CKD 3.
• Documented in medical record:
– BMI 41.7.
– “91‐year‐old female who comes in with respiratory distress, noted to have low sats in the 70s, placed on high‐flow oxygen. She is normally on home oxygen.”
– Clarification sent for morbid obesity and acute on chronic respiratory failure.
• Discussing how their quality definitions differ from coding definitions
• Encouraging them to see the “whole person”
– Documenting all the problems being managed
• Morbid obesity
• Malnutrition
– Looking beyond the surgery
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Clarification/Query Process
• CDI clarifications sent through Epic in basket
• “Urgent documentation question”
• Standard templates used
• Sent to attending and associate staff/resident
• Response required
• Follow‐up process
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Acute Respiratory Failure TemplateDear ***,
According to the progress notes, the diagnosis of "***" with "***" has been documented.
If one of the following choices accurately describes the condition being treated and/or monitored, please indicate by selecting the appropriate diagnosis and adding it to the problem list.
Acute respiratory failure
Chronic respiratory failure
Acute on chronic respiratory failure
Acute respiratory distress
Acute respiratory insufficiency
Unable to determine
Other
Acute respiratory failure guidelines
Present if any of the following criteria met:
o Respiratory distress AND
o pO2 < 60 (pulse ox 88% on room air) – hypoxemic
o pCO2 > with pH < 7.35 – hypercapnic
Chronic respiratory failure guidelines
o On continuous home oxygen
o Indicate if hypoxic or hypercapnic
Please use the REPLY ALL button to indicate if you agree or disagree with the clarification. This will inform all parties that the clarification has been addressed.
“At my new hospital, I frequently need to update my problem list because I know it needs to be more specific.”
“I felt very prepared for my fellowship and my current position. My peers do not seem to focus on the specificity of diagnoses such as acute on chronic combined systolic and diastolic CHF.”
“There was no one in your position to provide feedback to residents, fellows, or staff. I believe you do assist us with capturing more, and painting a more clear picture of the complexity of the
patients we care for.”
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CDI Feedback
Hospitalists
“The coders had never seen this kind of documentation before.”
“They were hoping I would help start a program at my new
hospital.”
Current residents
“Thank you for teaching me so much about documentation.”
“Thank you for bringing those clinical indicators to my
In order to receive your continuing education certificate(s) for this program, you must complete the online evaluation. The link can be found in the continuing education section at the front of the program guide.