In the CDI profession, a common question from those not in the healthcare industry is “What do CDI professional do and why are they important?” TrustHCS CDI Director, Autumn Reiter, has always answered this question with a metaphor that tends to work well. “CDIS are editors to each chapter in the book that is the patent’s story”, according to Autumn. And these edits are essential!

 

Regardless of insurance payor or the statistics being analyzed, each patient has a story that needs to be told accurately. With each story, like any you hear in life, you want the correct version recounted. The story needs to be told with precise detail and accuracy. Consider the patient journey like a biography; the author is the physician, the patient is the life account being written about, and CDI serves as the editor.

 

The value of the editor’s intervention impacts the story being told in various ways:

 

#1 Resource Utilization

Making sure that the diagnosis is clearly stated in turn helps justify treatment that is given to a patient. Here is an example:

 

Shortness of breath alone does not seem to reflect the need for BiPAP (or BPAP, Bilevel Positive Airway Pressure) use. There is likely a more specific diagnosis present that is causing the shortness of breath if that level of treatment is needed.

 

Being an editor, a CDIS’ role is to question the cause and help define what the etiology of the shortness of breath in this situation. CDIS can match clinical experience, with documentation and coding knowledge, to clarify the medical necessity of the treatment and support the severity of the patient.

 

#2 Quality Matrix

When we see something in the record that does not make sense, just like an editor altering a story, the CDI specialist should ask “why?”. Let us use Pneumonia for instance. What risk factors does the patient have? Was it present on admission, or did it develop after admission? What antibiotics are being used to treat it?  At times, these are the additional types of questions that would need to be asked. With the questions comes clarity in the patient’s story.

 

 

#3 Appropriate Status and Length of Stay

Documentation can determine whether a patient’s admission status is appropriate.  Should the patient be registered as inpatient or outpatient? The detail of the records can help determine and justify the choice, or how the choice could have been different if additional documentation was present. We have one chance to be as accurate as possible. The assistance of CDI specialists can place significance on those details where they might otherwise be missed.

 

While most of the examples above are circumstantial, the bottom line is the importance of CDI programs in our facilities will always remain. In many cases, the lack of a CDI program can mean missed opportunity to appropriately evaluate the severity of illness, risk of mortality, and quality data that is essential to our healthcare success. We want to make sure appropriate resource utilization takes place, and that quality of care is documented.

 

This is not to say that there is an underlying “issue” that needs to be found in every CDI department; but there are always instances where we can work together to better document the patient’s story.

 

Autumn Reiter would love to speak with you at any point about the state of your CDI department and its efficacy. Connect with her on LinkedIn and send her a message anytime.