Clinical Documentation Improvement (CDI) Programs

To ensure the true acuity of your patients is reflected in your coding and reimbursement, PRG can develop or optimize your CDI program to bridge the gap between “clinical” and “code-able” language

PRG has years of experience in starting and leading successful pediatric CDI programs at children’s hospitals and pediatric units around the country. Accurate documentation of the patient’s care is important for the sharing of information amongst the clinical team to provide the best care possible. In addition, complete documentation also ensures that the appropriate acuity of the patient is reflected in the chart, which drives the severity-adjustment for quality and operational metrics and can also significantly impact hospital reimbursement.

Appropriately documented and coded diagnoses drive the severity-adjustment when looking at severity-adjusted length-of-stay, severity-adjusted complication rates, severity-adjusted mortality rates and other severity-adjusted metrics. When trending your own hospital’s performance over time or when comparing yourself to peer organizations, it’s critical that the appropriate coding and severity-adjustment is accounted for to ensure that the common phrase of “we have sicker patients” is truly reflected in the coding of the record.

This coding and severity-adjustment is also what drives hospital reimbursement in certain payment models. To ensure hospitals receive full and fair compensation for the care they provide to their patients, it’s important for the coding department to code at the appropriate acuity level.

“Coding language” and “clinical language” can be different for many of the conditions we care for. We don’t want physicians to be coders and to remember when to use certain code-able phrases. To bridge this gap between “code-able” and “clinical” language, hospitals rely on clinical documentation improvement (CDI) programs to ensure the chart is documented and coded correctly.

Potential areas for assessment and intervention

  • Chart review of final coded inpatient discharges to identify query & documentation opportunities
  • Chart review of final coded observation discharges to identify opportunities for status change to inpatient based on use of InterQual™/MCG™ or documentation by the clinicians
  • CDIS/coder education on clinical indicators for 25 common pediatric conditions with top query opportunities
  • Creation of definitions for common pediatric conditions such as “acute respiratory failure”, etc…
  • Physician/executive team education on CDI
  • Physician Advisor interface with the CDI program
  • Electronic query template development for the EMR
  • CDI governance, committee composition, and query follow-up policies/procedures
  • CDI dashboard development with key performance indicators
  • CDI financial benefit tracking based on query answer & payer reimbursement model