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CHAPTER
May 6, 2021. CDI Strategies - Volume 15, Issue 18. Clinical & Coding, News, Policies & Procedures, Quality & Regulatory. Hospitals that successfully participate in the Hospital Inpatient Quality Reporting program and are meaningful EHR users could see a 2.8% payment ReadMore ».
ACDIS VIRTUAL
It's our mission: To serve as the premier healthcare community for clinical documentation specialists, providing a medium for education, professional growth, program recognition, and networking. To further that mission, ACDIS is offering a number of online and virtual education events. Click on the events in the side menu to learn more! 2021 ACDIS POCKET GUIDE The 2021 ACDIS Pocket Guide includes updates to clinical diagnostic standards, the Official Coding Guidelines, ICD-10-CM codes, CMS-HCCs and CDI critical thinking tips! The 2021 ACDIS Pocket Guide is co-written by ACDIS’ CDI Education Director Laurie Prescott, RN, MSN, CCDS, CDIP, CRC, CCDS-O, and a practicing physician steeped in the latest physician documentation terminology, James Manz NEWS: UNITEDHEALTHCARE TO USE SEPSIS-3 CRITERIA FOR PRE UnitedHealthcare has announced that, effective July 1, 2021, Medicare Advantage and commercial claims for sepsis-related treatment may be reviewed on a pre-payment or post payment basis. Claims will be reviewed using UnitedHealthcare’s Sepsis Clinical Guidelines, including use of Sepsis-3 criteria.. UnitedHealthcare states that these reviews “promote accurate diagnosis and LOG IN | POCKET RESOURCE ONLINE Log in to Pocket Resource Online. Username. Password GUIDELINES FOR ACHIEVING A COMPLIANT QUERY PRACTICE—2019 February 13, 2019. Position Papers. ACDIS Guidance, Physician Queries. “Guidelines for Achieving a Compliant Query Practice” was produced through the joint effort of the Association of Clinical Documentation Improvement Specialists (ACDIS) and the American Health Information Management Association (AHIMA). Both associations collaborated on Q&A: UNDERSTANDING SOI AND ROM IN THE APR-DRG SYSTEM First, the APR-DRG system stratifies patients into two categories—SOI and ROM—each containing four groups ranging from minor (1), moderate (2), major (3), or extreme (4). The system also takes into account the patient’s age and sex. In the APR-DRG system, a condition will impact a patient’s SOI/ROM depending on what otherconditions are
NEWS: OIG AUDIT FINDS VIRTUA OUR LADY OF LOURDES HOSPITAL The Office of Inspector General (OIG) performed a provider compliance audit of the Virtua Our Lady of Lourdes Hospital and found that the hospital received overpayments of approximately $4.8 million between January 1, 2016 and December 31, 2017.. According to the OIG, the hospital complied with Medicare billing requirements for 60 of the 100 inpatient and outpatient claims there were audited. "VERSUS" DIAGNOSIS PRECEDED BY A SYMPTOM afrady@blr.com. The guideline for Vs followed by possible causes was eliminated with the introduction of ICD 10. Current advice now suggests coding all possible diagnoses listed and letting the circumstances of admission govern the selection of pdx. Just to nitpick. "Fall" is not a medical diagnosis. (neither is "jump", "satdown" or "cheered
AKI / ARF DENIALS (NOT CLINICALLY SUPPORTED) June 2010 edited May 2016. This is one of the many reasons why ARF/AKI will become a CC after Oct 1. (more than likely), we have the same problem with BC denying ARF, depending on which auditor is reviewing which facility. The NY auditor. uses the RIFLE criteria, he uses this criteria irregardless if the. ACDISLOG INENEWSLETTER SIGNUPCONTACT USSPONSORSHIPACDIS VIRTUALNEWCHAPTER
May 6, 2021. CDI Strategies - Volume 15, Issue 18. Clinical & Coding, News, Policies & Procedures, Quality & Regulatory. Hospitals that successfully participate in the Hospital Inpatient Quality Reporting program and are meaningful EHR users could see a 2.8% payment ReadMore ».
ACDIS VIRTUAL
It's our mission: To serve as the premier healthcare community for clinical documentation specialists, providing a medium for education, professional growth, program recognition, and networking. To further that mission, ACDIS is offering a number of online and virtual education events. Click on the events in the side menu to learn more! 2021 ACDIS POCKET GUIDE The 2021 ACDIS Pocket Guide includes updates to clinical diagnostic standards, the Official Coding Guidelines, ICD-10-CM codes, CMS-HCCs and CDI critical thinking tips! The 2021 ACDIS Pocket Guide is co-written by ACDIS’ CDI Education Director Laurie Prescott, RN, MSN, CCDS, CDIP, CRC, CCDS-O, and a practicing physician steeped in the latest physician documentation terminology, James Manz NEWS: UNITEDHEALTHCARE TO USE SEPSIS-3 CRITERIA FOR PRE UnitedHealthcare has announced that, effective July 1, 2021, Medicare Advantage and commercial claims for sepsis-related treatment may be reviewed on a pre-payment or post payment basis. Claims will be reviewed using UnitedHealthcare’s Sepsis Clinical Guidelines, including use of Sepsis-3 criteria.. UnitedHealthcare states that these reviews “promote accurate diagnosis and LOG IN | POCKET RESOURCE ONLINE Log in to Pocket Resource Online. Username. Password GUIDELINES FOR ACHIEVING A COMPLIANT QUERY PRACTICE—2019 February 13, 2019. Position Papers. ACDIS Guidance, Physician Queries. “Guidelines for Achieving a Compliant Query Practice” was produced through the joint effort of the Association of Clinical Documentation Improvement Specialists (ACDIS) and the American Health Information Management Association (AHIMA). Both associations collaborated on Q&A: UNDERSTANDING SOI AND ROM IN THE APR-DRG SYSTEM First, the APR-DRG system stratifies patients into two categories—SOI and ROM—each containing four groups ranging from minor (1), moderate (2), major (3), or extreme (4). The system also takes into account the patient’s age and sex. In the APR-DRG system, a condition will impact a patient’s SOI/ROM depending on what otherconditions are
NEWS: OIG AUDIT FINDS VIRTUA OUR LADY OF LOURDES HOSPITAL The Office of Inspector General (OIG) performed a provider compliance audit of the Virtua Our Lady of Lourdes Hospital and found that the hospital received overpayments of approximately $4.8 million between January 1, 2016 and December 31, 2017.. According to the OIG, the hospital complied with Medicare billing requirements for 60 of the 100 inpatient and outpatient claims there were audited. "VERSUS" DIAGNOSIS PRECEDED BY A SYMPTOM afrady@blr.com. The guideline for Vs followed by possible causes was eliminated with the introduction of ICD 10. Current advice now suggests coding all possible diagnoses listed and letting the circumstances of admission govern the selection of pdx. Just to nitpick. "Fall" is not a medical diagnosis. (neither is "jump", "satdown" or "cheered
AKI / ARF DENIALS (NOT CLINICALLY SUPPORTED) June 2010 edited May 2016. This is one of the many reasons why ARF/AKI will become a CC after Oct 1. (more than likely), we have the same problem with BC denying ARF, depending on which auditor is reviewing which facility. The NY auditor. uses the RIFLE criteria, he uses this criteria irregardless if the.ACDIS VIRTUAL
It's our mission: To serve as the premier healthcare community for clinical documentation specialists, providing a medium for education, professional growth, program recognition, and networking. To further that mission, ACDIS is offering a number of online and virtual education events. Click on the events in the side menu to learn more! LOCAL CHAPTER UPDATE: ACDIS RECOMMENDATIONS FOR CHAPTER While ACDIS only requires chapters hold two meetings per year in order to be considered an “active” chapter, we recommend four meetings per year to keep chapter members engaged and connected throughout the year.. In normal times, ACDIS recommends holding virtual meetings in winter when travel can be complicated by unpredictable weather and in summer when scheduling can be challenging due NEW TECHNOLOGY AND CHANGE MANAGEMENT Today’s guests are Kory Anderson, MD, medical director, and Kearstin Jorgenson, MSM, CPC, COC, system operations director for Intermountain Physician Advisory Services.The show is co-hosted by Dawn Valdez, RN, LNC, CCDS, CDIP, CDI education specialist for HCPro/ACDIS.. Today’s show is supported by 3M Health Information Systems. 3M Health Information Systems, now with M*Modal, TIP: COVID-19 ANTIBODY TESTING AND CDI/CODING by Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O. The American Hospital Association recently published a Coding Clinic Advisor FAQ regarding ICD-10-CM coding for COVID-19. This article takes a closer look at the main topics addressed in the FAQ, including ICD-10-CM coding for COVID-19 antibody testing, virus signs and symptoms, and comorbidities. ACDIS UPDATE: CELEBRATE REVENUE INTEGRITY WEEK WITH NAHRI ACDIS’ sister association, the National Association of Healthcare Revenue Integrity (NAHRI), is currently hosting their fourth annual Revenue Integrity Week.The week’s celebrations ends tomorrow, June 11, so make sure to join in the fun with your revenue integrity peersnow!
ACDIS UPDATE: SUBMIT CLINICAL DEFINITIONS, VALIDATION Each and every tool in the ACDIS Resource Library was contributed by an ACDIS member and reviewed for helpfulness and compliance by the Forms & Tools Library Committee.The Library is built by members and for members, so from time to time ACDIS calls for submissions to| ACDIS
In this article, Elizabeth Morgenroth, RHIA, CPC, Curation Health’s Director of Outpatient CDI, examines why providers need to demonstrate a sense of urgency when it comes to creating an outpatient clinical documentation improvement (CDI) program and the three key steps to get started.Read More » LOG IN | POCKET RESOURCE ONLINE Log in to Pocket Resource Online. Username. Password ACDIS VIRTUAL SUMMIT: STATE OF THE CDI PROFESSION Join ACDIS April 21-22 for ACDIS Virtual Summit: State of the CDI Profession. Open to qualified CDI professionals, this event features a panel session on current best practices in CDI, ranging from concurrent coding, to secondary reviews and denials management, to evolving metrics that reflect the changing quality and reimbursementlandscape.
NEW AHIMA-ACDIS PHYSICIAN QUERY PRACTICE BRIEF With special guests Katy Good, RN, RBS, CCS, CCDS, Training Materials Specialist for Enjoin CDI, and Fran Jurcak, MSN, RN, CCDS, Vice President of Clinical Affairs for Iodine Software.Both were contributors to the new query brief. Co-hosted by Allen Frady, RN, BSN, CCDS, CCS, CDI Education Specialist for ACDIS. To read Guidelines for Achieving a Compliant Query Practice--2019 update in its ACDISLOG INENEWSLETTER SIGNUPCONTACT USSPONSORSHIPACDIS VIRTUALNEWCHAPTER
May 6, 2021. CDI Strategies - Volume 15, Issue 18. Clinical & Coding, News, Policies & Procedures, Quality & Regulatory. Hospitals that successfully participate in the Hospital Inpatient Quality Reporting program and are meaningful EHR users could see a 2.8% payment ReadMore ».
ACDIS UPDATE: INTRODUCING THE PHYSICIAN PRO ACDIS update: Introducing the Physician PRO. May 6, 2021. CDI Strategies - Volume 15, Issue 18. At the end of 2020, we introduced our ACDIS Pocket Guide online resource tool, ACDIS PRO, allowing CDI specialists to take the latest Pocket Guide anywhere, virtually. ACDIS recently released a new version of the online tool geared specificallyfor
DIRECTORY OF CREDENTIAL HOLDERS Directory of Credential Holders This directory includes currently-certified individuals, both newly-certified and those who have completed recertification requirements. The directory is updated daily. Please call 800-650-6787 if you have any questions or concerns. Please also note that any additional information, apart from that contained in this directory, will not be Q&A: TWO PRINCIPAL DIAGNOSES Q&A: Two principal diagnoses. December 17, 2020. CDI Strategies - Volume 14, Issue 56. Q: When two conditions are both present on admission, both meet definition to be the principal diagnosis, and are “equally treated,” my understanding is that the condition does not have to be "equally treated" in the sense of duration/frequency. Q&A: CLINICAL DEFINITIONS TO IMPROVE PROVIDER SUPPORT The CDI team at the University of California, San Diego, partnered with quality leads and quality medical directors to determine shared clinical definitions. “I think we processed through the four phases of grief,” says Analyn Dolopo-Simon MPH, RN, ACM, CCDS, CDI director there: “Anger—It’s coding. Denial—It’s coding. Bargaining. NEWS: EXPERTS PROPOSE NEW HEART FAILURE DEFINITION In a report by the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, and Japanese Heart Failure Society published in the Journal of Cardiac Failure, the associations have proposed a new universal definition of heart failure (HF), hoping to directly impact patient outcomes.. They propose to redefine HF as “a clinical syndrome with symptoms and Q&A: UNDERSTANDING SOI AND ROM IN THE APR-DRG SYSTEM First, the APR-DRG system stratifies patients into two categories—SOI and ROM—each containing four groups ranging from minor (1), moderate (2), major (3), or extreme (4). The system also takes into account the patient’s age and sex. In the APR-DRG system, a condition will impact a patient’s SOI/ROM depending on what otherconditions are
Q&A: HYPONATREMIA QUERY FOR CLINICAL INDICATORS The same can be said for hyponatremia. As you formulate your query, documentation of the Glasgow Coma Scale may be an additional clinical indicator as hyponatremia is a risk factor for injury to the central nervous system due to cerebral edema. As a diagnosis, hyponatremia effects the severity of illness and risk of mortality scores for a NEWS: OIG AUDIT FINDS VIRTUA OUR LADY OF LOURDES HOSPITAL The Office of Inspector General (OIG) performed a provider compliance audit of the Virtua Our Lady of Lourdes Hospital and found that the hospital received overpayments of approximately $4.8 million between January 1, 2016 and December 31, 2017.. According to the OIG, the hospital complied with Medicare billing requirements for 60 of the 100 inpatient and outpatient claims there were audited. NOTE FROM THE INSTRUCTOR: ENCEPHALOPATHY TIPS Encephalopathy is a broad term used to describe abnormal brain function or brain structure. The hallmark of encephalopathy is altered mental status. The abnormality may be transient, recurrent, or permanent. There are numerous types of encephalopathy and brain disorders with a variety of different etiologies. Some types arepermanent, some are
ACDISLOG INENEWSLETTER SIGNUPCONTACT USSPONSORSHIPACDIS VIRTUALNEWCHAPTER
May 6, 2021. CDI Strategies - Volume 15, Issue 18. Clinical & Coding, News, Policies & Procedures, Quality & Regulatory. Hospitals that successfully participate in the Hospital Inpatient Quality Reporting program and are meaningful EHR users could see a 2.8% payment ReadMore ».
ACDIS UPDATE: INTRODUCING THE PHYSICIAN PRO ACDIS update: Introducing the Physician PRO. May 6, 2021. CDI Strategies - Volume 15, Issue 18. At the end of 2020, we introduced our ACDIS Pocket Guide online resource tool, ACDIS PRO, allowing CDI specialists to take the latest Pocket Guide anywhere, virtually. ACDIS recently released a new version of the online tool geared specificallyfor
DIRECTORY OF CREDENTIAL HOLDERS Directory of Credential Holders This directory includes currently-certified individuals, both newly-certified and those who have completed recertification requirements. The directory is updated daily. Please call 800-650-6787 if you have any questions or concerns. Please also note that any additional information, apart from that contained in this directory, will not be Q&A: TWO PRINCIPAL DIAGNOSES Q&A: Two principal diagnoses. December 17, 2020. CDI Strategies - Volume 14, Issue 56. Q: When two conditions are both present on admission, both meet definition to be the principal diagnosis, and are “equally treated,” my understanding is that the condition does not have to be "equally treated" in the sense of duration/frequency. Q&A: CLINICAL DEFINITIONS TO IMPROVE PROVIDER SUPPORT The CDI team at the University of California, San Diego, partnered with quality leads and quality medical directors to determine shared clinical definitions. “I think we processed through the four phases of grief,” says Analyn Dolopo-Simon MPH, RN, ACM, CCDS, CDI director there: “Anger—It’s coding. Denial—It’s coding. Bargaining. NEWS: EXPERTS PROPOSE NEW HEART FAILURE DEFINITION In a report by the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, and Japanese Heart Failure Society published in the Journal of Cardiac Failure, the associations have proposed a new universal definition of heart failure (HF), hoping to directly impact patient outcomes.. They propose to redefine HF as “a clinical syndrome with symptoms and Q&A: UNDERSTANDING SOI AND ROM IN THE APR-DRG SYSTEM First, the APR-DRG system stratifies patients into two categories—SOI and ROM—each containing four groups ranging from minor (1), moderate (2), major (3), or extreme (4). The system also takes into account the patient’s age and sex. In the APR-DRG system, a condition will impact a patient’s SOI/ROM depending on what otherconditions are
Q&A: HYPONATREMIA QUERY FOR CLINICAL INDICATORS The same can be said for hyponatremia. As you formulate your query, documentation of the Glasgow Coma Scale may be an additional clinical indicator as hyponatremia is a risk factor for injury to the central nervous system due to cerebral edema. As a diagnosis, hyponatremia effects the severity of illness and risk of mortality scores for a NEWS: OIG AUDIT FINDS VIRTUA OUR LADY OF LOURDES HOSPITAL The Office of Inspector General (OIG) performed a provider compliance audit of the Virtua Our Lady of Lourdes Hospital and found that the hospital received overpayments of approximately $4.8 million between January 1, 2016 and December 31, 2017.. According to the OIG, the hospital complied with Medicare billing requirements for 60 of the 100 inpatient and outpatient claims there were audited. NOTE FROM THE INSTRUCTOR: ENCEPHALOPATHY TIPS Encephalopathy is a broad term used to describe abnormal brain function or brain structure. The hallmark of encephalopathy is altered mental status. The abnormality may be transient, recurrent, or permanent. There are numerous types of encephalopathy and brain disorders with a variety of different etiologies. Some types arepermanent, some are
ACDIS VIRTUAL
It's our mission: To serve as the premier healthcare community for clinical documentation specialists, providing a medium for education, professional growth, program recognition, and networking. To further that mission, ACDIS is offering a number of online and virtual education events. Click on the events in the side menu to learn more! CERTIFIED CLINICAL DOCUMENTATION AND CERTIFICATION ACDIS provides the resources you need to become a Certified Clinical Documentation Specialist (CCDS) for a variety of specialized disciplines including education in anatomy and physiology, pathophysiology, pharmacology, medical coding guidelines, and more. CCDS certification starts here. 2021 ACDIS POCKET GUIDE The 2021 ACDIS Pocket Guide includes updates to clinical diagnostic standards, the Official Coding Guidelines, ICD-10-CM codes, CMS-HCCs and CDI critical thinking tips! The 2021 ACDIS Pocket Guide is co-written by ACDIS’ CDI Education Director Laurie Prescott, RN, MSN, CCDS, CDIP, CRC, CCDS-O, and a practicing physician steeped in the latest physician documentation terminology, James Manz ACDIS UPDATE: INTRODUCING THE PHYSICIAN PRO ACDIS update: Introducing the Physician PRO. May 6, 2021. CDI Strategies - Volume 15, Issue 18. At the end of 2020, we introduced our ACDIS Pocket Guide online resource tool, ACDIS PRO, allowing CDI specialists to take the latest Pocket Guide anywhere, virtually. ACDIS recently released a new version of the online tool geared specificallyfor
LOCAL CHAPTER UPDATE: ACDIS RECOMMENDATIONS FOR CHAPTER While ACDIS only requires chapters hold two meetings per year in order to be considered an “active” chapter, we recommend four meetings per year to keep chapter members engaged and connected throughout the year.. In normal times, ACDIS recommends holding virtual meetings in winter when travel can be complicated by unpredictable weather and in summer when scheduling can be challenging due DIRECTORY OF CREDENTIAL HOLDERS Directory of Credential Holders This directory includes currently-certified individuals, both newly-certified and those who have completed recertification requirements. The directory is updated daily. Please call 800-650-6787 if you have any questions or concerns. Please also note that any additional information, apart from that contained in this directory, will not be NEW TECHNOLOGY AND CHANGE MANAGEMENT Today’s guests are Kory Anderson, MD, medical director, and Kearstin Jorgenson, MSM, CPC, COC, system operations director for Intermountain Physician Advisory Services.The show is co-hosted by Dawn Valdez, RN, LNC, CCDS, CDIP, CDI education specialist for HCPro/ACDIS.. Today’s show is supported by 3M Health Information Systems. 3M Health Information Systems, now with M*Modal,| ACDIS
In this article, Elizabeth Morgenroth, RHIA, CPC, Curation Health’s Director of Outpatient CDI, examines why providers need to demonstrate a sense of urgency when it comes to creating an outpatient clinical documentation improvement (CDI) program and the three key steps to get started.Read More » ACDIS UPDATE: SUBMIT CLINICAL DEFINITIONS, VALIDATION Each and every tool in the ACDIS Resource Library was contributed by an ACDIS member and reviewed for helpfulness and compliance by the Forms & Tools Library Committee.The Library is built by members and for members, so from time to time ACDIS calls for submissions to ACDIS UPDATE: CELEBRATE REVENUE INTEGRITY WEEK WITH NAHRI ACDIS’ sister association, the National Association of Healthcare Revenue Integrity (NAHRI), is currently hosting their fourth annual Revenue Integrity Week.The week’s celebrations ends tomorrow, June 11, so make sure to join in the fun with your revenue integrity peersnow!
ACDISLOG INENEWSLETTER SIGNUPCONTACT USSPONSORSHIPACDIS VIRTUALNEWCHAPTER
The ongoing VA efforts to modernize their electronic health record (EHR) system will likely cost between $1 billion and $2.6 billion morethan
ACDIS VIRTUAL
ACDIS Virtual Events. Like all of us during the COVID-19 pandemic, the CDI community needs to practice physical distancing to help keep eachother safe.
2021 ACDIS POCKET GUIDE The 2021 ACDIS Pocket Guide includes updates to clinical diagnostic standards, the Official Coding Guidelines, ICD-10-CM codes, CMS-HCCs and CDI critical thinking tips! The 2021 ACDIS Pocket Guide is co-written by ACDIS’ CDI Education Director Laurie Prescott, RN, MSN, CCDS, CDIP, CRC, CCDS-O, and a practicing physician steeped in the latest physician documentation terminology, James Manz NEWS: UNITEDHEALTHCARE TO USE SEPSIS-3 CRITERIA FOR PRE UnitedHealthcare has announced that, effective July 1, 2021, Medicare Advantage and commercial claims for sepsis-related treatment may be reviewed on a pre-payment or post payment basis. Claims will be reviewed using UnitedHealthcare’s Sepsis Clinical Guidelines, including use of Sepsis-3 criteria.. UnitedHealthcare states that these reviews “promote accurate diagnosis and GUIDELINES FOR ACHIEVING A COMPLIANT QUERY PRACTICE—2019 “Guidelines for Achieving a Compliant Query Practice” was produced through the joint effort of the Association of Clinical Documentation Improvement Specialists (ACDIS) and the American Health Information Management Association (AHIMA). Q&A: UNDERSTANDING SOI AND ROM IN THE APR-DRG SYSTEM Q: I need some help understanding severity of illness (SOI) and risk of mortality (ROM) as it’s my first encounter with APR-DRG factors that may affect reimbursement. First, how does one measure the SOI and ROM? Could you elaborate on how complications or comorbidities (CC) and major CCs (MCC) affect severity levels? Second, what are the criteria for choosing the levels for Q&A: HYPONATREMIA QUERY FOR CLINICAL INDICATORS When I was trained as a new CDI specialist, I was told that I could query for hyponatremia with two low sodium (NA) values as a clinical indicator as it shows that while it is not necessarily being treated, hyponatremia is being monitored. A recent conversation with a senior CDI specialist on our team, however, made me question this approach. I know about pseudo-hyponatremia NEWS: OIG AUDIT FINDS VIRTUA OUR LADY OF LOURDES HOSPITAL The Office of Inspector General (OIG) performed a provider compliance audit of the Virtua Our Lady of Lourdes Hospital and found that the hospital received overpayments of approximately $4.8 million between January 1, 2016 and December 31, 2017.. According to the OIG, the hospital complied with Medicare billing requirements for 60 of the 100 inpatient and outpatient claims there were audited. "VERSUS" DIAGNOSIS PRECEDED BY A SYMPTOM The guideline for Vs followed by possible causes was eliminated with the introduction of ICD 10. Current advice now suggests coding all possible diagnoses listed and letting the circumstances of admission govern the selection of pdx. AKI / ARF DENIALS (NOT CLINICALLY SUPPORTED) We've been getting denials for ARF but they don't bother to tell us why they're denying it. In my appeal letters, I reiterate the fact that there is no gold standard, despite the increasing use of RIFLE, and I will find and cite research articles that either disparage the use of a single standard or that suggest another standard. ACDISLOG INENEWSLETTER SIGNUPCONTACT USSPONSORSHIPACDIS VIRTUALNEWCHAPTER
The ongoing VA efforts to modernize their electronic health record (EHR) system will likely cost between $1 billion and $2.6 billion morethan
ACDIS VIRTUAL
ACDIS Virtual Events. Like all of us during the COVID-19 pandemic, the CDI community needs to practice physical distancing to help keep eachother safe.
2021 ACDIS POCKET GUIDE The 2021 ACDIS Pocket Guide includes updates to clinical diagnostic standards, the Official Coding Guidelines, ICD-10-CM codes, CMS-HCCs and CDI critical thinking tips! The 2021 ACDIS Pocket Guide is co-written by ACDIS’ CDI Education Director Laurie Prescott, RN, MSN, CCDS, CDIP, CRC, CCDS-O, and a practicing physician steeped in the latest physician documentation terminology, James Manz NEWS: UNITEDHEALTHCARE TO USE SEPSIS-3 CRITERIA FOR PRE UnitedHealthcare has announced that, effective July 1, 2021, Medicare Advantage and commercial claims for sepsis-related treatment may be reviewed on a pre-payment or post payment basis. Claims will be reviewed using UnitedHealthcare’s Sepsis Clinical Guidelines, including use of Sepsis-3 criteria.. UnitedHealthcare states that these reviews “promote accurate diagnosis and GUIDELINES FOR ACHIEVING A COMPLIANT QUERY PRACTICE—2019 “Guidelines for Achieving a Compliant Query Practice” was produced through the joint effort of the Association of Clinical Documentation Improvement Specialists (ACDIS) and the American Health Information Management Association (AHIMA). Q&A: UNDERSTANDING SOI AND ROM IN THE APR-DRG SYSTEM Q: I need some help understanding severity of illness (SOI) and risk of mortality (ROM) as it’s my first encounter with APR-DRG factors that may affect reimbursement. First, how does one measure the SOI and ROM? Could you elaborate on how complications or comorbidities (CC) and major CCs (MCC) affect severity levels? Second, what are the criteria for choosing the levels for Q&A: HYPONATREMIA QUERY FOR CLINICAL INDICATORS When I was trained as a new CDI specialist, I was told that I could query for hyponatremia with two low sodium (NA) values as a clinical indicator as it shows that while it is not necessarily being treated, hyponatremia is being monitored. A recent conversation with a senior CDI specialist on our team, however, made me question this approach. I know about pseudo-hyponatremia NEWS: OIG AUDIT FINDS VIRTUA OUR LADY OF LOURDES HOSPITAL The Office of Inspector General (OIG) performed a provider compliance audit of the Virtua Our Lady of Lourdes Hospital and found that the hospital received overpayments of approximately $4.8 million between January 1, 2016 and December 31, 2017.. According to the OIG, the hospital complied with Medicare billing requirements for 60 of the 100 inpatient and outpatient claims there were audited. "VERSUS" DIAGNOSIS PRECEDED BY A SYMPTOM The guideline for Vs followed by possible causes was eliminated with the introduction of ICD 10. Current advice now suggests coding all possible diagnoses listed and letting the circumstances of admission govern the selection of pdx. AKI / ARF DENIALS (NOT CLINICALLY SUPPORTED) We've been getting denials for ARF but they don't bother to tell us why they're denying it. In my appeal letters, I reiterate the fact that there is no gold standard, despite the increasing use of RIFLE, and I will find and cite research articles that either disparage the use of a single standard or that suggest another standard. NEW TECHNOLOGY AND CHANGE MANAGEMENT Today’s guests are Kory Anderson, MD, medical director, and Kearstin Jorgenson, MSM, CPC, COC, system operations director for Intermountain Physician Advisory Services.The show is co-hosted by Dawn Valdez, RN, LNC, CCDS, CDIP, CDI education specialist for HCPro/ACDIS.. Today’s show is supported by 3M Health Information Systems. 3M Health Information Systems, now with M*Modal,RECERTIFICATION
CCDS Recertification Click here for the list of items accepted as continuing education credits (CEUs) for CCDS recertification Click here for vendor and Local Chapter CCDS CEU applications (not applicable for individual CCDS certification holders)| ACDIS
In this article, Elizabeth Morgenroth, RHIA, CPC, Curation Health’s Director of Outpatient CDI, examines why providers need to demonstrate a sense of urgency when it comes to creating an outpatient clinical documentation improvement (CDI) program and the three key steps to get started.Read More » TIP: COVID-19 ANTIBODY TESTING AND CDI/CODING by Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O. The American Hospital Association recently published a Coding Clinic Advisor FAQ regarding ICD-10-CM coding for COVID-19. This article takes a closer look at the main topics addressed in the FAQ, including ICD-10-CM coding for COVID-19 antibody testing, virus signs and symptoms, and comorbidities. GUIDELINES FOR ACHIEVING A COMPLIANT QUERY PRACTICE—2019 “Guidelines for Achieving a Compliant Query Practice” was produced through the joint effort of the Association of Clinical Documentation Improvement Specialists (ACDIS) and the American Health Information Management Association (AHIMA). ACDIS UPDATE: CELEBRATE REVENUE INTEGRITY WEEK WITH NAHRI ACDIS’ sister association, the National Association of Healthcare Revenue Integrity (NAHRI), is currently hosting their fourth annual Revenue Integrity Week.The week’s celebrations ends tomorrow, June 11, so make sure to join in the fun with your revenue integrity peersnow!
NEWS: MACS RESUME POST-PAYMENT REVIEWS OF CLAIMS SUBMITTED In response to the COVID-19 pandemic, CMS paused all Medicare Administrative Contractor (MAC) and Recovery Audit Contractor (RAC) activity in April 2020. The agency then announced they would restart reviews in August 2020, regardless of the state of the public health emergency, focusing only on claims submitted before March 2020 (essentially, pre-pandemic claims). ACDIS VIRTUAL SUMMIT: STATE OF THE CDI PROFESSION Join ACDIS April 21-22 for ACDIS Virtual Summit: State of the CDI Profession. Open to qualified CDI professionals, this event features a panel session on current best practices in CDI, ranging from concurrent coding, to secondary reviews and denials management, to evolving metrics that reflect the changing quality and reimbursementlandscape.
LOG IN | POCKET RESOURCE ONLINE Log in to Pocket Resource Online. Username. Password NEWS: 33% OF HOSPITALS’ DENIAL RATES ARE IN THE ‘DANGER Thirty-three percent of hospital executives said their organization’s average rate of denials is in the “danger zone” (i.e., more than 10% of all claims), according to a recently released survey by Harmony Healthcare.The findings were based on a survey of 131 hospital executives surveyed via LinkedIn between April 27 and May 20, according to Becker’s Hospital Review. ACDISLOG INENEWSLETTER SIGNUPCONTACT USSPONSORSHIPACDIS VIRTUALNEWCHAPTER
May 6, 2021. CDI Strategies - Volume 15, Issue 18. Clinical & Coding, News, Policies & Procedures, Quality & Regulatory. Hospitals that successfully participate in the Hospital Inpatient Quality Reporting program and are meaningful EHR users could see a 2.8% payment ReadMore ».
ACDIS VIRTUAL
It's our mission: To serve as the premier healthcare community for clinical documentation specialists, providing a medium for education, professional growth, program recognition, and networking. To further that mission, ACDIS is offering a number of online and virtual education events. Click on the events in the side menu to learn more! CERTIFIED CLINICAL DOCUMENTATION AND CERTIFICATION ACDIS provides the resources you need to become a Certified Clinical Documentation Specialist (CCDS) for a variety of specialized disciplines including education in anatomy and physiology, pathophysiology, pharmacology, medical coding guidelines, and more. CCDS certification starts here. 2021 ACDIS POCKET GUIDE The 2021 ACDIS Pocket Guide includes updates to clinical diagnostic standards, the Official Coding Guidelines, ICD-10-CM codes, CMS-HCCs and CDI critical thinking tips! The 2021 ACDIS Pocket Guide is co-written by ACDIS’ CDI Education Director Laurie Prescott, RN, MSN, CCDS, CDIP, CRC, CCDS-O, and a practicing physician steeped in the latest physician documentation terminology, James Manz GUIDELINES FOR ACHIEVING A COMPLIANT QUERY PRACTICE—2019 February 13, 2019. Position Papers. ACDIS Guidance, Physician Queries. “Guidelines for Achieving a Compliant Query Practice” was produced through the joint effort of the Association of Clinical Documentation Improvement Specialists (ACDIS) and the American Health Information Management Association (AHIMA). Both associations collaborated on Q&A: UNDERSTANDING SOI AND ROM IN THE APR-DRG SYSTEM First, the APR-DRG system stratifies patients into two categories—SOI and ROM—each containing four groups ranging from minor (1), moderate (2), major (3), or extreme (4). The system also takes into account the patient’s age and sex. In the APR-DRG system, a condition will impact a patient’s SOI/ROM depending on what otherconditions are
Q&A: HYPONATREMIA QUERY FOR CLINICAL INDICATORS The same can be said for hyponatremia. As you formulate your query, documentation of the Glasgow Coma Scale may be an additional clinical indicator as hyponatremia is a risk factor for injury to the central nervous system due to cerebral edema. As a diagnosis, hyponatremia effects the severity of illness and risk of mortality scores for a NEWS: OIG AUDIT FINDS VIRTUA OUR LADY OF LOURDES HOSPITAL The Office of Inspector General (OIG) performed a provider compliance audit of the Virtua Our Lady of Lourdes Hospital and found that the hospital received overpayments of approximately $4.8 million between January 1, 2016 and December 31, 2017.. According to the OIG, the hospital complied with Medicare billing requirements for 60 of the 100 inpatient and outpatient claims there were audited. "VERSUS" DIAGNOSIS PRECEDED BY A SYMPTOM afrady@blr.com. The guideline for Vs followed by possible causes was eliminated with the introduction of ICD 10. Current advice now suggests coding all possible diagnoses listed and letting the circumstances of admission govern the selection of pdx. Just to nitpick. "Fall" is not a medical diagnosis. (neither is "jump", "satdown" or "cheered
AKI / ARF DENIALS (NOT CLINICALLY SUPPORTED) June 2010 edited May 2016. This is one of the many reasons why ARF/AKI will become a CC after Oct 1. (more than likely), we have the same problem with BC denying ARF, depending on which auditor is reviewing which facility. The NY auditor. uses the RIFLE criteria, he uses this criteria irregardless if the. ACDISLOG INENEWSLETTER SIGNUPCONTACT USSPONSORSHIPACDIS VIRTUALNEWCHAPTER
May 6, 2021. CDI Strategies - Volume 15, Issue 18. Clinical & Coding, News, Policies & Procedures, Quality & Regulatory. Hospitals that successfully participate in the Hospital Inpatient Quality Reporting program and are meaningful EHR users could see a 2.8% payment ReadMore ».
ACDIS VIRTUAL
It's our mission: To serve as the premier healthcare community for clinical documentation specialists, providing a medium for education, professional growth, program recognition, and networking. To further that mission, ACDIS is offering a number of online and virtual education events. Click on the events in the side menu to learn more! CERTIFIED CLINICAL DOCUMENTATION AND CERTIFICATION ACDIS provides the resources you need to become a Certified Clinical Documentation Specialist (CCDS) for a variety of specialized disciplines including education in anatomy and physiology, pathophysiology, pharmacology, medical coding guidelines, and more. CCDS certification starts here. 2021 ACDIS POCKET GUIDE The 2021 ACDIS Pocket Guide includes updates to clinical diagnostic standards, the Official Coding Guidelines, ICD-10-CM codes, CMS-HCCs and CDI critical thinking tips! The 2021 ACDIS Pocket Guide is co-written by ACDIS’ CDI Education Director Laurie Prescott, RN, MSN, CCDS, CDIP, CRC, CCDS-O, and a practicing physician steeped in the latest physician documentation terminology, James Manz GUIDELINES FOR ACHIEVING A COMPLIANT QUERY PRACTICE—2019 February 13, 2019. Position Papers. ACDIS Guidance, Physician Queries. “Guidelines for Achieving a Compliant Query Practice” was produced through the joint effort of the Association of Clinical Documentation Improvement Specialists (ACDIS) and the American Health Information Management Association (AHIMA). Both associations collaborated on Q&A: UNDERSTANDING SOI AND ROM IN THE APR-DRG SYSTEM First, the APR-DRG system stratifies patients into two categories—SOI and ROM—each containing four groups ranging from minor (1), moderate (2), major (3), or extreme (4). The system also takes into account the patient’s age and sex. In the APR-DRG system, a condition will impact a patient’s SOI/ROM depending on what otherconditions are
Q&A: HYPONATREMIA QUERY FOR CLINICAL INDICATORS The same can be said for hyponatremia. As you formulate your query, documentation of the Glasgow Coma Scale may be an additional clinical indicator as hyponatremia is a risk factor for injury to the central nervous system due to cerebral edema. As a diagnosis, hyponatremia effects the severity of illness and risk of mortality scores for a NEWS: OIG AUDIT FINDS VIRTUA OUR LADY OF LOURDES HOSPITAL The Office of Inspector General (OIG) performed a provider compliance audit of the Virtua Our Lady of Lourdes Hospital and found that the hospital received overpayments of approximately $4.8 million between January 1, 2016 and December 31, 2017.. According to the OIG, the hospital complied with Medicare billing requirements for 60 of the 100 inpatient and outpatient claims there were audited. "VERSUS" DIAGNOSIS PRECEDED BY A SYMPTOM afrady@blr.com. The guideline for Vs followed by possible causes was eliminated with the introduction of ICD 10. Current advice now suggests coding all possible diagnoses listed and letting the circumstances of admission govern the selection of pdx. Just to nitpick. "Fall" is not a medical diagnosis. (neither is "jump", "satdown" or "cheered
AKI / ARF DENIALS (NOT CLINICALLY SUPPORTED) June 2010 edited May 2016. This is one of the many reasons why ARF/AKI will become a CC after Oct 1. (more than likely), we have the same problem with BC denying ARF, depending on which auditor is reviewing which facility. The NY auditor. uses the RIFLE criteria, he uses this criteria irregardless if the. CERTIFIED CLINICAL DOCUMENTATION AND CERTIFICATION ACDIS provides the resources you need to become a Certified Clinical Documentation Specialist (CCDS) for a variety of specialized disciplines including education in anatomy and physiology, pathophysiology, pharmacology, medical coding guidelines, and more. CCDS certification starts here.| ACDIS
In this article, Elizabeth Morgenroth, RHIA, CPC, Curation Health’s Director of Outpatient CDI, examines why providers need to demonstrate a sense of urgency when it comes to creating an outpatient clinical documentation improvement (CDI) program and the three key steps to get started.Read More »| ACDIS
by Carolyn Riel. I know that summer doesn’t officially begin for a few more weeks, but June always feels like the unofficial start of summer. It’s when the weather really starts to stay consistently warm in New England, the sun is up later into the evening, restaurantsswitch over
TIP: COVID-19 ANTIBODY TESTING AND CDI/CODING by Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O. The American Hospital Association recently published a Coding Clinic Advisor FAQ regarding ICD-10-CM coding for COVID-19. This article takes a closer look at the main topics addressed in the FAQ, including ICD-10-CM coding for COVID-19 antibody testing, virus signs and symptoms, and comorbidities. ACDIS VIRTUAL SUMMIT: STATE OF THE CDI PROFESSION Join ACDIS April 21-22 for ACDIS Virtual Summit: State of the CDI Profession. Open to qualified CDI professionals, this event features a panel session on current best practices in CDI, ranging from concurrent coding, to secondary reviews and denials management, to evolving metrics that reflect the changing quality and reimbursementlandscape.
Q&A: CLINICAL DEFINITIONS TO IMPROVE PROVIDER SUPPORT The CDI team at the University of California, San Diego, partnered with quality leads and quality medical directors to determine shared clinical definitions. “I think we processed through the four phases of grief,” says Analyn Dolopo-Simon MPH, RN, ACM, CCDS, CDI director there: “Anger—It’s coding. Denial—It’s coding. Bargaining.WEBINARS | ACDIS
September 19, 2016. Webinars. Risk adjustment requires coding and CDI professionals to work together as one team to ensure the capture of the most appropriate risk score for each patient. This free webinar will explore ways to expand your CDI department into outpatient settings and services-all of which can impact risk 2020 CANDIDATE HANDBOOK 2020 HCPro, a Simplify Compliance brand | 6 ˜˚˛˝˙˝˚ˆˇ˘ ˚˛˝ ˜˚˛˝˙ˆ˙˚ˇ˘˜ ˙ ˙ ˘ ˚ ˝ ˝˙ ˘ ˚ ˙ ˙ ˝ A year of experience is defined as full-time employment or greater than 2,000 hours worked during LOG IN | POCKET RESOURCE ONLINE Log in to Pocket Resource Online. Username. Password THREE STEPS FOR LAUNCHING A SUCCESSFUL OUTPATIENT CDI In this article, Elizabeth Morgenroth, RHIA, CPC, Curation Health’s Director of Outpatient CDI, examines why providers need to demonstrate a sense of urgency when it comes to creating an outpatient clinical documentation improvement (CDI) program and the three key steps to getstarted.
ACDISLOG INENEWSLETTER SIGNUPCONTACT USSPONSORSHIPACDIS VIRTUALNEWCHAPTER
May 6, 2021. CDI Strategies - Volume 15, Issue 18. Clinical & Coding, News, Policies & Procedures, Quality & Regulatory. Hospitals that successfully participate in the Hospital Inpatient Quality Reporting program and are meaningful EHR users could see a 2.8% payment ReadMore ».
CERTIFIED CLINICAL DOCUMENTATION AND CERTIFICATION ACDIS provides the resources you need to become a Certified Clinical Documentation Specialist (CCDS) for a variety of specialized disciplines including education in anatomy and physiology, pathophysiology, pharmacology, medical coding guidelines, and more. CCDS certification starts here. ABOUT CCDS-O CERTIFICATION About the CCDS-O Certification. ACDIS developed the Certified Clinical Documentation Specialist-Outpatient (CCDS-O) to provide a trusted baseline of competency for CDI in the outpatient setting, which includes physician practices, hospital clinics, and the emergency department, among other settings. Q&A: UNDERSTANDING SOI AND ROM IN THE APR-DRG SYSTEM First, the APR-DRG system stratifies patients into two categories—SOI and ROM—each containing four groups ranging from minor (1), moderate (2), major (3), or extreme (4). The system also takes into account the patient’s age and sex. In the APR-DRG system, a condition will impact a patient’s SOI/ROM depending on what otherconditions are
LOG IN | POCKET RESOURCE ONLINE Log in to Pocket Resource Online. Username. Password GUEST POST: PSI QUIRKS James S. Kennedy, MD, CCS, CDIP, CCDS . by James S. Kennedy, MD, CCS, CDIP, CCDS . As I mentioned previously, during my review of Patient Safety Indicator (PSI) version 7.0, I came across a few quirks that I think CDI and coding professionals need to be aware of.. PSI 04, Death Rate among Surgical Inpatients with Serious Treatable Conditions: The universe for this death rate includes patientsCALIFORNIA | ACDIS
Click here to download the March 2021 California chapter newsletter. The California ACDIS chapter meets every other month via webinar and hosts an annual full-day event, which gathered more than 100 attendees at Good Samaritan Hospital Robert Armstrong Memorial Auditorium in SanJose in 2016.
ACDIS DAY3-5 TRACK5-9 PRES 0517-ROGERS-F 16 Neonatal Coding Guidelines • Since providers may use different criteria in determining prematurity, capture only when documented bythe
NOTE FROM THE INSTRUCTOR: REPORTING POST-OPERATIVE ACUTE By Allen Frady, RN-BSN, CCDS, CCS, CRC Recently, I came across a discussion on the ACDIS Forum about physicians’ failure to document acute respiratory insufficiency or, in many cases, over-documenting the conditions post-operatively. From a coding/reporting standpoint, respiratory insufficiency or failure (depending on the severity and the provider’s judgement) should not be "VERSUS" DIAGNOSIS PRECEDED BY A SYMPTOM afrady@blr.com. The guideline for Vs followed by possible causes was eliminated with the introduction of ICD 10. Current advice now suggests coding all possible diagnoses listed and letting the circumstances of admission govern the selection of pdx. Just to nitpick. "Fall" is not a medical diagnosis. (neither is "jump", "satdown" or "cheered
ACDISLOG INENEWSLETTER SIGNUPCONTACT USSPONSORSHIPACDIS VIRTUALNEWCHAPTER
May 6, 2021. CDI Strategies - Volume 15, Issue 18. Clinical & Coding, News, Policies & Procedures, Quality & Regulatory. Hospitals that successfully participate in the Hospital Inpatient Quality Reporting program and are meaningful EHR users could see a 2.8% payment ReadMore ».
CERTIFIED CLINICAL DOCUMENTATION AND CERTIFICATION ACDIS provides the resources you need to become a Certified Clinical Documentation Specialist (CCDS) for a variety of specialized disciplines including education in anatomy and physiology, pathophysiology, pharmacology, medical coding guidelines, and more. CCDS certification starts here. ABOUT CCDS-O CERTIFICATION About the CCDS-O Certification. ACDIS developed the Certified Clinical Documentation Specialist-Outpatient (CCDS-O) to provide a trusted baseline of competency for CDI in the outpatient setting, which includes physician practices, hospital clinics, and the emergency department, among other settings. Q&A: UNDERSTANDING SOI AND ROM IN THE APR-DRG SYSTEM First, the APR-DRG system stratifies patients into two categories—SOI and ROM—each containing four groups ranging from minor (1), moderate (2), major (3), or extreme (4). The system also takes into account the patient’s age and sex. In the APR-DRG system, a condition will impact a patient’s SOI/ROM depending on what otherconditions are
LOG IN | POCKET RESOURCE ONLINE Log in to Pocket Resource Online. Username. Password GUEST POST: PSI QUIRKS James S. Kennedy, MD, CCS, CDIP, CCDS . by James S. Kennedy, MD, CCS, CDIP, CCDS . As I mentioned previously, during my review of Patient Safety Indicator (PSI) version 7.0, I came across a few quirks that I think CDI and coding professionals need to be aware of.. PSI 04, Death Rate among Surgical Inpatients with Serious Treatable Conditions: The universe for this death rate includes patientsCALIFORNIA | ACDIS
Click here to download the March 2021 California chapter newsletter. The California ACDIS chapter meets every other month via webinar and hosts an annual full-day event, which gathered more than 100 attendees at Good Samaritan Hospital Robert Armstrong Memorial Auditorium in SanJose in 2016.
ACDIS DAY3-5 TRACK5-9 PRES 0517-ROGERS-F 16 Neonatal Coding Guidelines • Since providers may use different criteria in determining prematurity, capture only when documented bythe
NOTE FROM THE INSTRUCTOR: REPORTING POST-OPERATIVE ACUTE By Allen Frady, RN-BSN, CCDS, CCS, CRC Recently, I came across a discussion on the ACDIS Forum about physicians’ failure to document acute respiratory insufficiency or, in many cases, over-documenting the conditions post-operatively. From a coding/reporting standpoint, respiratory insufficiency or failure (depending on the severity and the provider’s judgement) should not be "VERSUS" DIAGNOSIS PRECEDED BY A SYMPTOM afrady@blr.com. The guideline for Vs followed by possible causes was eliminated with the introduction of ICD 10. Current advice now suggests coding all possible diagnoses listed and letting the circumstances of admission govern the selection of pdx. Just to nitpick. "Fall" is not a medical diagnosis. (neither is "jump", "satdown" or "cheered
ACDIS VIRTUAL
It's our mission: To serve as the premier healthcare community for clinical documentation specialists, providing a medium for education, professional growth, program recognition, and networking. To further that mission, ACDIS is offering a number of online and virtual education events. Click on the events in the side menu to learn more!HOW TO APPLY
How to apply for the CCDS exam Understand the program and its requirements The other sections on this website, including the Examination Candidate's Handbook, provide specific and detailed information about the Certified Clinical Documentation Specialist (CCDS) credential and its requirements. It is the candidate's responsibility to read and understand the contents of theRECERTIFICATION
CCDS Recertification Click here for the list of items accepted as continuing education credits (CEUs) for CCDS recertification Click here for vendor and Local Chapter CCDS CEU applications (not applicable for individual CCDS certification holders)| ACDIS
by Carolyn Riel. I know that summer doesn’t officially begin for a few more weeks, but June always feels like the unofficial start of summer. It’s when the weather really starts to stay consistently warm in New England, the sun is up later into the evening, restaurantsswitch over
ACDIS TIP: THE DIFFERENCE BETWEEN ANC AND WBC COUNT A low neutrophil count is called neutropenia. The ANC can be calculated by { (% of neutrophils + % of bands) divided by 100} x WBC count = ANC. An ANC count of less than 1,000 or lower is an indicator of a weakened immune system. There are different types of WBCs (leukocytes) including lymphocytes, monocytes, neutrophils,eosinophils, and
CALIFORNIA | ACDIS
Click here to download the March 2021 California chapter newsletter. The California ACDIS chapter meets every other month via webinar and hosts an annual full-day event, which gathered more than 100 attendees at Good Samaritan Hospital Robert Armstrong Memorial Auditorium in SanJose in 2016.
GUEST COLUMN: AIRWAY PROTECTION? NOW WHAT? By Rita Garcia, BAS, LVN, CCDS The first time I read “airway protection” documented in the medical record, I realized it would require a more in-depth record review and research because airway protection by itself is not a diagnosis. It does, however, imply potential or impending complications related to the patient’s protective airway mechanisms. 2019 UPDATE: GUIDELINES FOR ACHIEVING A COMPLIANT QUERY 2019 update: Guidelines for achieving a compliant query practice. March 1, 2019. CDI Journal - Volume 13, Issue 2. Note: To read the complete version of the new query practice brief that includes sample queries and references, click here. This American Health Information Management Association – Association of Clinical DocumentationVTE CORE MEASURE
The patient has a history of DVT and is on eliquis daily. The eCQM algorithm- "encounter with prior or present Diagnosis of Atrial fibrillation or VTE.QUERY FOR SHOCK
Tracey, Here is some verbiage I used recently. Maybe you can find something useful in it. Could you render your opinion as to the clinical significance , if any, and the diagnosis being treated in ACDISLOG INENEWSLETTER SIGNUPCONTACT USSPONSORSHIPACDIS VIRTUALNEWCHAPTER
May 6, 2021. CDI Strategies - Volume 15, Issue 18. Clinical & Coding, News, Policies & Procedures, Quality & Regulatory. Hospitals that successfully participate in the Hospital Inpatient Quality Reporting program and are meaningful EHR users could see a 2.8% payment ReadMore ».
CERTIFIED CLINICAL DOCUMENTATION AND CERTIFICATION ACDIS provides the resources you need to become a Certified Clinical Documentation Specialist (CCDS) for a variety of specialized disciplines including education in anatomy and physiology, pathophysiology, pharmacology, medical coding guidelines, and more. CCDS certification starts here. ABOUT CCDS-O CERTIFICATION About the CCDS-O Certification. ACDIS developed the Certified Clinical Documentation Specialist-Outpatient (CCDS-O) to provide a trusted baseline of competency for CDI in the outpatient setting, which includes physician practices, hospital clinics, and the emergency department, among other settings. Q&A: UNDERSTANDING SOI AND ROM IN THE APR-DRG SYSTEM First, the APR-DRG system stratifies patients into two categories—SOI and ROM—each containing four groups ranging from minor (1), moderate (2), major (3), or extreme (4). The system also takes into account the patient’s age and sex. In the APR-DRG system, a condition will impact a patient’s SOI/ROM depending on what otherconditions are
LOG IN | POCKET RESOURCE ONLINE Log in to Pocket Resource Online. Username. Password GUEST POST: PSI QUIRKS James S. Kennedy, MD, CCS, CDIP, CCDS . by James S. Kennedy, MD, CCS, CDIP, CCDS . As I mentioned previously, during my review of Patient Safety Indicator (PSI) version 7.0, I came across a few quirks that I think CDI and coding professionals need to be aware of.. PSI 04, Death Rate among Surgical Inpatients with Serious Treatable Conditions: The universe for this death rate includes patientsCALIFORNIA | ACDIS
Click here to download the March 2021 California chapter newsletter. The California ACDIS chapter meets every other month via webinar and hosts an annual full-day event, which gathered more than 100 attendees at Good Samaritan Hospital Robert Armstrong Memorial Auditorium in SanJose in 2016.
ACDIS DAY3-5 TRACK5-9 PRES 0517-ROGERS-F 16 Neonatal Coding Guidelines • Since providers may use different criteria in determining prematurity, capture only when documented bythe
NOTE FROM THE INSTRUCTOR: REPORTING POST-OPERATIVE ACUTE By Allen Frady, RN-BSN, CCDS, CCS, CRC Recently, I came across a discussion on the ACDIS Forum about physicians’ failure to document acute respiratory insufficiency or, in many cases, over-documenting the conditions post-operatively. From a coding/reporting standpoint, respiratory insufficiency or failure (depending on the severity and the provider’s judgement) should not be "VERSUS" DIAGNOSIS PRECEDED BY A SYMPTOM afrady@blr.com. The guideline for Vs followed by possible causes was eliminated with the introduction of ICD 10. Current advice now suggests coding all possible diagnoses listed and letting the circumstances of admission govern the selection of pdx. Just to nitpick. "Fall" is not a medical diagnosis. (neither is "jump", "satdown" or "cheered
ACDISLOG INENEWSLETTER SIGNUPCONTACT USSPONSORSHIPACDIS VIRTUALNEWCHAPTER
May 6, 2021. CDI Strategies - Volume 15, Issue 18. Clinical & Coding, News, Policies & Procedures, Quality & Regulatory. Hospitals that successfully participate in the Hospital Inpatient Quality Reporting program and are meaningful EHR users could see a 2.8% payment ReadMore ».
CERTIFIED CLINICAL DOCUMENTATION AND CERTIFICATION ACDIS provides the resources you need to become a Certified Clinical Documentation Specialist (CCDS) for a variety of specialized disciplines including education in anatomy and physiology, pathophysiology, pharmacology, medical coding guidelines, and more. CCDS certification starts here. ABOUT CCDS-O CERTIFICATION About the CCDS-O Certification. ACDIS developed the Certified Clinical Documentation Specialist-Outpatient (CCDS-O) to provide a trusted baseline of competency for CDI in the outpatient setting, which includes physician practices, hospital clinics, and the emergency department, among other settings. Q&A: UNDERSTANDING SOI AND ROM IN THE APR-DRG SYSTEM First, the APR-DRG system stratifies patients into two categories—SOI and ROM—each containing four groups ranging from minor (1), moderate (2), major (3), or extreme (4). The system also takes into account the patient’s age and sex. In the APR-DRG system, a condition will impact a patient’s SOI/ROM depending on what otherconditions are
LOG IN | POCKET RESOURCE ONLINE Log in to Pocket Resource Online. Username. Password GUEST POST: PSI QUIRKS James S. Kennedy, MD, CCS, CDIP, CCDS . by James S. Kennedy, MD, CCS, CDIP, CCDS . As I mentioned previously, during my review of Patient Safety Indicator (PSI) version 7.0, I came across a few quirks that I think CDI and coding professionals need to be aware of.. PSI 04, Death Rate among Surgical Inpatients with Serious Treatable Conditions: The universe for this death rate includes patientsCALIFORNIA | ACDIS
Click here to download the March 2021 California chapter newsletter. The California ACDIS chapter meets every other month via webinar and hosts an annual full-day event, which gathered more than 100 attendees at Good Samaritan Hospital Robert Armstrong Memorial Auditorium in SanJose in 2016.
ACDIS DAY3-5 TRACK5-9 PRES 0517-ROGERS-F 16 Neonatal Coding Guidelines • Since providers may use different criteria in determining prematurity, capture only when documented bythe
NOTE FROM THE INSTRUCTOR: REPORTING POST-OPERATIVE ACUTE By Allen Frady, RN-BSN, CCDS, CCS, CRC Recently, I came across a discussion on the ACDIS Forum about physicians’ failure to document acute respiratory insufficiency or, in many cases, over-documenting the conditions post-operatively. From a coding/reporting standpoint, respiratory insufficiency or failure (depending on the severity and the provider’s judgement) should not be "VERSUS" DIAGNOSIS PRECEDED BY A SYMPTOM afrady@blr.com. The guideline for Vs followed by possible causes was eliminated with the introduction of ICD 10. Current advice now suggests coding all possible diagnoses listed and letting the circumstances of admission govern the selection of pdx. Just to nitpick. "Fall" is not a medical diagnosis. (neither is "jump", "satdown" or "cheered
ACDIS VIRTUAL
It's our mission: To serve as the premier healthcare community for clinical documentation specialists, providing a medium for education, professional growth, program recognition, and networking. To further that mission, ACDIS is offering a number of online and virtual education events. Click on the events in the side menu to learn more!HOW TO APPLY
How to apply for the CCDS exam Understand the program and its requirements The other sections on this website, including the Examination Candidate's Handbook, provide specific and detailed information about the Certified Clinical Documentation Specialist (CCDS) credential and its requirements. It is the candidate's responsibility to read and understand the contents of theRECERTIFICATION
CCDS Recertification Click here for the list of items accepted as continuing education credits (CEUs) for CCDS recertification Click here for vendor and Local Chapter CCDS CEU applications (not applicable for individual CCDS certification holders)| ACDIS
by Carolyn Riel. I know that summer doesn’t officially begin for a few more weeks, but June always feels like the unofficial start of summer. It’s when the weather really starts to stay consistently warm in New England, the sun is up later into the evening, restaurantsswitch over
ACDIS TIP: THE DIFFERENCE BETWEEN ANC AND WBC COUNT A low neutrophil count is called neutropenia. The ANC can be calculated by { (% of neutrophils + % of bands) divided by 100} x WBC count = ANC. An ANC count of less than 1,000 or lower is an indicator of a weakened immune system. There are different types of WBCs (leukocytes) including lymphocytes, monocytes, neutrophils,eosinophils, and
CALIFORNIA | ACDIS
Click here to download the March 2021 California chapter newsletter. The California ACDIS chapter meets every other month via webinar and hosts an annual full-day event, which gathered more than 100 attendees at Good Samaritan Hospital Robert Armstrong Memorial Auditorium in SanJose in 2016.
GUEST COLUMN: AIRWAY PROTECTION? NOW WHAT? By Rita Garcia, BAS, LVN, CCDS The first time I read “airway protection” documented in the medical record, I realized it would require a more in-depth record review and research because airway protection by itself is not a diagnosis. It does, however, imply potential or impending complications related to the patient’s protective airway mechanisms. 2019 UPDATE: GUIDELINES FOR ACHIEVING A COMPLIANT QUERY 2019 update: Guidelines for achieving a compliant query practice. March 1, 2019. CDI Journal - Volume 13, Issue 2. Note: To read the complete version of the new query practice brief that includes sample queries and references, click here. This American Health Information Management Association – Association of Clinical DocumentationVTE CORE MEASURE
The patient has a history of DVT and is on eliquis daily. The eCQM algorithm- "encounter with prior or present Diagnosis of Atrial fibrillation or VTE.QUERY FOR SHOCK
Tracey, Here is some verbiage I used recently. Maybe you can find something useful in it. Could you render your opinion as to the clinical significance , if any, and the diagnosis being treated inACDIS |
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CDI NEWS
NOTE FROM THE ACDIS EDITOR: HAPPY JUNE!June 3, 2021
CDI Strategies - Volume 15, Issue 22Education
_by Carolyn Riel_
I know that summer doesn’t officially begin for a few more weeks, but June always feels like the unofficial start...Read More » NEWS: HALF OF DISCHARGED HOSPITALIZED COVID-19 PATIENTS IN DECLININGHEALTH
June 3, 2021
CDI Strategies - Volume 15, Issue 22News
A study from Michigan Medicine found that nearly half of COVID-19 patients left the hospital with...ReadMore »
NEWS: VA EHR MODERNIZATION COSTS TO INCREASEJune 3, 2021
CDI Strategies - Volume 15, Issue 22News
The ongoing VA efforts to modernize their electronic health record (EHR) system will likely cost between $1 billion and $2.6 billion morethan...Read More »
NEWS: PHYSICIAN COMPENSATION STABLE DURING PANDEMICJune 3, 2021
CDI Strategies - Volume 15, Issue 22News
Physician compensation during the COVID-19 pandemic remained largely unchanged, even as just about everything else across the healthcare landscape...Read More » Q&A: MENTAL INCOMPETENCYJune 3, 2021
CDI Strategies - Volume 15, Issue 22 Ask ACDIS , Clinical & Coding I believe there was a Coding Clinic several years ago where the diagnosis of “mental incompetence” was changed to “intellectual disability,” but I...Read More » ACDIS UPDATE: THE 2021 CDI WEEK THEME IS…June 3, 2021
CDI Strategies - Volume 15, Issue 22Education
CDI Week serves as an annual week of recognition for those professionals in the clinical documentation...Read More »View More News
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