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ACDIS Back in Person – And I Was There

Dr. Remer was very conflicted about attending, but had committed, so she went. This is her story. 

I’m not going to lie.

I was anxious about attending the Association of Clinical Documentation Integrity Specialists’ (ACDIS) annual national conference in person. It was being held in Dallas, and I have been concerned with the way Texas has been approaching the pandemic. ACDIS assured me they could run the conference safely, so it was a go.

There were fewer attendees than in the past – around 400-ish, with an additional approximately 100 vendor participants. Before COVID, the conference usually connected about 2,000 people. The space was large enough to accommodate social distancing. Many people I spoke with had been vaccinated. Masks were mandated when not actively eating or drinking.

Keep in mind that the coronavirus doesn’t respect eating or drinking as a reason to put its quest to procreate on pause. When I flew, I didn’t remove my N95 mask to eat or drink. Also, we humans normally breathe in and out of our noses. If your mask doesn’t go over your nose, it isn’t protecting anyone. If your mask is too big and keeps slipping down, either get a new one that fits or put a piece of tape over the top to hold it up.

I decided to attend the welcome reception with my N95 mask snugly on. I hung out with Juliet Ugarte-Hopkins at the American College of Physician Advisors booth. We recruited physician advisors to join our organization and gave out some cool goodies. Shout out to those of you who came and said hi! I think that they should no longer have alcohol available at these meet-and-greets; alcohol reduces inhibitions and relaxes judgment.

One thing in particular at ACDIS was quite clever. They distributed three color-coded lanyards with nametags. Green meant “I am comfortable with networking.” Yellow meant “I am receptive to networking, but please respect social distance.” And red meant “back off, buster, I ain’t there yet.” I actually read the instructions, because I was going to select the saucy red one to go with my outfit, but opted for the yellow one for the messaging, instead.

On Tuesday morning, Brian Murphy, the director of ACDIS, kicked us off with an inspiring talk about the state of clinical documentation integrity (CDI) and the future of ACDIS. Then, Dr. Nicole Fox did an evocative talk on resilience, managing up and down. She ended a bit early, which gave me the ability to flex. Time is like closet space to me – I ooze into whatever you give me.

My talk centered on lessons from COVID-19. I think of it like Buzz Lightyear’s “Pandemic and Beyond!”

Key points from my talk were the following:

  • How providers could phrase prolonged cases of COVID to achieve correct coding, like documenting “ongoing symptomatic” or “persistent COVID-19 infection.”
  • How to use U09.9, Post COVID-19 condition, unspecified. This is the code for the entity Merriam-Webster just added to their lexicon: long COVID. There can be myriad presentations, and the manifestation gets coded first.
  • That although we may treat empirically for a secondary bacterial infection, at the end of the day, COVID-19 is more than enough to warrant an admission.
  • How to address sepsis with COVID.
  • How breakthrough COVID, another Merriam-Webster newcomer, gets coded. There is no code to signify full vaccination and Z28.3, Under-immunization, is not appropriate for COVID-19. If a patient has had a previous infection, they may have Z86.16, Personal history of COVID-19 or U09.9, the sequela indicator.
  • How Z03.818, Contact ruled out and Z11.52, Encounter for screening for COVID-19 will be used post-pandemic.

As I said, I was very conflicted about attending, but I had committed, so I went. I also left right after my talk. I eagerly look forward to the virtual component of the conference, which we are all going to be able to access in November. I will get to attend some sessions I missed – and I really missed attending sessions!

At the airport, I saw a digital sign noting that the National Guard was giving out free COVID-19 shots at Gates B1 and C2, so I moseyed over. I asked if they were giving boosters, and they said yes. I was ecstatic when they said I could have mine. I opted to mix and match – I had been fully vaccinated with Moderna and selected a Pfizer booster. I experienced my usual headache, body aches, and fatigue the next day. I relish side effects – it makes me feel like my body is doing what it is supposed to be doing.

This brings me to the final new Merriam-Webster phrase: vaccine passport. The National Guardsman made me a new card with all my shots on it. I shrank it down and laminated it so it can fit in my wallet. I only wish more places demanded proof of vaccination. It is very regional. I know it would make me feel safer.

This may not be the last booster we need. Time will tell. And I will get mine as soon as I am able, every time.

Programming Note: Listen to Dr. Erica Remer on Talk Ten Tuesdays, 10 Eastern when she co-hosts the broadcast with Chuck Buck.

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Erica E. Remer, MD, CCDS

Erica Remer, MD, FACEP, CCDS, has a unique perspective as a practicing emergency physician for 25 years, with extensive coding, CDI, and ICD-10 expertise. As physician advisor for University Hospitals Health System in Cleveland, Ohio for four years, she trained 2,700 providers in ICD-10, closed hundreds of queries, fought numerous DRG clinical determination and medical necessity denials, and educated CDI specialists and healthcare providers with engaging, case-based presentations. She transitioned to independent consulting in July 2016. Dr. Remer is a member of the ICD10monitor editorial board and is the co-host on the popular Talk Ten Tuesdays weekly, live Internet radio broadcasts.

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