Expanding clinical conversations to involve all players can only benefit the entire organization.

EDITOR’S NOTE: This article is based upon Dr. Erica Remer’s remarks during a recent live Talk Ten Tuesdays Internet broadcast.

A while back, I told readers about a fun activity I do with one of my clients. In order to give their clinical documentation integrity specialists (CDISs) regular education, we regularly hold a half-hour conference call about a topic of their choice.

Their analyst prepares the presentation, and I serve, as I affectionately call it, as the color commentator. For those of you who don’t watch sports on television, a color commentator is a chatty co-host who assists the play-by-play commentator, filling in when play is not in progress.

I add the clinical perspective. I expand on the CDI topic. I mention some coding nuances. I go off on some tangent.

I wanted to share something we did a few weeks ago, because I think you could try doing it at your facility.

Their acting physician advisor had contacted me for my opinion on a medical necessity case that was fascinating and multi-faceted. It was a patient with an abscess and cellulitis from injecting an illicit substance. The ED personnel was unable to perform an incision and drainage in the emergency department.

The first question was what the appropriate status determination was, but there were numerous other points to address the coding and the clinical documentation.

What was really exciting was that we invited the utilization review/case management team and the coders to participate in the call. We usually have about 35 participants, and that day we had 99 callers. We knocked down the silos and had a fascinating interdisciplinary discussion about how to support the clinical providers’ documentation.

The medical necessity aspect was eye-opening to the CDISs, who didn’t realize that their efforts in making each patient look as sick and complex as they really also support the utilization management (UM) folks. If a patient is placed in the wrong status and it is not resolved prior to discharge, serious financial repercussions can ensue.

The UR/CM folks don’t always know what the CDISs can do to help support them, or how getting complications and co-morbidities (CCs) and major CCs (MCCs) change the DRG tier and affect reimbursement.

Also, coders always appreciate being included in clinical discussions, because it helps them more deeply understand the medical issues and allows them to bring their coding expertise to the table.

I have to confess that I am prejudiced. I think that institutions should always invite the clinical documentation team to participate in all their ventures. When I was a physician advisor, our system started setting up best-practice, high-reliability medicine groups for different conditions and specialties. The first one I was invited to be a member of was the colorectal group because the chair was a strong proponent of clinical documentation. In fact, in the first meeting, he made me blush when he announced that he thought I was going to be the most important team member present. What he was trying to convey was that he thought once they had ironed out the wrinkles in standardizing excellent patient care, we needed to ensure that the documentation accurately represented it.

Documentation can’t fix bad medicine. But good medicine without good documentation will go unrecognized. Knockdown the silos and spread the good clinical documentation word around.


Programming Note: 

Listen to Dr. Erica Remer each Tuesday on Talk Ten Tuesday, 10-10:30 a.m. EST.


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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