Unity is strength… when there is teamwork and collaboration, wonderful things can be achieved.
— Mattie Stepanek
Clinical documentation improvement (CDI) professionals have a worthy task to help identify and communicate opportunities and risks related to documentation inefficiencies in the medical record. And health information management (HIM) coding professionals are deeply devoted to identifying the correct category of codes to accurately represent patient care, resources consumed, severity of illness, and risk of mortality.
Despite clinical documentation specialists and coding professionals working diligently toward common objectives—accuracy, transparency, availability, compliance, information integrity—there is often a disconnect between applications of code methodology. This article explores root causes and offers thoughts on ways to bridge the gap.
HIM and CDI departments are different work streams for many reasons. Both have very important responsibilities to the organization, but they may have independent priorities. For example, CDI professionals reviewing for both the MS-DRG assignment and the most accurate APR-DRG assignment could deem a record incomplete, pending a provider query that might impact severity of illness or risk of mortality. On the other hand, the policy in HIM may be to finalize the record and proceed with billing if additional documentation does not impact the MS-DRG.
The differing perspectives as to what and how clinical scenarios are portrayed come from deeply ingrained learning of respective clinical and coding applications—and overreaching policies. In the example above, the conflict in opinion is: how important is the APR-DRG assignment, and should it hold up the billing process? Education may be needed to discuss the pros and cons of accurate APR-DRG (severity of illness and risk of mortality scores) assignment—not only with coding staff but also with middle and senior leadership. Sharing and reaching agreement on how to acknowledge APR-DRG assignment could promote a more cohesive approach, avoiding repeated nonproductive interplay.
According to Merriam-Webster, communication is “a process by which information is exchanged between individuals through a system of symbols, signs, or behavior.” While methods of communication can help define the intent of an exchange, most important are the expressions used to exchange information. Sincere, open-minded efforts that engage others, for the purpose of clarity and better understanding, can improve receptivity of the communication and resulting outcomes.
Our approach to resolving any policy or practice conflict will determine the overall integrity of coding and documentation efforts, and the benefits to the healthcare facility. In addition, workplace satisfaction of these two highly valuable and respected groups is necessary to support work balance, motivation, and productivity. I believe that the ability of coders and CDI professionals to engage collaboratively can influence patient outcome profiles and fiduciary accuracy.
Fortunately, HIM and CDI leaders are keenly aware of the need for harmony in the work environment. Over the past few years, great strides have been made to align coding and CDI teams to comb documentation and accurately apply governmental guidelines. Here are several examples of such efforts observed in forward-thinking facilities:
While encouraging collaboration, it is also important to recognize respective departmental lines between CDI and coding. Examples of departmental perspectives and practices might involve:
These different practices should be included in the educational initiatives for both departments and providers as appropriate. Further, it is important to draft policy that is clearly documented and available to all parties involved. Though various perspectives influence departmental boundaries, sometimes coding guidelines and/or AHA rules must be prioritized. In any case, people skills—ability to listen, communicate clearly, and understand mutual roles and responsibilities—are critical to meaningful collaboration.
According to Diana Karff, RHIA, CCS, CPC, a medical technology reimbursement consultant and former instructor at the American Coding School, “The bridges we build with a CDI team cannot be complete without coding staff members who understand basic clinical pathways and anticipated medical and procedural interventions. Established clinical pathways provide the context for the documentation framework constructed by physicians.”1
How can CDI professionals and HIM coding professionals work together to promote communication and achieve common goals? First, they must be allowed to consider and act on building a bridge of communication. There are many avenues to achieve that goal. A collaborative team approach opens the way to discuss issues and explore solutions together. Here are six strategies to encourage communication, trust, and teamwork:
Building a culture of collaboration among coders, CDI professionals, physicians, and all other stakeholders requires unity around a shared set of governing principles. Together, we can promote positive values, set shared priorities, and achieve common goals that benefit our departments independently and the organization as a whole—improved care, resulting quality scores, and value-based reimbursement.