This above all: to thine own self be true,
And it must follow, as the night the day,
Thou canst not then be false to any man
– William Shakespeare
Clinical documentation should include a thorough record of all of the diagnoses for the patient (past and present), symptoms experienced, treatments and procedures planned and executed, all of the care provided, and the outcome of the treatments. This documentation naturally evolves and develops during a hospital stay, thereby presenting a challenge when trying to measure the impact of a Clinical Documentation Improvement (CDI) program.
A useful concept that helps in this measurement is the Baseline DRG, defined is the DRG that would have been coded and billed without the intervention of the CDI staff. The impact that CDI has on a patient’s chart is then measured as the difference between the Baseline DRG and the Billed DRG (either the weights or the reimbursement).
Selection of the Baseline DRG should be done carefully, honestly, and precisely. It is important that you have control over the designation of the Baseline DRG, and not leave this to automation or to non-medical staff (such as the clerk at the admissions desk).
The problem in determining the Baseline DRG and the impact of the CDI program is illustrated by the following example:
So, what is the impact of the CDI program for this patient? It is tempting to say that the impact is $12,470, which is the difference between the initial diagnosis and DRG ($5,008) and the final billed DRG ($17,478). And, this is what would be reported by software that picks up the initial diagnosis for its analysis. But in reality, the surgeon did not operate because a query was sent, so CDI can’t take credit for that. And, the documentation for the MCC designation came unprompted from the Cardiology consult. So, the impact that the CDI process had on this particular patient is $0!
Of course, responses from queries like the CDK stage query may impact Severity of Illness or Risk of Mortality. Such queries are vital to fulfill our role in producing the complete and high-quality medical record, as was discussed in a previous blog entry.
Concept of the “Baseline CMI”
Training Effect Shown by Initial CMI
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