Eight Predictions for ’18
Clinical Documentation Improvement
In a blog post directed at tarot card readers new
to the tradition, a veteran reader advised that it
can be overwhelming and easy to get lost in the
esoteric systems made up by tarot cards. 2 The
author told young users to form a personal connection with the
cards and identify how elements of the cards are presented in
their daily lives.
This same advice could be given to physicians by clinical documentation improvement (CDI) specialists, whose job it is to
sort through esoteric terminology to find meaning and patterns
in clinical documentation.
And just as someone’s personal background and personality
makes them good at reading tarot cards, the same goes for CDI
professionals. There’s long been a discussion brewing around
the ideal professional background of a CDI specialist, says Tammy Combs, RN, MSN, CCS, CCDS, CDIP, director of HIM practice excellence, CDI/nurse planner at AHIMA. There are two
primary schools of thought around the proper CDI background.
“This is a topic that has haunted CDI programs from their initial conception. The ongoing question of who makes the best
CDI professionals (nurses or coding professionals). The truth of
the matter is that either background has the knowledge to be
a successful CDI professional. However, many organizations
want to hire CDI professionals with a nursing background. This
is very frustrating for coding professionals wanting to work in
CDI,” Combs says.
CDI specialists will continue to be deeply involved with claims
denials in 2018. Combs says that claim denials teams are increasingly reaching out to CDI and coding professionals as subject matter experts to help identify denials for coding and documentation that should be appealed, and using them to assist in
creating solid appeal letters. AHIMA will be releasing a toolkit to
assist CDI and coding professionals with this in 2018.
The coming year will also see a continuing expansion of CDI
into specialty areas of healthcare. “We are seeing an increase in
interest in having CDI in areas such as long-term care, home
health, psychiatric units, and rehab facilities,” Combs says.
“With the shift to quality-based reimbursement it is becoming crucial for all settings to have high quality documentation
across the continuum of care.”
Inpatient and Outpatient Coding
The practice of gazing into a crystal ball, called
“scrying,” has been done for thousands of
years, and can also be done by looking at reflective surfaces such as mirrors and other
crystals. 3 Practitioners are advised to reach a meditative state
before gazing into the ball to look for symbols. Scrying takes
practice and patience.
An HIM domain that also involves lots of practice and patience
is coding, which requires a keen attention to detail and can have
a major impact on a provider’s revenue. However, it doesn’t take
a crystal ball to predict some of the trends and changes that will
occur in inpatient and outpatient coding in 2018 since regulatory agencies make it pretty clear that there are new requirements
in the pipeline.
According to Sue Bowman, MJ, RHIA, CCS, FAHIMA, senior
director of coding policy and compliance at AHIMA, starting
in January physicians will have to start reporting modifiers on
claims to indicate their relationship to the patient—known as
patient relationship modifiers. While this reporting is voluntary
in 2018, and not a condition of payment, it is a required part of
MACRA and is likely to stay for the foreseeable future, with CMS
fine-tuning the requirements along the way.
“There will be opportunities for HIM professionals to help
educate physicians on how to apply these modifiers, and cod-
ing professionals coding physician claims will likely often be
responsible for determining the appropriate relationship modi-
fier as part of the coding process,” Bowman says.
Donna Rugg, RHIT, CDIP, CCS, director of HIM practice excellence at AHIMA, sees four main issues that will impact inpatient
and outpatient coding in 2018:
3. Copy/paste and cloning in EHRs
4. Coding auditing
In terms of reimbursement, MACRA, the Merit-based In-
centive Payment System, and hierarchical condition category
(HCC) coding will be priorities for providers and coding profes-
sionals this year, Rugg says. “Some are still being implemented,
others are being revised/changed so challenges exist as well as
opportunities for HIM professionals to get involved in these new
avenues,” Rugg says. “Coding auditing is something that will be
increasing now that ICD- 10 has been in place for two years, and
organizations are focusing more on the quality and accuracy of