fied for CDI roles, based on both their professional experiences
and educations. HIM professionals with RHIA and RHIT credentials and registered nurses undergo similar—if not identical—coursework, including classes in medical terminology,
anatomy, physiology, pharmacology, pathophysiology, biology, chemistry, and clinical pathology, according to Paul Evans,
RHIA, CCS, CCS-P, CCDS, clinical documentation team staff
member at Sutter Health, who currently works on a CDI team
made up of HIM professionals and nurses.
As someone who has worked on CDI teams with registered
nurses and even physicians, Evans sees nurses and HIM professionals as equally qualified—but pushes back against what
he sees as a pervasive assumption that HIM professionals don’t
have the clinical chops for CDI.
“When I was trained, one of my last courses in college was
from a physician. He’d give us signs and symptoms and we had
to stand up and say, ‘I think the patient has pneumonia and
diabetes, here are the tests I would order.’ He was training us to
think critically and clinically so that we could have a conversation with a physician,” Evans says.
He notes that when working with nurses, some have been
surprised by the depth of knowledge coding professionals
bring to CDI.
“There’s a different mindset when you’re looking at evidence
and thinking critically about that rather than simply following
the orders. The RNs were surprised we think that way. But really,
it’s just germane to how I was trained,” Evans says.
One reason that nurses, vendors, and consultants might underestimate coders’ clinical expertise and what they bring to the
table is the fact that coders are out of sight. Many more providers are outsourcing coders and letting them work remotely. Physicians still receive queries from coders, but that’s the extent of
Debra Beisel Denton, RHIA, CCS, CCDS, CDIP, CRCR, CICA,
supervisor, HIM system coding educator, revenue cycle and
inpatient coding auditor at Maricopa Integrated Health Sys-
tem, agrees that remote coders aren’t as able to demonstrate
their clinical knowledge to colleagues. She says technology
that allows remote work such as EHRs and coding platforms
are great, but they eliminate occasions for HIM professionals
to talk shop.
“I see it as a disadvantage to not have a peer next to you to talk to
and discuss cases—so they’re missing out on that,” Denton says.
Nurses do have that ability to have clinical discussions with
doctors, which helped them edge into HIM’s CDI territory.
“They bring a unique perspective with their clinical experi-
ence—and the fact that they have built and understand how to
drive relationships with providers,” says Deirdre LeBlanc, RHIA,
vice president for HIM, Parkland Health and Hospital System,
in Dallas, TX, where CDI specialists are RNs and report to her in
the HIM department.
LeBlanc says CDI specialists at Parkland are all nurses cur-
rently because when CDI staff transitioned from the case
management department to HIM, the department was staffed
by nurses. However, it is her interest and intention to hire
both coders and nurses depending on their availability and
skill. In addition, if CDI specialists don’t come in with a cre-
dential, they would be required to earn one during their time
While it can be accurate to say that some physicians have a
higher level of comfort working alongside nurses and commu-
nicating with them, the mindset that this domain belongs to
clinicians alone is one that that HIM professionals can—and
In CDI, “the HIM professional brings an in-depth understand-
ing of coding guidelines and an understanding of the content
that’s required in the clinical record to support so many things,”
Hess says. “Not only an accurate code, but medical necessity
guidelines and an understanding of how a payer reads the re-
cord and accepts it and pays the claim.”
Hess notes that it’s not easy for someone who has never stud-
ied coding or coded themselves to understand how far-reaching
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