coding is. HIM professionals with coding backgrounds understand how researchers and organizations such as the Centers
for Disease Control and Prevention use codes to identify patient
populations and conduct statistical analyses to reach conclusions on treatments and diagnoses.
“We have an advantage there in that we know that process and
how the clinical record connects to a code number. HIM professionals know more about how to analyze data, where to find it,
and how to present it. We also have a lot of experience managing processes and workflows and leading large groups of people.
HIM departments are often led by individuals who used to be
coders,” Hess says.
The Case for a Hybrid Dream Team
It would take work to transition CDI teams made up of only
nurses or only coding or HIM professionals to a hybrid team
with a perfect ratio of each perspective. But providers that have
been lucky enough to deliberately hire a mix are glad they did.
In her consulting work, Hess encourages providers launching
CDI programs to hire a team that’s made up of half clinicians
and half individuals with HIM backgrounds. When facilities
have the option of including physicians in that group, all the
better. In many places, CDI teams comprised of foreign-born
MDs have also been successful.
Hess says that if she were to assemble a hybrid CDI “dream
team” she would have nurses paired up with HIM professionals and they would be given the same tasks during the workday.
Ideally, the pairs would set aside 10- or 15-minute meetings at
the beginning and end of each day to discuss their cases.
“That’s a really nice learning tool and it also helps build their
relationship together,” Hess says. “In complicated care settings
there are always issues that need to be talked through.”
Irina Zusman, RHIA, CCS, CCDS, director of HIM, coding, and
CDI initiatives at New York University Langone Health, was en-
couraged to form a hybrid CDI team by a consultant who had
seen good results in other facilities. Zusman says the suggestion
was quite a new concept at the time. Once she had a blended
CDI team in place, however, they became “famous” at the facil-
ity for helping physicians with documentation questions, in part
because the HIM professionals on the team understood data
analysis and clinical concepts.
“It came to the point where we don’t have to run after the phy-
sicians. They’re coming to us because they know we can help
and analyze data and explain how they can improve their re-
imbursement using some other methods. How they document
so they can directly capture PSIs, what kind of clarifications
they can provide. So yeah, I think that we were lucky in many
respects,” Zusman says. “I talk to people who say, ‘We only hire
RNs with ICU experience’ or ‘We don’t hire foreign medical
graduates,’ and we have foreign medical graduates working in
our program. I think that CDI is a multifaceted profession, and
every background brings something else and enriches it. We are
living in the era of data. In order to analyze data you really have
to understand coding.”
Having hybrid teams lets CDI professionals play to their
strengths while acknowledging areas where they might have
Carolyn Page, CDIP, CCS, coding manager and CDI liaison at
Sisters of Charity Leavenworth Health System, oversees clinical
documentation specialists who are all nurses that are required
to get a CDI credential. Even though her clinical documentation
specialists aren’t hybrid by definition, they work in close collaboration with coders. The team has taken an integrated approach
to pre-bill reconciliation where clinical documentation specialists and coders work together on every bill.
“With implementation of the CDI program, it was a great opportunity to collaborate and bring the clinical and coding side
together,” Page says. “The reason we like it is that you just give
everybody the opportunity to do what they do best. Nurses do
clinical, coders do coding, then we bring them together before
the bill goes out the door and hopefully get a bill that comes
back without a denial—and the cooperation has paid off.
“We decreased our rebill percentages dramatically because of
pre-bill reconciliation… The other thing was satisfaction among
the team. Coders learned so much from CDS [clinical documentation specialists] and CDS learned from coders at the time of
coding, even if it was email back and forth. We’ve seen tremendous increases in job satisfaction,” Page says.
One thing on which healthcare professionals on both sides
of the CDI qualification spectrum agree, however, is the notion that CDI shouldn’t be considered solely the domain of
professionals with one background. CDI professionals should
be hired, they say, based on their abilities, skills, training, and
“Part of the conversation around the CDI role is one of the
things I find people don’t talk about,” says Sutter Health’s Evans.
“I’m being very honest. I have a lot of RN friends that are wonderful in this role. I’ve trained many RNs. I’m not saying only
we [HIM] can do this. I’m saying if a person displays the critical
skills and abilities to think critically and logically and work in a
compliant manner with clinical knowledge, the person should
be considered suitable for this role.” ¢
1. Combs, Tammy. “The State of CDI.” Journal of AHIMA 90, no. 4 (April 2019): 18-21. http://bok.ahima.org/
Mary Butler ( firstname.lastname@example.org) is associate editor at the Journal of
Coders or Nurses for CDI
Teams: Both Work Best
Quiz ID: Q1919007 | EXPIRATION DATE: JULY 1, 2020
HIM Domain Area: Clinical Data Management
Article—“Coders or Nurses for CDI Teams: Why Hiring Both to
Collaborate Works Best”
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