The Physician Advisor's Guide to Clinical Documentation Integrity, Second Edition

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The Physician Advisor's Guide to Clinical Documentation Integrity, Second Edition

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Available August 2020

The Physician Advisor’s Guide to Clinical Documentation Integrity, Second Edition

Available August 2020

Physician advisors are not just needed for case management anymore. ICD-10-CM/PCS and the changing landscape of healthcare reimbursement make their input invaluable in the realm of CDI and coding, too. This book will help your physician advisors quickly understand the vital role they play and how they can not only help improve healthcare reimbursement, but also reduce claims denials and improve the quality of care overall.

This book will:

  • Provide job descriptions and sample roles and responsibilities for CDI physician advisors
  • Outline the importance of CDI efforts in specific relation to the needs and expectations of physicians
  • Highlight documentation improvement focus areas by Major Diagnostic Category
  • Review government initiatives and claims denial patterns, providing physician advisors concrete tools to sway physician documentation


Pages: 175
Dimensions: 8.5x11 perfect bound
ISBN: 978-1-64535-022-4

Table of Contents

About the Authors

Introduction

Chapter 1: Foundations of CDI

Team Composition
Core Responsibilities
Organization of CDI Programs

Chapter 2: Coding Rules and Guidance

Official Guidelines for Coding and Reportin
Additional Coding Guidance

Chapter 3: Multiple Coding and Reimbursement Systems

Growth in Healthcare Costs
Quality Improvement Payment Methodology
CDI Benefits for Physician Efforts

Chapter 4: Physician Queries and Coding Compliance

Regulatory Environment
False Claims Act
Auditors and Other Government Efforts
Advancement of Query Guidance
Current Guidance

Chapter 5: Identifying Clinical Indicators

MDC 1: Nervous System
MDC 2/3: Disorders of Eyes; Disorders of Ears, Nose, Mouth, and Throat
MDC 4: Respiratory Diseases
MDC 5: Diseases and Disorders of the Circulatory System
MDC 6: Diseases and Disorders of the Digestive System
MDC 7: Diseases and Disorders of the Hepatobiliary System and Pancreas
MDC 8: Diseases and Disorders of the Musculoskeletal System and Connective Tissue
MDC 9: Skin, Subcutaneous Tissue, and Breast
MDC 10: Endocrine, Nutritional, and Metabolic Diseases and Disorders
MDC 11: Diseases and Disorders of the Kidney and Urinary Tract
MDC 16: Diseases and Disorders of the Blood and Blood-Forming Organs, and Immunological Disorders
MDC 17: Myeloproliferative Diseases & Disorders, Poorly Differentiated Neoplasms
MDC 18: Infectious and Parasitic Diseases
MDC 19: Mental Diseases and Disorders
MDC 20/21: Alcohol/Drug Use and Alcohol/Drug-Induced Organic Mental Disorders; Injury, Poisoning, and Toxic Effects of Drugs
MDC-24 Multiple Significant Trauma

Chapter 6: Medical Staff Engagement

CDI Steering Committee Sets the Foundation
Establish Clinical Standards Across the Facility or Health System
Understand Physician Workflow and Build the Program Around It
Provider Education Endeavors
Addressing the Financial Elephant
Specific Strategies to Promote Provider Adoption
CDI Program and Coding Team Educational Endeavors

Chapter 7: Evaluating CDI Success

Program Variances
CDI Assessments
Auditing Queries for Effectiveness
Unexpected Adverse Effects of CDI
Compliance Committee Effects
Performance Improvement Committee Effects
Final Thoughts


About the Authors

Trey La Charité, MD, FACP, SFHM, CCS, CCDS

Trey La Charité currently serves as the medical director for CDI and coding at the University of Tennessee Medical Center. He has previously served as the medical director for the University of Tennessee Medical Center’s Outpatient CDI Initiative and as the medical director for clinical integration for both the University of Tennessee Medical Center and for the University Physician’s Association, a 750-member independent provider association. He is a clinical assistant professor in the Department of Internal Medicine where he currently serves as a teaching attending and as the curriculum director for the Internal Medicine Residency Program’s hospitalist rotation. He is board certified in Internal Medicine and has been a practicing hospitalist since completion of his residency in 2002. Dr. La Charité also has responsibilities in case management, utilization review, medical records, compliance, and performance improvement.

Nicole Fox MD, MPH, FACS, CPE

Nicole Fox currently serves as the associate chief medical officer at Cooper University Health Care. In that role she supports the clinical documentation integrity program as well as the physician advisor team for utilization review. Dr. Fox is also an associate professor of surgery and practicing trauma surgeon and surgical intensivist. She is board certified in general surgery and surgical critical care and has been in practice since 2011. She serves as the trauma medical director for Cooper’s pediatric trauma center. Dr. Fox is a published researcher and vice-chair of the Guidelines Committee for the Eastern Association for the Surgery of Trauma.