Outpatient CDI has become the most recent CDI buzz word, and these programs are proving to be beneficial. One important aspect of Outpatient CDI is the capture of Hierarchial Condition Codes (HCCs) as the shift to value based care and Medical Advantage Plans risk adjustment payment model continues to increase.
Similar to the inpatient setting, physicians in the office-based setting are often lacking in the knowledge of what specificity is needed in the documentation to code conditions to the highest degree of specificity. To add fuel to the fire, some electronic health documentation structures are not “user friendly” for proper selection of diagnosis codes. In an already busy day, physicians often select the first available code which they believe describes the patient’s condition. Due to time pressures, other chronic conditions being managed are often not documented at all for a specific encounter.
Through improved documentation, Outpatient CDI programs can also assist in the prevention of outpatient denials. Medical necessity denials can occur when the ICD-10 CM codes are coded to an unspecified code. An unspecified code may inaccurately describe the patient’s condition, and therefore, not support the services provided.
Therefore, Outpatient CDI is certainly a buzz word worthy of attention. A CDI Specialist can assist and educate the physician in documentation gaps which prevent the coding of a condition to the highest degree of specificity. A CDI Specialist can assist the physician in the outpatient setting through either a concurrent review of the patient encounter, or post-encounter, using query clarification for accurate and precise diagnosis capture.
By Barb Brant, MPA RN CDIP CCDS CCS