The work of a CDI professional can at times seem isolating and unimportant. Does it matter if a query gets answered? When we educate physicians, and tell them what they document matters, are they listening? Then a case comes along and demonstrates not just that the CDI profession does matter—but that it matters a lot. That point was driven home to me while reading a May 16, 2017 court document, United States of America ex rel. Benjamin Poehling v. UnitedHealth Group, Inc., in which the Department of Justice (DOJ), alleges that UnitedHealth artificially increased Medicare Advantage (MA) reimbursement/Hierarchical Condition Category assignment by mining for non-supported diagnoses that were not documented/reported by the physician or through chart documentation.

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

Before the first word of an appeal is ever written, review the denial chart thoroughly with the hospital’s appeal response ream. An appeal response team does not need to be big and certainly should not follow the usual constraints imposed by traditional hospital committee structure.

Q: Sometimes I confuse the secondary diagnosis for the primary diagnosis. Do you have any tips for me to help me discern better?

A: This question touches on several concepts essentially at the core of CDI practices. I think you are confusing three definitions:

1. Primary diagnosis
2. Principal diagnosis
3. Secondary diagnosis

Let’s take each of these individually.

With the summer months swiftly behind us, it’s time to start looking toward fall for the next great local chapter events. And, it’s going to be a busy month at that. The second week of September is really when things start to ramp up. In fact, there are three large events taking place in different locations across the country on Friday, September 15.

You might recall that Boot Camp Instructor Laurie L. Prescott, MSN, RN, CCDS, CDIP, CRC, will be presenting a “Where’s Waldo?” themed presentation at the ACDIS Symposium: Outpatient CDI in a couple weeks. Well, we wanted to know where in the world our Boot Camp instructors will be over the coming weeks—other than at the podium for the Symposium, that is. Maybe you’ll catch them near you!

If you’ll be in Chicago the week before the Symposium (September 11-14), be on the lookout for Boot Camp Instructor Allen Frady, RN, BSN, CCDS, CCS, CRC, who will be teaching the original Clinical Documentation Improvement Boot Camp! This one is especially helpful for those who are a bit newer to CDI as it offers a comprehensive look at the duties of the role.

If you’re in Dallas, Texas, September 18-20, be on the lookout for Frady teaching the Risk Adjustment Documentation and Coding Boot Camp while Prescott presents her Waldo session at the Symposium.

Did you know there’s a new CDI tip, trick, or post on the ACDIS Blog every day? In case you haven’t subscribed just yet, the ACDIS team put together a list of the articles you might have missed from the last month. Here’s what’s been happening from August 1-August 31.