CDI Committee – Member Articles
Artificial Intelligence Documentation Prompts Must be Compliant, Too
January 22, 2024 | Erica Remer, MD, CCDS | ICD10Monitor.com
Today I would like to share my opinion on proactive provider documentation decision-making technology. I am completely supportive of genuinely concurrent (that is, occurring in...
“Ask Dr. Remer:” Bridging the Gap Between Coders and Clinicians
January 16, 2024 | Erica Remer, MD, CCDS | ICD10Monitor.com
EDITOR’S NOTE: As you may know, Dr. Erica Remer is a consultant, in addition to serving as co-host of the long-running Talk Ten Tuesdays weekly...
Lessons to Learn from OIG HCC Reviews
January 8, 2024 | Erica Remer, MD, CCDS | ICD10Monitor.com
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a report on a Medicare Advantage Compliance Audit of SelectCare...
Solutions for Long-Distance and End-of-Life Dementia Care
December 4, 2023 | Erica Remer, MD, CCDS | ICD10Monitor.com
As I’m sure you are aware, Rosalynn Carter died recently, after a short two days in hospice. Her husband, former President Jimmy Carter, has been...
A Tool to Help Set Evaluation and Management (E&M) Levels of Service
November 13, 2023 | Erica Remer, MD, CCDS | ICD10Monitor.com
I am the Co-Director of the Intensive Course in Medical Documentation: Clinical, Legal and Economic Implications for Healthcare Providers. It is a course created to...
How Do We Code Outpatient Surgeries-Turned-Hospitalizations?
October 30, 2023 | Erica Remer, MD, CCDS | ICD10Monitor.com
Last week I wrote about when surgery should be performed as an inpatient, when it can be outpatient, and how to utilize observation services in...
Inpatient or Outpatient Surgery: Exclusive Two-Part Series
October 16, 2023 | Erica Remer, MD, CCDS | ICD10Monitor.com
EDITOR’S NOTE: This is the first portion of a two-part series of articles by Erica Remer, MD, who routinely offers guidance for determining the correct...
Coding Clinic Raises Questions About Uncertain Behavior
October 2, 2023 | Erica Remer, MD, CCDS | ICD10Monitor.com
The American Hospital Association (AHA) Coding Clinic for the third quarter of 2023 was recently published. There was a question regarding post-molar pregnancy gestational trophoblastic...
The Hospital Sepsis Program Core Elements 2023: A Blueprint for Sepsis Management
September 2023 | Erica Remer, MD, CCDS | ICD10Monitor.com
The Centers for Disease Control and Prevention (CDC) released the Hospital Sepsis Program Core Elements: 2023 to monitor and optimize hospital management and improve outcomes of sepsis.
Fixing Procedures Unrelated to Principal Diagnosis Grouping Logic in the 2024 IPPS Final Rule
August 2023 | Erica Remer, MD, CCDS | ICD10Monitor.com
The 2024 Inpatient Prospective Payment System (IPPS) Final Rule was issued in early August, 2023.
Why Words Really Do Matter in Medicine
August 2023 | Erica Remer, MD, CCDS | ICD10Monitor.com
When we have the urge to use the word, “need,” we should consider framing the discussion differently. Something important is happening, we need to think about what it means, and what all the options are. We need to provide the patient and their loved ones with the information they require to make the decision that is right for them.
Revisiting COVID-19 Screening after PHE Ends
July 2023 | Erica Remer, MD, CCDS | ICD10Monitor.com
It’s time to revisit screening for COVID-19.
Making Trauma Documentation a Little Less Traumatic
June 2023 | Erica Remer, MD, CCDS | ICD10Monitor.com
CDI in trauma is important because many mortality-related cases stem from such services, and many such patients have no prior history with the facility, so comorbidities from prior encounters may not be discoverable.
Updates from ACDIS Conference Worth Sharing
June 2023 | Erica Remer, MD, CCDS | ICD10Monitor.com
Exploration of the annual 2023 Association of Clinical Documentation Specialists (ACDIS) Conference.
Fighting Back Against Medicare Advantage SNF Denials: Part II
May 2023 | Ben Kartchner, MD | RACMonitor.com
Medicare Advantage (MA) denials related to appropriate transfer to a skilled nursing facility (SNF) and the regulations regarding medical necessity for these transfers as determined by Medicare but they do not involve many of the metrics we often hear about in peer-to-peer conversations related to “how far the patient walked” or other internal criteria. How do we put it in practice and hold them accountable to these rules?
Fighting Back Against Medicare Advantage SNF Denials: Part I
May 2023 | Ben Kartchner, MD | RACMonitor.com
A U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) report released in April 2022 stated that “a central concern in the capitated payment model used in Medicare Advantage is the potential incentive for Medicare Advantage Organizations (MAO) to deny beneficiary access to services and deny payments to providers in an attempt to increase profits.”
Six Steps to Prevent Readmission Denials
February 2023 | Erica Remer, MD, CCDS | ICD10Monitor.com
Prevention of readmission denials improves case mix index (CMI), reimbursement, and quality metrics.
SDoH: At the Intersection of Lifestyle and Patient Care
February 2023 | Erica Remer, MD, CCDS | ICD10Monitor.com
When Social Determinants of Health (SDoH) are clinically relevant, they should be attended to and documented.
How to Make the EHR More Effective
January 2023 | Erica Remer, MD, CCDS | ICD10Monitor.com
Make your documentation tell a story that makes sense to the reader.
Coding Update for Acidosis Introduced
October 2022 | Erica Remer, MD, CCDS | ICD10Monitor.com
On Oct. 1 we saw an expansion in the code set of acidosis.
ACDIS/AHIMA Practice Brief: A Gold Mine for Best Practices
October 2022 | Erica Remer, MD, CCDS | ICD10Monitor.com
Providers would benefit from heeding the advice of the newly updated file.
Are Leading Queries Prohibited by Law or Lore?
October 2022 | Erica Remer, MD, CCDS | ICD10Monitor.com
Does the law prohibit leading questions in queries?” Healthcare attorneys David Glaser and Knicole Emanuel both concurred that there is no law, rule, or regulation prohibiting leading queries, however, there is more to this.
Surgery Documentation Specificity Key to Proper Coding
September 2022 | Erica Remer, MD, CCDS
People often ask me questions about fascinating CDI topics which spawn ICD10monitor articles, Talk Ten Tuesday TalkBacks, and newsletter articles. These topics that they broach usually come from some condition which has been difficult to understand, to reconcile the coding-clinical disconnect...
Clinical Validation: The Physician Advisor’s Role
September 2022 | Ritu Prasad, MD
There are billions of reasons why denials are generated ($). The level of care/medical necessity physician advisor (PA) may be more versed in the medical necessity/status denial, whereas the clinical documentation integrity (CDI) PA is tasked with clinical validation. Originally, coding denials were Diagnosis Related Group (DRG) validation audits...
Hospital Acquired Condition 14 (HAC 14)
August 2022 | Kristin Wallick, MD, FCCP
Case: A 72 year old male with tracheobronchomalacia underwent a fiberoptic bronchoscopy, right thoracotomy, and tracheal bronchoplasty. Prior to surgery, he had a PICC line placed by intervention radiology due to poor venous access without complication. Postoperatively he developed a right...
Lessons from the Case Management Society of America (CMSA) Annual Conference
August 2022 | Erica Remer, MD, CCDS
On June 2, Dr. Ronald Hirsch and I had the pleasure of presenting in a packed room at the Case Management Society of America (CMSA) Annual Conference in Kissimmee, Florida. Our talk was entitled: Medical Necessity – A Team Effort: The Case Manager, the Physician, and the Physician Advisor. Ron handled the explanation of medical necessity, and my contribution was detailing how case managers can influence providers to...
Introducing Functional Quadriplegia
August 2022 | Erica Remer, MD, CCDS
My first day of orientation as a CDI physician advisor my patients became instantly sicker. The director of CDI taught me about certain conditions which I didn’t previously recognize or document in the ED. These included encephalopathy, malnutrition, and today’s topic, functional quadriplegia...
Physician Advisors Guide to the 2023 Physician Fee Schedule Proposed Rule
August 2022 | Erica Remer, MD, CCDS
The unofficial, unpublished FY 2023 Physician Fee Schedule Proposed Rule (CMS-1770-P)) was posted on July 7, 2022 (Regulations.gov). The published version is set to drop on July 29, so by the time you are reading this, you will be able to see the official Rule. Comments will be taken at https://www.regulations.gov/search?filter=CMS-1770-p until September 6, 2022...
Understanding Why Clinical Validation Is a Process
August 2022 | Erica Remer, MD, CCDS | ICD10Monitor.com
Clinical validation is a bit of a misnomer. However, let's consider clinical validation as the act of questioning.
Patient Safety Indicator 15 (PSI 15): Abdominopelvic Accidental Puncture or Laceration Rate
June 2022 | Timothy Brundage, MD, CCDS
The following case study examines complication coding and quality tracking through PSI 15. This is an interesting case that dissects the complicated relationship between clinical medicine, quality metrics and coding compliance...
Is Encephalopathy Making Your Head Hurt? Documentation Tips for the Physician Advisor
May 2022 | Ben Kartchner, MD
Encephalopathy remains a notoriously difficult diagnosis for clinical documentation specialists, clinicians and physician advisors to correctly identify and document. Despite its importance, it is almost universally a manifestation of some other ...
Can a Patient with Sepsis Be Discharged from the ED?
March 2022 | Erica Remer, MD, CCDS
As hospitals and clinicians, we are facing increased scrutiny of the care we provide to our patients. There is increased demand for more transparency of our outcomes and a need for increased efficiency of the care we provide in the setting of already significant documentation...
What to do in 2022?
January 2022 | Trey La Charité, MD, FACP, SFHM, CCS, CCDS
If your organization is anything like mine, you have just received the annual request for your individual and/or your program’s performance goals for 2022. Ugh. Although I have received this request for the last 15 years, it still elicits the same visceral consternation as the first time I saw it. While the clinician side of us will always be perplexed by what we view as a superfluous endeavor, we must respond if we wish to continue our physician advisor agendas. Yes, like it or not, it’s another new year. Now what?
Reviewing the 2022 Physician Fee Schedule Proposed Rule
August 10, 2021 | Erica Remer, MD, CCDS | ICD10Monitor.com
With comments to CMS due by 9/13/2021, ACPA Board of Directors member and Clinical Documentation Integrity Co-Chair Dr. Erica Remer urges everyone to review the 2022 Physician Fee Schedule Proposed Rule - in particular, the portion about split/shared billing with the professional fee - in this ICD10Monitor.com article...
Improving Efficiency Using the EHR
February 2021 | Erica Remer, MD, CCDS
During our hiatus, I read an article from the AMA entitled, “With 2 new patients a day, medical scribes are profitable in one year,” by Sara Berg. As I am sure you are all aware, physicians are experiencing burnout directly related to spending excessive time managing the medical record instead...
One Code Alone is Inadequate to Tell the COVID-19 Sequela Story
December 21, 2020 | Erica Remer, MD, CCDS | ICD10Monitor.com
ACPA BOD member and CDI Committee Co-Chair, Dr. Erica Remer implores the American Hospital Association and The American Health Information Management Assoc. to instruct the use of code Z86.16 with B94.8 - indicating a condition is a sequela of COVID-19. Read more in this ICD10monitor.com article.
We Are All One Exposure Away from Contracting COVID-19
November 2020 | Erica Remer, MD, CCDS
My personal provider’s MyChart has become pretty sophisticated. In preparation for an outpatient visit with my doctor, I have to review many aspects of my health history included past medical history, medications, and allergies, and I have the opportunity to request edits. The provider must then review...
SEP-1 and Sepsis-3 Are Not Incompatible
October 26, 2020 | Erica Remer, MD, CCDS | ICD10Monitor.com
SEP-1 is the Hospital Inpatient Quality Reporting Program measure titled “Severe Sepsis and Septic Shock: Management Bundle.” But, some have noted this Centers for Medicare & Medicaid Services definition seems to be resulting in denials from Medicare Advantage and other plans, and using their preferred Sepsis-3 definition results in falling out of core measures. ACPA BOD member and CDI Committee Co-Chair, Dr. Erica Remer, discusses this catch-22 in her latest ICD10monitor article.
It’s No Accident That the OIG is Going After Acute CVA
October 5, 2020 | Erica Remer, MD, CCDS | ICD10Monitor.com
Documentation of strokes is tricky, so it's no accident the OIG is going after Acute CVA diagnoses as explained by ACPA BOD member and CDI Committee Co-Chair, Dr. Erica Remer in her latest ICD10monitor article.
New COVID-19 Codes Coming
September 15, 2020 | Erica Remer, MD, CCDS | ICD10Monitor.com
ACPA BOD member and CDI Committee Co-Chair, Dr. Erica Remer discusses the new COVID-19-associated codes coming from the latest CMS ICD-10 Coordination and Maintenance Committee meeting in this ICD10monitor.com article.
More COVID-19 Questions Answered
August 11, 2020 | Erica Remer, MD, CCDS | ICD10Monitor.com
People are getting more sophisticated and knowledgeable about COVID-19, but our BOD member and CDI Committee Co-Chair, Dr. Erica Remer, is still getting a lot of questions, including what to do with patients who are being tested for COVID-19, had it previously, or currently test positive for antibodies for COVID-19, suggesting a previous infection. Read more in her latest ICD10monitor article.
A Novel Approach to Advance Practice Provider Documentation Engagement
August 2020 | Debra Anoff MD, FACP, FHM & Amanda Brill, MSN, ACNP-BC
As hospitals and clinicians, we are facing increased scrutiny of the care we provide to our patients. There is increased demand for more transparency of our outcomes and a need for increased efficiency of the care we provide in the setting of already significant documentation...
ICD-10 Codes for Lactic Acidosis
July 28, 2020 | Erica Remer, MD, CCDS | ICD10Monitor.com
Lactic acidosis shares the ICD-10-CM code, E87.2, Acidosis, with other causes of acidosis, respiratory or metabolic. Mixed acid-base disorders are coded at E87.4. The key question for CDISs and coders is, “when is acidosis considered integral to the causative condition and not separately codable?” Learn the answer in this ICD10monitor article from ACPA BOD member and CDI Committee Co-Chair, Dr. Erica Remer.
The OIG is Coming for your Malnutrition MCCs
July 21, 2020 | Erica Remer, MD, CCDS | ICD10Monitor.com
The OIG released a report titled, “Hospitals Overbilled Medicare $1 Billion by Incorrectly Assigning Severe Malnutrition Diagnosis Codes to Inpatient Hospital Claims.” Yowzers. Read more in this ICD10Monitor.com article from ACPA BOD member and CDI Committee Co-Chair Dr. Erica Remer.
Functional Quadriplegia: A Code for a Real Condition
July 14, 2020 | Erica Remer, MD, CCDS | ICD10Monitor.com
ACPA BOD member and Co-Chair of the CDI Committee, Erica Remer, MD, FACEP, CCDS continues her "A Question a Day Keeps the Query Away" series on ICD10monitor.com, this time featuring functional quadriplegia, ICD-10-CM code R53.2. This condition is defined as being complete immobility due to severe disability or frailty caused by another medical condition, without physical injury or damage to the brain or spinal cord.
Racial and Ethnic Inequalities During COVID-19 Can’t Be Ignored
June 29, 2020 | Erica Remer, MD, CCDS | ICD10Monitor.com
We don't know the true percentage of the population that has or has had COVID-19. But, one of the facts not being contested is that racial and ethnic minority groups are being disproportionately affected. Read more in this ICD10monitor article from ACPA BOD member and CDI Committee Co-Chair, Erica Remer, MD, FACEP, CCDS.
A Question a Day will Keep the Queries Away: Acute Blood Loss Anemia
June 22, 2020 | Erica Remer, MD, CCDS | ICD10Monitor.com
When should Acute Blood Loss Anemia be documented? ACPA BOD member and CDI Committee Co-Chair, Dr. Erica Remer delves into the details in this ICD10Monitor.com article.
Querying when a Pending COVID-19 Test Returns Results
June 11, 2020 | Erica Remer, MD, CCDS | ICD10Monitor.com
ACPA BOD member and CDI Committee Co-Chair, Erica Remer, MD, FACEP, CCDS offers her suggestions for querying providers after COVID-19 testing results return in this ICD10Monitor.com article.
10 Tips And Pointers for Physician Advisors About Documentation of Covid-19
June 2020 | Erica Remer, MD, CCDS
1. The World Health Organization’s ICD-10 lifted their code set freeze for this pandemic and created U07.1, COVID-19, virus identified. In a matter of weeks, in an unprecedented fashion...
COVID-19 and Long-Term Care: A Troubling Combination
May 13, 2020 | Ben Kartchner, MD | RACMonitor.com
ACPA member Benjamin Kartchner MD, CHCQM-PHYADV explains how providers nationwide are seeking to identify ways to mitigate the uncontrolled spread of #COVID19 amid vulnerable populations within nursing homes in this RACmonitor article.
COVID-19 Coding Dilemma: Z20.828 and Z03.818
May 5, 2020 | Erica Remer, MD, CCDS | ICD10Monitor.com
ICD-10-CM codes under the current guidelines are not robust enough to tell the story correctly. The American Hospital Association (AHA) guidance tried to eliminate some of the confusion about Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out, and Z20.828, Contact with and (suspected) exposure to viral communicable diseases. Learn more from ACPA BOD member and CDI Committee co-chair Dr. Erica Remer in this ICD10Monitor article.
I’m in a New York State of Sepsis
December 9, 2019 | Erica Remer, MD, CCDS | ICD10Monitor.com
ACPA BOD member and #CDI Committee co-chair Erica Remer, MD, FACEP, CCDS proposes early detection and successful treatment of SIRS + infection to prevent life-threatening organ dysfunction due to dysregulated systemic host response does not equate final diagnosis of #sepsis in this ICD10monitor article.
Caution: “Consensus”
December 2019 | Timothy Brundage, MD, CCDS
Consensus statements are not always consensus. I’m happy to report to the ACPA that our CDI committee is working very diligently on our sepsis education for the physician advisors. We enjoy creating material that we hope will provide value for the physician advisors who...
HCCs for the Holidays
December 2019 | Erica Remer, MD, CCDS
If you don’t know what Hierarchical Condition Categories (HCCs) are, you should. It is a risk-adjustment model, which is patient-centered in contradistinction to the encounter-based risk-adjustment inpatient model of DRGs. Diagnoses which impact the HCC model come from inpatient and outpatient encounters, professional and technical billing. Although its most robust use is in population health management...
New CC and MCC Designation Technology Explained by CMS
October 26, 2019 | Erica Remer, MD, CCDS | ICD10Monitor.com
ACPA BOD member and CDI Committee co-chair Erica Remer, MD, FACEP, CCDS describes in ICD10monitor how CMS explained recently during a conference call focusing on CC and MCC designation methodology, how they asses what CC designation a given diagnosis should have.
Does using SIRS to diagnose sepsis improve mortality?
September 30, 2019 | Erica Remer, MD, CCDS | ICD10Monitor.com
ACPA BOD member and CDI Committee co-chair Erica Remer, MD, FACEP, CCDS wonders (as do many across the country) if diagnosing and treating sepsis early truly saves lives. Read more in this ICD10monitor article.
Complete Diagnosis Set and Patient as a Whole
August 2019 | Erica Remer, MD, CCDS
I don’t think about my previous life as a practicing physician much, but I took a little trip down memory lane this morning. When I was on my pediatrics rotation, I had a supervising resident who probably had the most profound influence on my career. Dr. Deirdre Bastible was...
Expand the Role of the Physician Advisor to Break Down Silos
May 2019 | Timothy Brundage, MD, CCDS
At NPAC, I met with physicians who truly care about providing support to their hospitals. As a key takeaway from the conference, I’d like to encourage physician advisors around the country to break down the silos that exist within hospital organizations. Physician advisors should be focused on much more than patient status assignment; they should be looking at the chart from a global perspective to accurately...
Challenges of Educating Doctors on Documentation
March 2019 | Erica Remer, MD, CCDS
In response to a call for blog articles from the ACPA blogmaster Dr. Juliet Ugarte Hopkins, Dr. Erica Remer submitted this list of issues she faces when educating doctors and how to overcome them.
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