CDI: Not Just for Inpatient Any More

BY SUSAN GATEHOUSE, AXEA SOLUTIONS CEO

Once considered a luxury of well-endowed major medical facilities, clinical documentation improvement (CDI) specialists have made their way to the mainstream. The majority of facilities nationwide now provide some CDI oversight. The requirement for microscopic review of patient safety indicators, severity, and risk of mortality, along with the complexity of both patient care services and procedures, have made CDI specialists a staple of inpatient hospital coding departments.

The same cannot be said for outpatient areas. It is not a given that outpatient documentation will receive the same attention that is found in the inpatient setting. This may be because “outpatient” and “hospital” are two entities that have not historically been linked. However, healthcare is shifting to more interdependence between the outpatient and inpatient settings. This more holistic approach to patient care carries with it some logistical and reimbursement challenges.

THE HOSPITAL IS NOT THE ONLY PLACE TO GET SERVICES.

Shifting ideals of healthcare and wellness, in addition to changing reimbursement structures, have prompted hospitals to add outpatient services, either on-campus or remotely, to their retinues. Outpatient services offered close to home are attractive to a population that can get a sports physical at a pharmacy, or a flu shot at a big box store. Additionally, the move toward reimbursement linked to total population care may be a factor behind the increase in hospital-affiliated outpatient services.

Outpatient coding continues to have a significant role in the hospital itself, particularly with patients coming into the emergency department. Ambulatory surgery provided in the hospital may lead to observation stays that will be coded as outpatient.

BUT OUTPATIENT CODING IS SO MUCH SIMPLER…

Inpatient coders typically have a greater depth of knowledge because of the more complex patient records that they code. But outpatient coding should not be relegated to second-class status. While inpatients may be sicker and more complex to code, with more outpatient services offered, outpatient coding will become significantly more demanding in terms of volume. That volume equates to a greater piece of overall revenue. The importance of CDI in the outpatient setting becomes evident when the number of records is considered.

In addition, recent OPPS changes for 340B drugs further drive home the point that outpatient services are no longer considered easier to manage and code, and are not necessarily more likely to be accurately reimbursed. 

WHY CDI IS ALWAYS IMPORTANT

The primary goal of CDI is making the patient record as accurate as possible to ensure that the most correct, most granular picture of the patient is captured. Thorough documentation in any setting can make a huge difference in the outcome for every patient. For outpatient care, physicians need to have and provide excellent documentation in order to treat a patient with whom they may have only a brief encounter, but a potentially life-changing one. Goal one is always the patient's wellbeing.

It is also true that without documentation, the care might be outstanding, but the hospital will not be reimbursed for it. The hospital needs to keep its doors open, whether they be the doors at the main campus or those in an imaging center in the distant suburbs. Outpatient care may offer another stream of revenue for a hospital. It is one that deserves top-notch CDI, just as inpatient does.

Axea Solutions has proven success in assisting outpatient coding departments with the implementation of CDI, coder training, and charge reconciliation procedures. We realize that every dollar counts, and outpatient procedures and services require the same level of detailed attention that inpatient receives.