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UASI in ACDIS: “Outpatient clinical validation queries offer advanced CDI opportunities” 

October 10, 2018

UASI’s Tara Bell, MSN, RN, CCDS, CCM was recently interviewed for the ACDIS blog concerning the opportunities for CDI in the outpatient setting. Click here to read the full interview. 

Bell is slated to present “Clinical Validation: Expanding Clinical Validation into Outpatient CDI” at the ACDIS Symposium: Outpatient CDI Conference in November. 

A “Different Dialect:” Moving from Inpatient to Outpatient Coding 

In the interview, the UASI experts explain why CDI reviews now cover far more ground than in the past. And as the process becomes more prevalent in the outpatient setting, the industry is becoming more aware of the varied focus areas beyond generic outpatient/ambulatory categorization. 

Even with all the nuance, as CDI expands into the outpatient area, there really isn’t that much of a difference when compared to inpatient CDI or clinical validation reviews, Bell pointed out. “I often say that the goal is the same, the language is the same, but in the outpatient world you might just be speaking a different dialect.” 

 Clinical Experience is Key 

Despite the similarities, for coding professionals making the switch, a strong clinical background is crucial. “The professional needs to be able to link the clinical indicators in the outpatient role as well,” Bell said. “The transition from inpatient to outpatient CDI can be an easy one.” 

And it’s also important for physicians to realize that the detail involved in inpatient records is just as important as in outpatient care to minimize the risk of denials. Physicians now must focus on accuracy in both inpatient and outpatient settings 

 For Proving ROI, Many of the Metrics Are the Same 

Outpatient CDI efforts will not differ too much from the inpatient setting in terms of specific metrics. But Bell noted that while coding professionals don’t need to get bogged down in worrying about the differences, it’s important to maintain a focus on the balance between productivity and accuracy: 

“The number of records a CDI staff member can review will depend on the type and focus of the review. Is the team conducting prospective, concurrent, retrospective reviews, or all three? Will there be an expectation of focused audits and reporting? How much physician education will the CDI team be conducting or will those educations session be carried out by a physician advisor or other member of the CDI team?”

While there is much uncertainty, one thing is clear: given current trends in healthcare, outpatient CDI is going to remain a hot topic for the foreseeable future.  

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