Interest in CDI Outside of the US

This monthly blog will discuss all the components of quality clinical documentation with a comprehensive approach to cover all areas of the healthcare industry.

By Wil Lo, MD, CDIP, CCA


Clinical documentation improvement (CDI) serves as a cornerstone in this era of patient-centric care, patient safety indicators, quality metrics, utilization management, performance improvement, value-based purchasing, public reporting, facility/physician profiling, and the shifting landscape of prospective and retrospective reimbursement for services rendered. It is exciting to be involved in CDI initiatives in the US. Outside of the US, CDI programs are being implemented, leading to increased demand for CDI specialists and a keen interest in the CDIP credential.

Based on the initiatives of the AHIMA World Congress and conversations with esteemed healthcare professionals from many regions, including South East Asia, the Middle East, and Europe, it is apparent that documentation challenges are rampant. Similar to the US, the documentation issues range from physicians’ inadvertent oversights to egregious disregard for the content and quality of the patient medical record.

Documentation challenges exist, regardless of the code sets. For instance, the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) is used by several countries to report diagnosis codes. ICD-10-AM contains 21,885 codes, whereas ICD-10-CM contains 69,823 codes. Likewise, the Australian Classification of Health Interventions (ACHI) is used by several countries to report inpatient procedure codes. ACHI contains 6,284 codes, compared to 71,924 code combinations present in ICD-10-PCS. The concept of the Australian Refined Diagnosis Related Groups (AR-DRGs) is similar to the MS-DRGs, in which ICD-10-AM codes, ACHI codes and other factors (e.g., age, gender, patient discharge disposition) generate one AR-DRG for each inpatient stay.

Interestingly, although there is a general consensus that ICD-10-AM and ACHI are not as specific or clinically aligned as ICD-10-CM and ICD-10-PCS, the number of AR-DRGs (698) is similar to the number of MS-DRGs (751). An inherent problem exists, due to the fact that ICD-10-AM and ACHI have fewer diagnosis and inpatient procedure codes respectively. Documentation that is too specific and precise may lead to diagnoses and procedures that are not indexed in ICD-10-AM or ACHI. As a result, more general or unspecified codes will be assigned, leading to AR-DRGs that do not reflect the severity of illness or utilization of resources during each patient’s stay. However, in countries outside of the US, lack of proper documentation appears to be the more common culprit and, in a similar fashion, will lead to the incorrect assignment of AR-DRGs.

There is another layer of complexity because the reimbursement models in most of these countries may differ from the US. Some countries utilize ICD-10-AM and ACHI, whereas other countries utilize ICD-10-AM and CPT-4 to assign codes for inpatient stays. Some countries utilize AR-DRGs and others are in the infancy stages to develop a model for prospective payment. Moreover, some countries utilize variations of ICD-10, such as ICD-10-CA, ICD-10-GM, and ICD-10-TM. It is evident that the code sets and reimbursement models may vary from country to country. However, the common theme is that improper documentation practices exist in facilities throughout the world and CDI programs are being implemented to address this issue.

Healthcare leaders from various regions in the world have discussed their plans to implement CDI programs and create CDI specialist positions in their facilities. These leaders cite patient care and safety as the compelling reasons to create CDI initiatives. These leaders have the foresight to realize that their respective countries are in the early stages of adopting a prospective payment or reimbursement model, so the concepts of AR-DRGs, case mix index, public reporting and facility/physician profiling will be addressed in the distant future. Also, these leaders recognize the versatility of the AHIMA CDIP credential as a global standard of proficiency in documentation practices and have suggested that the AHIMA CDIP credential should be a prerequisite for employment as a CDI specialist in their respective facilities.


Wil Lo ( is a CDI physician consultant.


  1. Great article! This is interesting, as I just recieved a job offer today for CDI in the Phillipines and India. I can imagine the demand for Quality CDI experts abroad. See below!

    Vice President of Healthcare Coding Operations

    This position reports into the COO, India Operations and Sr. Vice President of Client Services. The VP of Coding Operations is accountable for the P & L for coding services provided on an international scale to include growing client base, retaining current base and managing margins for both new and existing clients. This individual will be responsible for the service delivery for the coding service line in addition to the growth of this division.

    The VP of Coding Operations needs to be experienced with the entire scope and dependencies of coding operations in the revenue cycle including technical core competencies, training/development, quality improvement initiatives, offshore operations management and strong sales abilities. Additionally, this individual will need to understand the rigors of the revenue cycle and coding industry; and the competitive landscape and operate with a strong customer orientation. He/she will have a strong and established leadership style and will need to possess superb communication skills, a people-oriented, collegial style and integrate easily into a complex environment.

    • Leadership and development of service delivery coding leaders globally.
    • Meet or exceed customer expectations resulting in a high retention rate and satisfaction scores.
    • Ensure successful delivery of operating results as measured by revenue and appropriate margins, and quality.
    • Ensure successful implementation of new clients.
    • Oversee the development and implementation of global policies and procedures to assure clear and consistent operation of coding areas while encompassing departmental and organizational needs. This includes but is not limited to quality assurance, training/development and productivity standards.
    • Oversee the development and implementation of a global coding education program to all coding staff and business development staff.
    • Responsible for staff management to include engagement, training, education and retention.
    • Remain abreast of all developments in the coding and medical records field, especially as they apply to coding, reimbursement, and clinical database developments/changes.
    • Strengthen and grow coding capabilities in US, India and the Philippines to meet client and market demand.
    • This position will require significant international and domestic travel as needed.
    • Responsible and accountable for internal control implementation and performance within their area of ownership/responsibility.
    • Ensure proper internal control change management protocol is followed.

    • Minimum requirement of Bachelor’s degree in related discipline or equivalent experience required.
    • Must have a minimum 10 years’ experience in a senior leadership role involving technical coding practices and HIM processes preferably in a hospital, vendor organization or large group practice setting.
    • Certifications in coding from AHIMA/AAPC with one or more of the following credentials such as BSHIM, RHIA, CCS, CPC or other AHIMA/AAPC recognized certifications.
    • Must have a strong history/experience managing and leading offshore teams in a senior role.

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    • HI Good morning.. I heard that CDIP jobs are On-Site jobs. I am working in a medical coding company in INDIA as an Auditor. I have cleared my CCS recently and planning to write CDIP. I need suggestion whether to schedule CDIP and will there be a scope in India.

      What is the future of medical coding in india. This is the question all coders are having. Please clarify.

      Post a Reply
  2. Are there any CDI jobs in Dubai currently?

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