Looking Beyond RNs for CDI Roles

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 Chinedum Mogbo MBBS, RHIA, CDIP, CCDS, CCS


Clinical documentation improvement (CDI) is the recognized process of improving healthcare records to improve patient outcomes documentation, data quality, and accurate reimbursement. The profession has grown in response to the Centers for Medicare and Medicaid Services (CMS) Diagnostic-Related Group (DRG) system, and gained greater notice around 2007. CDI professionals act as intermediaries between coding professionals (who translate diagnoses into data), healthcare providers, and nurses. As many clinical coding professionals don’t have patient care backgrounds, and healthcare providers may not realize the importance of accurate documentation, CDI professionals serve as the connection between these two groups.1

CDI has become a hot topic over the years, with widespread interest and debate regarding who qualifies to be a CDI professional. The fact that there is little specialized academic education or curriculum for CDI only intensifies the debate.

Generally, because of their medical background and experience interacting with physicians, registered nurses (RNs) have been looked to when it comes to filling CDI roles. A strong medical background is essential to critically analyze a physician’s documentation and tie together the clinical picture that the documentation is intended to reflect.

While nurses have dominated the CDI field for a while, we now have other medical professionals like physicians (both US- and foreign-trained), physician assistants, medical school graduates, and coding professionals who have started to make a mark in the CDI world.

As previously noted, a strong clinical background is beneficial to accurately review a health record, but coding knowledge is also a valuable skill set to precisely interpret the health record data. The role of CDI is a good fit for a variety of healthcare professionals—including coding professionals, who through their experience in reviewing health records understand the complexities of documentation.

Although we still have some healthcare organizations restricting the hire of CDI professionals to only RNs (I still see job advertisements requesting that only RNs apply), a good number of healthcare organizations have come to the realization that medical graduates, physicians, physician assistants, and coding professionals can also be a good fit for CDI roles—which is truly encouraging. I believe everyone with medical background andknowledge, good communication skills, good critical and analytical skills, and coding knowledge make excellent CDI professionals.

I am a foreign-trained physician who has worked in the CDI world for a good number of years, and I can say that the CDI world, with time, has opened up to be more accepting of other professionals. I have trained a good number of foreign-trained physicians in CDI and I have seen them flourish as CDI professionals.

My only hope is that organizations like AHIMA and ACDIS blaze the trail and encourage organizations to think outside the box when hiring CDI professionals.

  1. Brown, Linda Renee. (February 2013). “The secret life of a clinical documentation improvement specialist.” Nursing 43 (2) (Supplement): 10–12. http://www.nursingcenter.com/journalarticle?Article_ID=1493953&Journal_ID=54016&Issue_ID=1493946.


Chinedum Mogbo is manager, CDI for Tenet Health’s California Market.


  1. I couldn’t agree more with this article. Experienced coders with excellent clinical knowledge and good communication skills can be a perfect fit for a CDI role.

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    • Amen! I have been reviewing medical records for 22 years as an insurance defense paralegal & I love it. I was frustrated that almost ALL the healthcare medical record review & summary jobs are directed toward RNs. NOW I can say that I am heading the CDI direction with confidence!

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  2. While the concept of coding professionals with a strong bent for clinical medicine transitioning into the CDI profession makes perfect sense to me, the reality is most coders are unfortunately shut out of the CDI arena. The mitigating factor is consulting companies have promoted and advocated for nurses as the only individuals competent to be CDI specialists, virtually locking out the coding profession from making inroads in the CDI space. Hospitals have bought into the fallacy and misnomer of nurses only as CDI professionals, not recognizing and oblivious to the fact that other skill sets far and above clinical acumen and past patient experience are a requisite to demonstrating competency as an accomplished CDI specialists. There is far more than the purported ability of nurses to effectively communicate with the physician on documentation improvement issues and concerns. By the way, the CDI profession is moving away from communicating with physicians on documentation improvement opportunities, given the fact so many CDI staff are remote, simply lobbing queries at physicians from cubicles offsite or from a desk located at home. This is certainly not communicating with physicians in any logical shape or form

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  3. I agree with Chinedum. Great post. Thank you

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    • Hmmm, it seems like this article is promoting physicians (or the next best) to start looking into CDI. The coding professional is still at the bottom, even in this article (they are the last one’s to be mentioned behind MD, Phys-asst.,foreign-trained MD’s etc).

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  4. Great article Chinedum, more states have to be open to make use of the skills that are going to waste such as foreign physicians residing in USA. Sadly in my state they will not even offer CDI positions to anyone else than RNs. These positions don’t require someone who can write prescription or monitor side effects of drugs. More acceptance needed for foreign trained physicians doing cdip and they are doing so well in the field.

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  5. I was excited to see and read this article. It is due time that other dedicated professionals will be considered to fill the CDI role. This field truly evolves through constant awareness. Great to see these opportunities.

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  6. HIM professionals can distinguish themselves in their post-discharge pre-bill queries that manage all the ICD-10-CM/PCS risk models in play and in their construction of clinical validation queries and appeals. JAHIMA should have more articles describing these dynamics. Furthermore, AHIMA should be more active in reducing the CDI work burden. The requirement that ICD-10-CM/PCS coding rely only on provider documentation is unnecessarily expensive.

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