Accomplish Goals by Working Together: The ICIV Model
Both coding and clinical documentation integrity (CDI) professionals are dedicated to establishing strong, justified, and compliant reporting. What if a process was in place to intersect the strengths of both roles? That is, a defined route that could apply to all diagnoses.
When a documentation/coding issue is first identified, wouldn’t it be great if there was a process that could be followed to allow both teams to work in tandem, averting potential divergent outcomes?
This article will identify ways both teams can collaborate during patient admission and post-discharge to effectively meet documentation objectives. Identifying the specific guideposts while adhering to compliant guardrails allows both the coding and CDI professional to lay out an effective work pathway integrating clinical documentation with compliant coding. Outlined below is the Identify, Clarify, Interconnect, and Validate (ICIV) model (pronounced “eye-siv”) and a detailed example of how it can be applied.
Identify
Current journal publications or other sources, such as a Centers for Medicare & Medicaid Services (CMS) Target Probe and Educate (TPE), Comprehensive Error Rate Testing (CERT) related to the Inpatient Prospective Payment System (IPPS), and Recovery Audit Contractors (RAC) audits, may help managers identify one clinical/coding topic to focus on for documentation and coding improvement. This focus should also encompass all accepted clinical pathways, physician specialties, and time of occurrence of issue during the patient stay (at admission or postoperative).
Providers may also provide insight into clinical issues they experience as a documentation quandary. It is important to remember that this first step in the ICIV model should be based on a clearly acknowledged and legitimate documentation/coding deficit. Do not identify a potential deficit based solely on the presence of complication or comorbidity (CC) or a major complication or comorbidity (MCC) indicator.
Clarify
Clarify refers to identifying all professional and technical guidance related to the chosen topic. A shared file should be created for both teams to collaborate and develop training documents. This file may include:
- Initial article(s) or source of clinical topic chosen
- AHA Coding Clinics and Official Coding Guidelines applicable to the topic
- CDI guidance from respected references
- Documentation recommendations (tips) for physicians treating the disease process
Interconnect
The coding and CDI departments should interconnect through professional communication. The common goal to improve and validate documentation can be acquired through a straightforward and collaborative process.
A workplan should be developed and shared with team members detailing the chosen clinical topic, including clearly identified implementation responsibilities and timelines. It is recommended to store this document in a shared folder or drive, allowing both coders and CDI professionals easy access to the stored information.
Validate
During the validation phase, tasked expectations commence. Communication between teams via email is important for tracking any improvement regarding the identified clinical topic. Validation should continue to be followed up with monthly or quarterly statistics and feedback.
Below is an example of how the ICIV model can be practically applied using postoperative ileus (POI):
ICIV Model Postoperative Ileus (POI) |
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Identify: Postoperative ileus introduction article and basic clinical understanding of POI. |
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Clarify: References for technical and clinical guidance for POI from accredited organizations. |
Coding: AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2017 Issue 1; Ask the Editor. AHA Coding Clinic® for ICD-9 - 2012 Issue 1; Ask the Editor. AHIMA Article: Complicated Coding: Postoperative Ileus
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CDI: ACDIS Articles:
ACDIS Forums: |
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Interconnect: Materials to be used by CDI and the coding professionals encourage surgeon engagement with documentation tips.
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CDI: Follow up gastrointestinal surgeries until discharge. Inpatient charts will be followed, identifying potential clinical benchmarks and utilization of facility resources. When there is documentation of vomiting, reversal of diet, or nasogastric tube placement post-surgery a query should be initiated to clarify if a POI. |
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Access daily surgery schedule and follow each patient postoperatively. Educate surgeons that while writing an order to investigate/validate POI, they may include the clinical rationale. Key documentation clinical guideposts:
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Coders: Discharged patients who received gastrointestinal surgery will be analyzed for documentation specifically identifying postoperative ileus, assigning ICD-10-CM codes if coding and documentation rules apply. Submit post-discharge query if clinical documentation and utilization of resources are identified related to: Key documentation clinical guideposts:
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Validate |
Monthly or quarterly meetings include further discussion of ICIV issue. Additional ICIV topics are added every quarter. |
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Building a compliant framework for both CDI and coding professionals to focus on specific clinical topics may improve documentation with measurable, cumulative outcomes over the course of the year.
The ICIV model encourages interdisciplinary collaboration between CDI specialists and coding professionals. Within the ICIV model, each team member contributes within their own role, while supporting the shared goal of complete and accurate documentation.
Disclosures: Both Diana Karff, RHIA, CCS, CPC, and Melissa Paper, JD, MPA, CHC, CHPC are consultants with MCRA LLC. Entac Medical engaged MCRA LLC to assist with the creation of a Clinical Documentation Improvement Companion Program for their PrevisEA device. The PrevisEA device is placed on a patient’s abdomen immediately after surgery and can detect the presence of abnormal digestive health in patients following intestinal surgery, such as gastrointestinal impairment (GII). GII is most commonly associated with postoperative ileus.
Diana Karff is a coding expert with MCRA LLC.
Melissa Paper is the vice president and head of healthcare compliance at MCRA LLC.