Q&A: Defining outpatient CDI processes

Q: What clinical documentation integrity (CDI) methods should be used in the outpatient setting?

A: Organizations must be aware of how outpatient CDI programs differ from their inpatient counterparts. One of the main differences involves the methods used for reviews and queries. While inpatient CDI specialists typically work concurrently with providers, those in the outpatient setting do much more pre-visit work.

“In the outpatient setting, you typically review everything beforehand,” says Katie McLaughlin, DNP, FNP-BC, RN, CRC, CCDS-O, senior director of clinical solutions at Harmony Healthcare in Tampa, Florida. This requires you to take a clinical and coding eye to the patient’s chart before the provider even sees them in the office.” However, a best practice outpatient CDI program encompasses all three review methods (prospective, concurrent, and retrospective) in some capacity, she says.

The sheer volume of encounters in the outpatient setting is also an adjustment, says Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC, CDI education director at HCPro. “If you’re starting an outpatient CDI program at a large organization, you might have 200 primary care physicians who see 30–35 patients per day,” she says. “You’re not going to be able to review every encounter.”

There is more of an educational focus on the outpatient side as well, says Prescott. “In outpatient CDI, you will typically review a set of records, do an audit, find some trends, and then sit down one-on-one with a physician for education,” she says.

Editor’s note: This answer was excerpted from “Taking the leap into outpatient CDI,” in the July 2024 issue of the NAHRI Journal. The NAHRI Journal is a quarterly journal featuring in-depth analysis and expert advice and is an exclusive benefit of NAHRI membership. Not a member? Join today.