Potential for a New Role Amid Staffing Challenges: Inpatient Clinical Coder

a missing blue puzzle piece under a magnifying glass representing the space for inpatient clinical medical coders at healthcare organizations

Since the development and implementation of the Inpatient Clinical Documentation Improvement (CDI) role, seasoned medical coders and auditors have been advancing their knowledge through obtaining the CDI credential, attending CDI directed training and/or becoming CDI specialists. While some healthcare facilities or consulting firms require a nursing background, others understand that a seasoned medical coder is going to have the clinical knowledge and coding experience to be appropriately trained on their process and software for this role. 

Some inpatient coders like understanding what the CDI specialist role provides and how it relates to their job. Others would like to continue performing both clinical and inpatient coding reviews. It can be challenging for coders who wish to perform both duties rather than choosing just one.

What if they didn’t have to choose? What if the role of “Inpatient Clinical Coder” was established as a float or liaison position between the two teams?

Ways this role could be utilized to support both CDI and Coding teams:

  1. Perform clinical reviews either initial reviews or reviews where complex procedures were performed so they could also currently code these and provide an accurate working DRG.
  2. Perform both coding and clinical reviews from the weekend, a backlog or during a time of a high census.
  3. Provide assistance with coding questions to the CDI team so that it doesn’t impact the coding team’s productivity.
  4. Assist coders with any questions they may have for the CDI specialist or regarding clinical queries.

The allocation of time for working with each team and the specific assignments must be clearly established and mutually agreed upon by both departments involved, ensuring support is provided to each area. Depending on the healthcare facility’s size, this role may require the involvement of two or more individuals to effectively manage these responsibilities. This approach facilitates efficient collaboration and resource allocation, enhancing overall operational efficacy.

Each medical coder and CDI specialist brings a distinct background and set of interests to their role. For example, some nurses may have specialized in areas like Obstetrics (OB) or Intensive Care Units (ICU), whereas coders might have honed their skills in high-level trauma centers or children’s hospitals. Regardless of their specific experiences, both teams possess valuable insights and knowledge that can be shared for mutual benefit.

As highlighted in a previous blog post titled Best Practices to Bridge the Gap Between Your Coding and CDI Departments, sharing trends found in reviews and educational materials between departments can be instrumental. This collaborative approach helps to address recurring clinical or coding scenarios that were previously challenging. Additionally, this promotes greater consistency in reporting across both departments, ultimately improving the accuracy and efficiency of the coding and documentation process. This kind of interdepartmental communication and learning is key to maintaining high standards and continuously improving the quality of documentation.

In periods when staffing resources are constrained, it becomes crucial to adopt a smarter and more innovative approach in designing roles and processes. The goal is to maximize efficiency and provide extensive support across as many departments as possible. This involves not only rethinking traditional methods but also creatively leveraging available resources and talents to ensure the highest levels of productivity are maintained, even under limited staffing conditions. By doing so, we can ensure that each department receives the necessary support, fostering a more resilient and adaptable organizational structure.

Streamlined CDI Solutions

Our outsourced CDI services ensure accurate reimbursement through improved clinical documentation. MRA (A GeBBS Healthcare Company) employs credentialed and experienced CDI specialists known for their exceptional attention to detail. Whether assessing your program or supplementing your staff, they enhance and maintain your clinical documentation.

We offer quick access to interim or permanent CDI professionals who seamlessly integrate into your program. Our services encompass comprehensive CDI audits, including MS-DRG and APR-DRG metrics, severity of illness, risk of mortality, and financial opportunities. We also provide opportunities to physicians, specialties, nursing units, and coding professionals. This detailed analysis provides insights for enhancing your current CDI methods.

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AHIMA Approved

This program has been approved for continuing education unit(s) (CEUs) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting of Approved CEUs from AHIMA does not constitute endorsement of the program content or its program provider.