CDI — RN or HIM? Can AHIMA serve both?

RN or HIM for CDI - Is a hybrid team the best?

The article in AHIMA’s July-August 2019 Journal, “Coders or Nurses for CDI Teams: Why Hiring Both to Collaborate Works Best”, suggests the best approach to a CDI program is a combination of both nurses and HIM professionals. However, many in the medical community do not share this view – a team built on the exclusive skill set of nurses may be preferred for some organizations whereas, some teams built on the exclusive skill set of HIM professionals may be preferred based on the HIM professional’s experience with medical records, medical terminologies and use of the classification and coding systems (ICD-10, CPT, HCPCS, etc.)

The Hybrid Team —

AHIMA’s suggestion of a Hybrid team is valid. The article states, “In practice, a hybrid team builds on the strengths of both HIM and nurse professionals’ skill sets. A hybrid team benefits from the knowledge of coding guidelines and compliance expertise through its HIM professionals, as well as the intrinsic clinical relationships that have been forged between nurses and physicians.”

The Hybrid team brings together a skill set from nurses and a skillset from HIM professionals to provide the optimum leadership for CDI services. Nurses bring a domain to the table unique to nursing and this sphere of knowledge cannot be duplicated. In addition to nursing education and clinical training, hands-on patient care provides one with experience that cannot be obtained from a textbook or certification.

Who owns CDI - RN or HIM?

The nurse for CDI —

A nurse with direct surgical experience in the Operating Room (OR) suite provides a background for understanding the written operative report – what information is included and what information is omitted – be that accidental or not. With OR experience, one can understand the surgical environment – regardless of complexity of the procedure – and can navigate the ethical and legal documentation requirements. A nurse with OR experience or, experience providing care for immediate post-operative patients, lends credibility to understanding medical necessity as well as clinical documentation requirements – a large domain of CDI.

The HIM for CDI —

Likewise, the same concept holds true for HIM professionals. HIM professionals bring a domain to the medical record environment that is unique to the HIM professionals’ education and experience. The HIM professionals’ education requirements to obtain the RHIT or RHIA credential provides an in-depth understand of the medical record, coding guidelines and requirements, as well as, provides a critical link between the provider, the payer and the patient. Accurate coding of the services provided to a patient is critical as the information is shared with a myriad of government agencies, for example, the CDC, and is used for statistical purposes and decision making for populations.

A depth of experience coding medical records with diagnosis and procedure codes lends the HIM professional a skill set that is obtained from hours/years spent in-the-record coding medical conditions with ICD/CPT/HCPCS codes. This hands-on coding experience cannot be duplicated, just as the direct patient care experience cannot be duplicated.

Each discipline (the nurse and the HIM professional) is studied in their respective discipline and brings to the CDI table unique strengths. In the hybrid CDI model, the nurse learns from the HIM professional – coding requirements – and the HIM professional learns from the nurse – clinical aspects of health (for example, medications). Together, the two disciplines provide a skill set that best captures, identifies, and classifies patient medical information to best serve the patient and the provider as well as, obtain reimbursement for the services provided.

To address the question raised in the July-August 2019 issue of the AHIMA Journal –

HIM or RN for CDI – I look at the question differently and ponder –

“Should nurses belong to AHIMA?”

Do nurses have a position at the AHIMA table?

Is AHIMA positioned to serve or lead Registered Nurses

outside of their clinical environment?

AHIMA has traditionally been an organization supporting HIM professionals – coding, medical record and information management, etc. With the advent of electronic medical records and the expansion of payment models, VBC, federal mandates and MU requirements, the expansion of AHIMA to include other disciplines seemed a natural progression. However, does this model work for AHIMA, HIM professionals, or nurses and physicians?

If one takes the position that the lines defining CDI, informatics, or health information management have blurred, AHIMA must address the question – should the AHIMA CDI certification be extended to nurses, physicians or other clinical disciplines? This same question can be asked of other AHIMA credentials that have traditionally been offered to HIM professionals only, such as, the RHIA, RHIT, etc.? But the main question that has an impact on the HIM professionals’ career is – RN or HIM for CDI.

AHIMA's challenge —

If AHIMA continues to extend certification to nurses and physicians, CDI being one example, AHIMA must address clinical disciplines and include them in their scope of practice. Otherwise, it appears that the needle will continue to move away from HIM professionals and, or AHIMA.

Butler, Mary. “Coders or Nurses for CDI Teams: Why Hiring Both to Collaborate Works Best.” Journal of AHIMA 90, no. 7 (Jul-Aug 2019): 10-13. https://bok.ahima.org/doc?oid=302773#.XT5VjPJKjIU