1. Pediatric CDI Program Dr. Vijeta Salunkhe, MBBS, MHA, MBA, CCDS, CCS
10/21/2017

2. Dr. Vijeta Salunkhe, MHA, MBA, CCS, CCDS
Currently Clinical Documentation Improvement Manager and physician advisor for clinical documentation accuracy program at Baylor Scott and White McLane Children’s, Temple Texas. Holds extensive health care experience as a manager, CDI reviewer, and physician.
Completed medical school at Grant Medical College, Mumbai and graduated with a dual master’s degree in healthcare administration and business administration from University of Houston Clear Lake with Beta Gamma Sigma International Honorary membership.
Is CCS and CCDS certified by AHIMA and ACDIS respectively.
Led ICD-10 physician education efforts across the system, designed queries and EHR templates for the system
Is very proud to serve as a leader for Texas ACDIS Chapter with the leadership team and help ACDIS committee to expand the chapter.
Currently selected by the US News and World Report representing Baylor Scott and White McLane Children's Medical Center as an expert on the panel to develop recommendations for refinements of the Best Children's Hospital rankings!

3. Objectives of the presentation
APR DRGs Vs. MS DRGs
Pillars of Pediatric CDI program
Impact of physician engagement
Pediatric Educational resources

4. Baylor Scott & White - McLane Children’s Medical Center
HIMSS certified level 7
Medical/surgical rooms, Pediatric ICU & NICU at McLane Children's Hospital Scott & White - Temple
24-hour pediatric emergency department and verified trauma center emergency department

5. Baylor Scott & White - McLane Children’s Quality Awards and Recognition
Only Level II Pediatric Trauma Center between Dallas-Austin
ELSO certified Extra Corporeal Membrane program
College of American Pathologists CAP Accredited Lab
Only Gold Certified Safe Sleep Center in Texas by Cribs for Kids
Pending Level IV NICU Designation by TDHS
Application in for Pathways to Excellence Designation

6. APR DRG Vs. MS DRG The Journey Begins!

7. Common Terminologies

8. APR DRG Vs. MS DRG MS-DRG APR-DRG
Relative weight will increase with secondary diagnoses that are considered MCC/CC’s
MCC: Major complication and comorbidity
CC: Complication and Comorbidity
Relative weight will increase with Severity of Illness (SOI), SOI increases with secondary diagnoses that are considered MCC/CC’s
MCC: Major complication and comorbidity
CC: Complication and Comorbidity

9. Major Diagnostic Category 15
MS DRG
APR DRG
Number of DRGs 7 28
Severity levels
None
4 levels within each DRG
Recognition of Birth weight in DRGs
7 Birth weight ranges
Separate Surgical DRGs No
Yes

10. MS DRG – One or Two possibilities
Depends on capture rate – one MCC and one CC
MS DRG
MCC CC

11. APR DRG – Hundreds of possibilities!
MCC CC CC
APR DRG CC
MCC
MCC CC CC

12. CORES OF PEDIATRIC CDI PROGRAM

13. Cores of CDI Program

14. Physician & Leadership Engagement
Listen To What The Leaders In Your Organization Want
Find a physician Champion
Ask Questions
Make Your Case
Listen To The Response
Report

15. CDI Professional - a Leader
Put YOURSELF in the Driver’s Seat
Effective Communication
CDI Mission and Vision
Statement

16. Technology Electronic Health Records CDI Tools
Worklist management
Increased efficiency
CDI Tools
Transition from paper records
Electronic Query System
Leverage technology to improve CDI efforts
Accurate data

17. Chart Reviews APR DRG chart reviews within 24 – 48 hours of admission
Conduct root cause analysis
Find the hidden gems in the chart reviews
Send quality queries
Review the charts before it is final billed

18. Coding Reconciliation

19. Impact of Engagement Reduction in Query Rates
Increase in Query Responses
(Quality Responses)
Accurate physician profiles
Quality of patient care

20. PEDIATRIC EDUCATION EXAMPLE

21. Root Operations – For Surgery

22. Build Case Studies

23. Newborn Respiratory Distress
Respiratory Distress Syndrome
Transient Tachypnea of Newborn
Bronchopulmonary Dysplasia
Respiratory Failure in Newborn

24. Pediatric Respiratory Failure
Respiratory Distress
Respiratory Failure
Acute Respiratory Failure with hypoxia or hypercapnia

25. Table for McLane Children’s Neonatologist
In preterm infants,
Respiratory Distress Syndrome (first 1 week)
Respiratory Failure in newborn  (1 week to 28 days)
BPD (after 28 days)
In term infants, who do not have RDS but have TTN
Transient Tachypnea of Newborn
Respiratory Failure of newborn
In children, who has no TTN and no RDS
Respiratory Failure in newborn
All of the above should be supported with the treatment/assessment and plan.

26. Pediatric Malnutrition
Issues – Failure to thrive/severe weight loss/severe malnutrition
Description of the problem
Common issues identified at the institution
Benefit of implementing a uniform definition

27. Pediatric Malnutrition

28. References Source – AHIMA and CMS website
ww.cms.gov/Medicare/Coding/ICD10/downloads/pcs_refman.pdf]
Baylor Scott and White McLane Children's Medical Center clinical definitions
ACDIS CDI leadership white paper
Journal of AHIMA July 2017 edition

29. Questions/Discussion
Dr. Vijeta Salunkhe, MBBS, MHA, MBA, CCDS, CCS
Baylor Scott and White McLane Children's Medical Center