Career Minded
August 2015
 
Making the Move from Coding to CDI: 10 Tips to Help Coders Land CDI Positions
 
By Kayce Dover, MSHI, RHIA, and Jillian Hubbard, RN, MPH, CCDS, ACM
 
Clinically savvy coding professionals may be among some of the most qualified clinical documentation improvement (CDI) candidates, yet landing a formal CDI position is often easier said than done. Some organizations continue to hold tight to the belief that only individuals with formal clinical training (for example, a nurse) can perform CDI. This is a significant barrier that coders must overcome if they plan to move into this profession.
 
However, concurrent with the move to ICD-10, coders may find warm waters and perfect timing for career opportunities in CDI. Many coders have updated and enhanced their clinical knowledge of anatomy, physiology, pathophysiology, and pharmacology to prepare for ICD-10. Furthermore, queries are expected to increase significantly in ICD-10. Coders are uniquely positioned to manage CDI queries and educate others within the organization, including CDI specialists and physicians, about new documentation requirements. Why not take the next step to obtain a CDI credential or gain hands-on experience working in CDI?  
 
Following are 10 additional tips to gain the attention of CDI hiring managers or recruiters. 
 
1. Demonstrate a passion for CDI. Passion goes a long way in terms of convincing a hiring manager or recruiter that you're the one for the job. Every coder must be able to answer these important questions: How do you define CDI, and why do you see it as a cornerstone to accurate coding? What appeals to you about CDI? What do you most look forward to when working in CDI? What unique ideas and fresh perspectives would you bring to the table?
 
2. Get out of the coding mindset. Coders hoping to move into CDI need to step out of their comfort zones and get used to the idea of asking questions about conditions that aren't explicitly documented. For example, rather than asking for the specific type of congestive heart failure (CHF), a CDI specialist might look at the clinical indicators present in the record and ask whether CHF is present at all, and if so, what type.
 
This line of questioning may seem unfamiliar and even uncomfortable for coders, yet it's something that CDI specialists do every day. Coders must also review the entire medical record to search for clinical indicators and other clues they might have otherwise ignored for coding purposes.
 
3. Correlate your past experiences to the CDI role you seek. Like anyone transitioning into a new area, coders must be able reflect on their current and past positions to extract experiences corollary with the position they seek. For example, have you been involved with improving the query process within your facility? If so, how? What role did you play? Do you have any experience with educating physicians or developing tip sheets for them? Have you served on committees to train clinicians or analyze their documentation? In what other ways do you interact with clinical staff in your current position?
 
4. Articulate how your coding knowledge benefits CDI. Because coders work closely with the encoder, they possess a unique knowledge of how certain diagnoses affect risk of mortality (ROM) and severity of illness (SOI) scores, both of which are increasingly important in CDI. For example, coders know that although hypokalemia isn't a CC, it increases the ROM and SOI. This type of knowledge is invaluable in any CDI program, particularly as CDI expands beyond CC/MCC capture into quality.
 
Coders can also highlight their mastery and in-depth knowledge of ICD-10-PCS—an area in which queries are expected to skyrocket. Being able to pose a detailed and succinct query for clarification of a procedure in ICD-10 is a definite asset.
 
In addition, coders can focus on their ability to analyze data and explain the meaning behind that data. For example, coders can articulate why patients may appear to have poor outcomes based on the coded data or why certain inpatient stays were denied due to a lack of detailed documentation to support additional code assignment. Using their coding knowledge, coders should identify ways in which their organizations can use data to improve quality and processes—a skill that extends beyond traditional CDI and adds tremendous value to the department.
 
5. Enhance your clinical knowledge. Anatomy and physiology refresher trainings are helpful; however, it's even more beneficial to attend a formal CDI training or boot camp. AHIMA offers several self-paced online CDI courses that can help coders get started.
 
6. Obtain a CDI credential. Nothing shows initiative and competence more than a formal CDI credential, such as AHIMA's  certified documentation improvement practitioner (CDIP) credential. Recruiters and hiring managers agree that a credential is typically an accurate assessment of one's clinical knowledge and shows instant credibility. If you haven't obtained a credential yet, be sure your resume and cover letter indicate the year in which you intend to obtain it. Managers and recruiters want to know you've at least set the goal to get the credential and are working hard to achieve this goal.
 
7. Gain some CDI experience. For example, ask your CDI department manager if you can shadow a CDI specialist for a few days or attend CDI trainings on-site. Consider serving on a CDI committee or volunteering to assist with documentation reviews and informal physician education sessions.
 
8. Develop a CDI arsenal of tips sheets for common queries. Coders wishing to move into CDI must enhance their knowledge of clinical indicators for common queries, including:
  • Pneumonia
  • Acute and chronic renal failure
  • Sepsis
  • Shock
  • Heart failure
  • Malnutrition
Use nationally accepted clinical standards and guidelines to compile the clinical indicators for each of these diagnoses. Once developed, these tips sheets can be something you showcase during an interview and eventually use regularly once you land a CDI position.
 
9. Let your resume do the talking. A CDI candidate's resume and cover letter must reflect attention to detail and professionalism. Consider the following:
  • Include a professional summary that explicitly expresses your desire to move into CDI and any steps you've taken thus far to achieve that goal.
     
  • Ensure your resume reflects any or all CDI-related experiences. Don't submit your coding resume for a CDI position. Instead, reword each of your job responsibilities with a focus on CDI. For example, instead of saying "code inpatient records with a 98 percent accuracy rate," consider saying "ensure a 98 percent coding accuracy rate by clarifying documentation when necessary and taking steps to work with CDI specialists to ensure coding specificity."
     
  • Check your resume and cover letter for spelling and grammar errors. These documents provide managers and recruiters with valuable insight into whether your queries will be error free as well.
     
  • Include a professional e-mail address on your resume.
     
  • When providing your phone number, be sure to set up a professional voicemail response. Check your messages frequently to avoid a full mailbox—and to ensure managers and recruiters can leave you a message.
     
  • Respond to any voicemails or e-mails immediately upon receipt. Doing so indicates to managers and recruiters you are responsive and enthusiastic, both of which are must-haves for any CDI position.  
10. Focus on communication. During your interview, focus on the ways in which you interact with other clinical professionals. Have you facilitated any conversations between coders and CDI specialists at your own organization? How do you collaborate with CDI specialists who are nurses? How would you approach communications about clinical, financial, and quality data in a way that gains a physician's attention?
 
Take the reins

Coders have the potential to bring an incredible amount of value to any CDI team. The challenge is to articulate this value in a field that's currently dominated by clinical professionals. If you'd like to shift from coding to CDI, take steps now to increase your clinical knowledge, obtain a CDI credential, and gain CDI experience. The opportunities are there, and there's no time like the present to seize them as we head into ICD-10 and beyond.
 
 
Kayce Dover, MSHI, RHIA, is president and CEO at HIM Connections, LLC, and Jillian Hubbard, RN, MPH, CCDS, ACM, is CDI service line manager at Woodham HIM Solutions.