Based on previous documentation, which of the following diagnoses would a CDI specialist be MOST likely to bring to the provider’s attention in preparation for an upcoming visit of a 70-year-old patient?

For a pre-visit review, a CDI specialist focuses on identifying previously documented, chronic conditions with ongoing clinical and risk adjustment (RAF) impact. Epilepsy, chronic heart failure, and Crohn’s disease are all significant, persistent chronic conditions that carry RAF value. They require annual reassessment and documentation to be included in risk scoring, making them the highest priority to bring to a provider's attention for an upcoming visit to ensure they are addressed and documented.

B. A T3 compression fracture is often an acute or resolved condition and may not have ongoing RAF impact unless there are specific, documented sequelae.

C. "Family history of lung cancer" is not a patient diagnosis and has no RAF value. While atrial fibrillation is a valid RAF condition, the inclusion of a non-RAF item weakens this option.

D. Syncopal episode and pharyngitis are typically acute, transient conditions and are not the focus of a prospective review for chronic condition capture.

1. Centers for Medicare & Medicaid Services (CMS). (2023). Risk Adjustment 101 Participant Guide. Module 3: "Risk Adjustment Data," pp. 15-17. This guide explains that risk adjustment relies on the documentation of chronic and severe acute conditions within the data collection year.

2. Association of Clinical Documentation Integrity Specialists (ACDIS). (2021). The Outpatient CDI Specialist's Complete Training Guide. Chapter 4: "The Outpatient Review Process," Section on "Prospective Reviews," pp. 65-68. This section describes the process of reviewing records before a visit to identify historical diagnoses that need to be reassessed and documented.