Prompt Chain: Build a Comprehensive CDI Case Analysis Workflow

What This Builds

A multi-step prompt chain that walks a de-identified inpatient case through a complete CDI analysis, from initial chart review to prioritized query list to draft queries to physician education notes, in a single structured conversation. Instead of running multiple one-off requests, you chain prompts together so each step builds on the previous one, producing a complete CDI case workup in under 15 minutes.

This is most valuable for complex cases with multiple documentation gaps (multiple comorbidities, potential CC/MCC capture across several diagnoses, concurrent clinical validation concerns) where you'd normally spend 45-60 minutes on analysis before writing a single query.

Prerequisites

• Claude Pro subscription ($20/month): longer context handling required for multi-step analysis
• Comfortable using Claude for CDI reference work (Level 3)
• Your CDI Project set up with reference documents (see Level 4 guide: "Claude Project: Your Personal CDI Intelligence System"). Optional but recommended

The Concept

Prompt chaining is using the output of one AI request as the input to the next. Instead of asking a single question, you run a series of connected questions where each response builds context for the next. For CDI case analysis, this mirrors the way an experienced CDI specialist thinks through a complex case: first identify what's documented, then identify the gaps, then prioritize by DRG impact, then draft the queries.

The power of chaining is that by step 4, Claude has built up a complete understanding of the case context, so the query drafts it produces are more targeted and clinically coherent than if you'd just asked for queries directly.

Build It Step by Step

Part 1: Prepare Your De-identified Case Summary

Before starting the chain, prepare a de-identified case summary. Remove ALL PHI. Create a clinical facts document with:

• Reason for admission / chief complaint
• Key diagnoses documented (use the documented terms, not your CDI interpretation)
• Relevant clinical indicators (labs, vitals, imaging findings, with no dates and no identifiers)
• Treatments ordered and administered
• Current clinical status
• Any existing specialist consult findings

Part 2: Start the Chain. Step 1: Clinical Summary

Open Claude (or your CDI Project if you have one set up). Start with:

STEP 1 - CDI CASE REVIEW

I'm going to walk a de-identified inpatient case through a complete CDI analysis. Please respond to each step as I provide it. Start by acknowledging you're ready.

De-identified case summary:
[Paste your prepared case summary]

Step 1: Identify all diagnoses and conditions documented in this case. List each one and note whether the documentation is:
- Specific and complete (no query needed)
- Documented but with insufficient specificity (query opportunity)
- Present clinically but not documented at all (potential query opportunity)
- Uncertain/conditional (may need clinical validation)

Part 3: Step 2. DRG Impact Analysis

After Claude's response, continue the chain:

STEP 2 - DRG IMPACT ANALYSIS

Based on the documentation gaps you identified, which of these represent the highest DRG impact opportunities? Please rank the top 5 query opportunities by:
1. Estimated DRG weight impact (high/medium/low)
2. Likelihood the physician will confirm the queried diagnosis based on clinical evidence
3. Clinical documentation strength (how well does the evidence support the query?)

Format as a ranked list with brief rationale for each.

Part 4: Step 3. Query Priority List

STEP 3 - QUERY PLAN

Based on your analysis, create a query plan for this case:
1. List queries in recommended priority order (highest DRG impact first)
2. For each query, specify: query type (specificity/clinical validation/etiology/POA), the documentation gap, and the relevant clinical evidence
3. Flag any queries that have clinical validation risk (where confirming the diagnosis may not be clinically supportable)
4. Note any diagnoses I should NOT query due to insufficient clinical evidence

Part 5: Step 4. Draft the Top Priority Query

STEP 4 - QUERY DRAFT

Draft a compliant, non-leading AHIMA physician query for the #1 priority item from your query plan.

Requirements:
- Professional opening referencing the clinical review
- Clinical summary with only the documented findings (no interpretation)
- Clear statement of the documentation opportunity
- 4-6 multiple choice response options
- Must include: "Clinically undetermined" and "Other: ___" as final options
- Non-leading language throughout, with no preferred answer implied

Part 6: Step 5. Education Notes

STEP 5 - PHYSICIAN EDUCATION NOTE

Based on this case analysis, what 1-2 sentence documentation guidance would be most useful to share with the attending physician after this case closes? This is for educational follow-up, not for the query itself.

Also: Is there a pattern in this case's documentation gaps that suggests a broader physician education need for this service line?

Part 7: Complete the Remaining Queries

After completing steps 1-5, continue drafting the remaining priority queries:

Now draft AHIMA-compliant queries for priority items #2 and #3 from the query plan, using the same format as the Step 4 query draft.

Real Example: Complex CHF with Complications Case

Setup: De-identified case: patient admitted with CHF exacerbation, also has CKD Stage 3 documented, albumin 2.2, weight loss documented in nursing notes but not by physician, started on diuretics, required Foley for urine output monitoring.

Chain results across 5 steps:

Step 1 output: Identifies 4 documentation gaps: (1) CHF type unspecified (systolic vs. diastolic), (2) CKD with possible AKI given diuretic use (3) Possible malnutrition, not physician-documented, (4) Urinary catheter documented but no indication documented

Step 2 output: Ranks: #1 CHF type (high DRG impact, strong echo evidence), #2 Malnutrition (medium impact, nutrition consult supporting documentation available), #3 AKI (medium impact, creatinine trending data needed), #4 Catheter indication (low impact)

Step 3 output: Query plan with clinical validation flag on malnutrition (need nutrition consult to be specific about severity before querying)

Step 4 output: Compliant CHF type query with 5 response options, professionally formatted

Step 5 output: Education note suggesting physician document CHF ejection fraction in admission note rather than relying on prior echo reference

Total time: 12 minutes for complete 5-step workup on a complex case vs. 45-60 minutes manually.

What to Do When It Breaks

• Claude loses context between steps. If the conversation gets very long, paste a brief "Context: We are in the middle of a CDI case analysis for [brief description]" reminder at the start of each new step
• Step 2 rankings seem off. Provide more clinical specificity: "The echo from [relative time] shows EF of 35%, so update your DRG impact analysis"
• Queries don't match your facility format. Add your facility's query template at the top of Step 4: "Draft using this exact format: [paste template]"
• Clinical validation flags seem overly cautious. Ask: "Clarify the clinical evidence threshold for [diagnosis] query. Is the evidence I described sufficient?"

Variations

• Simpler version: Run only Steps 1-3 for documentation gap identification and prioritization; draft queries manually from the ranked list, which still saves 20-30 minutes on complex cases
• Extended version: Add a Step 6 asking for a one-paragraph case summary suitable for your CDI program's quality reporting log

What to Do Next

• This week: Run this chain on your 2-3 most complex pending cases and compare quality and time vs. your normal process
• This month: Build this into your workflow for any case with 3 or more potential query opportunities
• Advanced: Combine this with your CDI Project (Level 4 guide) so Claude has your AHIMA guidelines loaded when it does the query drafting step

Advanced guide for Clinical Documentation Improvement Specialist professionals. Requires Claude Pro subscription ($20/month).