Documentation improvement staff often struggle with principal diagnosis selection. A clear understanding of the definition of principal diagnosis and the factors that play into principal diagnosis selection is extremely important, although often confusing.
The quarterly reports issued by the Program for Evaluating Payment Patterns Electronic Report (PEPPER)contain large amounts of data on how a facility compares to others in the same state, the same jurisdiction (i.e., the same Medicare Administrative Contractor), and nationwide in terms of coding...Read More »
Q: How should I query for systemic inflammatory response syndrome (SIRS) if SIRS codes to sepsis? I want to correctly query and obtain the proper supporting information in the...Read More »
Well, we’re almost here at Clinical Documentation Improvement Week, which begins this Sunday, Sept. 18Almost since day 1 of the start of ACDIS back on Oct. 1, 2007, our members have asked (clamored might be a better word) for a week to recognize this unique profession. It’s finally here!...Read More »
Trying to convince physicians that good documentation has “something in it for them” is a battle that CDI specialists fight each day. But a new CMS initiative that bundles physician and hospital payment into one lump sum could represent a long-term, revolutionary solution to that age-old...Read More »
$8.9 million. That is the amount Kentucky-based Baptist Healthcare Systems, Inc., had to pay as of September 1 to settle claims of improper billing related to respiratory infections and inflammations, pulmonary edema (fluid accumulation in the lungs), respiratory failure, and septicemia (blood...Read More »
Out of 88 claims for MS-DRG 246 (percutaneous cardiovascular procedure with drug-eluting stent with MCC or 4+ vessels/stents with a length of stay less than or equal to two days) reviewed during a recent probe audit, TrailBlazer Health Enterprises, LCC, fully denied 65 of them,...Read More »
