The recently released FY 2019 ICD-10-CM update adds some codes to allow additional diagnoses to be reported while adding others for greater specificity.Read More »
The diagnosis of malnutrition has long been in the sights of the Office of Inspector General (OIG) for audits and denials. In fact, just as recently as December 2017, the OIG found...Read More »
The term “dysphagia” has many synonyms used by providers in medical documentation. However, not all of these symptoms are able to describe, with specificity, the real problem so it can be translated into its corresponding code assignment.
Documentation of developmental issues is critical because the goal is accurately diagnosing each child and focusing appropriate resources toward the maximization of the child’s abilities. To accomplish this goal, the integrity of each patient’s chart with accurate and specific diagnoses is...Read More »
You hear it all the time: “We only use SIRS,” “I like sepsis-3 because that’s the way I learned it medical school,” “one of our commercial insurance companies only pays for sepsis-3,” “CMS tells us to use sep-1”. For some unexplainable...Read More »
Q:If the provider documents: “Pressure ulcer with full thickness skin loss involving damage or necrosis of subcutaneous tissue, right elbow,” does the CDI specialist need to query for the stage? Or, will it be coded as a stage...Read More »
