What actions do CDI teams take when staff receive “unable to clinically determine” responses to queries? Some physicians may use this as an easy query “out” versus addressing the clinical question and we are seeing some repeat offenders. We started tracking and presenting these to our physician...Read More »
I've been told that if there are clinical indicators to support that chronic kidney disease (CKD) is the etiology of a patient’s hypertension, a code from category I15 would be assigned. Code I12 is for hypertensive CKD, isn’t it? So why do we have to use I15 codes instead? What’s the main...Read More »
Q: Have any other institutions had frequent clinical validation denials regarding acute pulmonary insufficiency following surgery? If so, what clinical indicators and resources do you use to appeal the denials?Read More »
What areas in the facility should be reviewed as part of outpatient CDI reviews (e.g., emergency department, same-day surgery, hospital-owned physician practices, etc.)? Does outpatient CDI include patients in the hospital currently in observation status? Do inpatient CDI specialists review...Read More »
Q: How do you measure productivity for a denials specialist? Do you measure the number of appeals per day, per week, or per month? Are there any other tasks that affect this metric?Read More »
Q: Our system is seeing increasing cases being denied inpatient care with the suggestion that the cases should have been billed as observation. Right now, our coding department handles the coding-based denials, CDI handles clinical validation denials, and care management...Read More »
Does the ACDIS/AHIMA “Guidelines for Achieving a Compliant Query Practice” brief support queries that only list one diagnosis, “other,” and “unknown”? Read More »
