Q:I often find CHF listed under past medical history. Frequently, the patient also has HTN and CAD, so they’re on medications. When I query for the type of CHF, the providers sometime document “no CHF.” I’ve heard before,...Read More »
Q:I have a patient with a UTI with pyuria and an elevated WBC count. There’s also recurrent plugging of the urine catheter secondary to sediment. I know the term “with” can link two diagnoses, but that it does not represent a...Read More »
So, you’ve worked hard at physician engagement and your physician response rate is stellar. But, how many of those providers actually carry through the queried diagnoses through to the daily progress notes? This is the question...Read More »
Q:If a patient is admitted with both pneumonia and COPD, does pneumonia need to be coded before the COPD exacerbation? We have been coding COPD exacerbation first based on the advice given in AHA Coding Clinic, Third...Read More »
Q:We’ve encountered audit takebacks and denials from a certain payer who removed codes and procedures that result in lower DRGs. Do you have any advice for fighting or preventing these types of denials?Read More »
Q: Our coders often select the principal diagnosis based on how invasive the testing is. For example, a patient comes in with vertigo and hematemesis. For the vertigo, the physician orders a brain CT, IV medications, and an ear, nose, and throat consult. The patient is diagnosed...Read More »