2014 Conference, Track 4: Where Did THAT Diagnosis Come From? Recognizing and Addressing Unreliable/Invalid Diagnoses

Andrew Rothschild, MD, MS, MPH, presentation explores how CDI specialists and coders are taught not to question a physician's clearly documented diagnosis. But what happens when that diagnosis seems to have come from left  field? Specialists and coders are also bound to clarify apparent discrepancies  rather than code something that doesn't appear to be supported. Increasingly, industry guidance (OIG, AHIMA, ACDIS, etc.) reinforces the hospital's responsibility to address unreliable diagnoses, and  ignoring the presence of these diagnoses can risk accusations of fraud or result in overtreatment.  Debate case examples, review options, consider implications, and bring recommendations back to your CDI program for internal discussion.