Q:We recently had a patient who was admitted with sepsis POA and a UTI. When the chart was coded, UTI was listed as the principal diagnosis. I was under the impression that when sepsis is POA, it should always be coded as the...Read More »
There are few things more frustrating than the “organ system” approach to medical record documentation. Unfortunately, coders cannot code “acute respiratory failure” if all the physician writes is “respiratory system, continue on...Read More »
An overhaul of the newly coined Promoting Interoperability Programs (PIP, formerly known as the Electronic Health Record Incentive Programs), significant reductions to reporting requirements for quality initiatives, updates to payment rates, and changes CC/MCC designations for some conditions,...Read More »
Q:Often, we get caught up on some clinical indicators that potentially introduce encephalopathy, for example, if patient has vascular dementia or other structural issues that might contribute to encephalopathy. Can you help...Read More »
Q: What is the difference between ICD-10-CM code I24.8 (other forms of acute ischemic heart disease) and code I21.A1 (myocardial infarction type 2)? In which situation would each of these codes be reported? Read More »
Q:The coders at our facility recently asked CDI to teach the providers to write EtOH use “disorder” or cocaine use “disorder,” so that they can code it to EtOH abuse and cocaine abuse. Do you agree with this request from the...Read More »
