When a patient comes in with two diagnoses and the documentation reflects that either could be the principal diagnosis, do we choose the principal as the diagnosis that is being treated more intensely, or do we choose the higher paying DRG? Is it true that when a patient comes in with two...Read More »
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 handles the status denials...Read More »
Currently, when we ask clinical validation queries, we do not take a financial impact into account. We only reconcile as "agreed and documented." Our vendor tells us that some facilities are taking a positive financial impact if they are successful in getting the supporting clinical evidence...Read More »
I’ve heard that the geometric length of stay (GMLOS) is always rounded to the nearest whole number as inpatient claims are paid by day. Based on my understanding of the inpatient prospective payment system (IPPS), I thought that each inpatient stay is paid by a fixed amount, regardless of the...Read More »
We recently had a patient admitted with severe acute meningitis causing respiratory decompensation. A diagnostic lumbar puncture and mechanical ventilation were both performed during the inpatient stay. Which of the two procedures would be the principal procedure, diagnostic lumbar puncture or...Read More »
My physicians use the term “bacteremia” frequently and are treating it. The patient may be febrile and receiving antibiotics, but they cannot figure out a source. What should they be calling it? Or, better yet, what query should I be sending?Read More »
We’re having a lot of discussions lately on whether we should query for pressure injuries when they’re only documented by nursing. Our wound care nurses determined that staff nurses identify pressure injuries correctly only 60% of the time. If we’re querying based on nursing documentation, our...Read More »
