Are institutions appealing sepsis denials if the patient meets sepsis-2/super systemic inflammatory response syndrome (SIRS) criteria, but not sequential organ failure assessment (SOFA) criteria? We have one hospital in our system that uses only sepsis-2 as their criteria, and many of them have...Read More »
When faced with a body mass index (BMI) denial, I have used the following Coding Clinic references with no luck:
Coding Clinic, Fourth Quarter, 2018, p. 77: "obesity and morbid obesity are always clinically significant and reportable when documented by the provider. In
I was wondering if anyone had experience with denials from commercial payers that goes beyond the third level of appeals. We are getting response letters that state “completion of a level 3 dispute exhausts internal administrative rights.” What are other hospital systems doing with this response...Read More »
Does anyone review inpatient psyche as part of their workflow? We are being asked to explore this and have done a small sample of reviews. We are finding minimal outcomes of any kind, but we do not really understand how these are paid (for Medicare). Does anyone have any experience with this...Read More »
I have a patient admitted with COVID-19 pneumonia and acute on chronic respiratory failure with hypoxia. The patient denied any chest pain. Routine chemistries revealed an elevated troponin level of 0.09; on repeat the level was 0.21 (reference range <0.10). The electrocardiogram (EKG)...Read More »
What are your thoughts on mentoring or allowing outside individuals to job shadow CDI staff at your facility? We were recently approached by a young nurse who heard about CDI and has set her sights on joining the profession once she has enough experience.Read More »
I recently had a case where the documented diagnoses were “paraneoplastic syndrome and possible encephalitis with references to both limbic encephalopathy and herpes simplex virus (HSV).” Treatment included intravenous immune globulin (IVIG) and steroids as well as vancomycin, meropenem, and...Read More »
