I've been told that if there are clinical indicators to support that chronic kidney disease (CKD) is the etiology of a patient’s hypertension, a code from category I15 would be assigned. Code I12 is for hypertensive CKD, isn’t it? So why do we have to use I15 codes instead? What’s the main...Read More »
Q: Have any other institutions had frequent clinical validation denials regarding acute pulmonary insufficiency following surgery? If so, what clinical indicators and resources do you use to appeal the denials?Read More »
What areas in the facility should be reviewed as part of outpatient CDI reviews (e.g., emergency department, same-day surgery, hospital-owned physician practices, etc.)? Does outpatient CDI include patients in the hospital currently in observation status? Do inpatient CDI specialists review...Read More »
Q: How do you measure productivity for a denials specialist? Do you measure the number of appeals per day, per week, or per month? Are there any other tasks that affect this metric?Read More »
Q: 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...Read More »
Does the ACDIS/AHIMA “Guidelines for Achieving a Compliant Query Practice” brief support queries that only list one diagnosis, “other,” and “unknown”? Read More »
Can you offer any insight as to how you are handling CMS’ new requirement for documentation of COVID-positive patients stating that the physician needs to document not only that the...Read More »
