2020 Guide to Clinical Validation & Documentation Improvement for Coding
Optum360 | 2020
This is a concise, reliable, and easy-to-follow tool for those problematic diagnoses and PCS inpatient procedures that are most often questioned by payers. This unique resource provides the extensive clinical criteria and associated documentation necessary for code assignment. This tool also describes the clinical documentation needed for determining if the condition is a complication or when a medical condition qualifies as an additional diagnosis. Also included is an introduction to the query process and how DRGs, CCs, MCCs, POAs, and HACs affect reimbursement. CDI staff, coders, utilization review staff, and HIM managers can use this to systematically evaluate the clinical criteria that influence code assignments and patient care.
• Covers many of the most challenging inpatient medical diagnoses and procedures plus the clinical criteria that support code assignment
• Provides detailed clinical criteria and physician documentation requirements needed to justify code assignments
• Helps craft physician queries that address fine distinctions in a patient’s medical condition and ensure appropriate reimbursement
• Reimbursement Impacts: Tutorials on additional factors that rely on concise, accurate documentation and impact reimbursement such as complications and comorbidities (CC and MCC), hospital acquired conditions (HAC), and present on admission (POA).
• Extensive clinical tools: Includes resources for how to interpret abnormal EKGs, lab values and diagnostic test outcomes in addition to pharmacology and organism information
• Identifies other terminology that would qualify as and translate into ICD-10-PCS specific root operations