2025 Clinical Validation and Documentation Integrity for Coding (eBook)
Optum | 2025 |
The Clinical Validation and Documentation Integrity for Coding 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.
Laura Anderson, RN, BSN, CCDS
Ms. Anderson is a Registered Nurse and CDI Specialist/Educator with more than 20 years of experience in the healthcare profession. She obtained her BSN at the University of Minnesota and spent most of her bedside nursing career on Medical-Surgical care units. Her clinical documentation experience began in 2007, covering CDI specialist training, education development, and physician engagement. She has served as a CDI Team Lead and consultant, working with senior leadership to incorporate CDI work into documentation compliance and quality metrics. Ms. Anderson also has a BS degree in Biology (Winthrop University), with research experience in liver cancer and radiation-induced leukemia. She has presented at the state and national levels for the Association of Clinical Documentation Integrity Specialists (ACDIS) and has served as a co-lead for the Minnesota state chapter.
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