2023 Guide to Clinical Validation and Documentation Improvement for Coding (eBook)

Optum | 2023 | Karen Krawzik; Anita Schmidt



209.95
List Price Per User

Item #: ECDCG23
ISBN: 9781622548958
Available: Dec 2022








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.

Karen Krawzik, RHIT, CCS, AHIMA-approved ICD-10-CM/PCS Trainer

Ms. Krawzik has expertise in ICD-10-CM, ICD-9-CM, CPT®/HCPCS, DRG and data quality and analytics, with more than 30 years’ experience coding in multiple settings, including inpatient, observation, ambulatory surgery, ancillary and emergency room. She has served as a DRG analyst and auditor of commercial and government payer claims, as a contract administrator, and worked on a team providing enterprise-wide conversion of the ICD-9-CM code set to ICD-10. More recently, she has been developing print and electronic content related to ICD-10-CM and ICD-10-PCS coding systems, MS-DRGs and HCCs. Ms. Krawzik is credentialed by the American Health Information Management Association (AHIMA) as a Registered Health Information Technician (RHIT) and a Certified Coding Specialist (CCS) and is an AHIMA-approved ICD-10-CM/PCS trainer. She is an active member of AHIMA and the Missouri Health Information Management Association.

CPT is a registered trademark of the American Medical Association.

Anita Schmidt, BS, RHIA, AHIMA-approved ICD-10-CM/PCS Trainer

Ms. Schmidt has expertise in ICD-10-CM/PCS, DRG, and CPT® with more than 15 years’ experience in coding in multiple settings, including inpatient, observation, and same-day surgery. Her experience includes analysis of medical record documentation, assignment of ICD-10-CM and PCS codes, and DRG validation. She has conducted training for ICD-10-CM/PCS and electronic health record. She has also collaborated with clinical documentation specialists to identify documentation needs and potential areas for physician education. Most recently she has been developing content for resource and educational products related to ICD-10-CM, ICD-10-PCS, DRG, and CPT®. Ms. Schmidt is an AHIMA-approved ICD-10-CM/PCS trainer and is an active member of the American Health Information Management Association (AHIMA) and the Minnesota Health Information Management Association (MHIMA).

CPT is a registered trademark of the American Medical Association.



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