HCPro, JustCoding Inpatient - 2016 Issue 43 (November)
New clinical criteria guideline ups the ante for coders
November 15th, 2016
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Article Overview
This article explains a 2017 ICD-10-CM Official Guidelines update that affects how coders, CDI staff, and auditors think about provider documentation and clinical validation. It focuses on the practical implications for claim review, denial management, and coordination between coding and documentation improvement teams, with attention to CMS-related concepts and outside audit activity.
Why This Topic Matters
The topic affects facility coding compliance, documentation quality, and denial risk. It is especially relevant for teams that must balance provider documentation, clinical support, and payer review under the updated ICD-10-CM guidance.
Article Sections
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Taking a closer look
Discusses the updated coding guidance and the broader controversy surrounding clinical validation and payer review. It also introduces related denial and DRG review issues.
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What is a coder to do?
Covers workflow considerations for coders and facility teams when documentation and clinical circumstances do not align neatly. It also summarizes a published documentation-improvement perspective and the role of querying.
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Increasing clinical documentation
Focuses on documentation improvement, audit pressure, and the need for stronger collaboration between coding and CDI functions. It also addresses the role of external reviewers and documentation clarity.
What You Will Learn
- How the 2017 ICD-10-CM guideline change affects code assignment and clinical validation
- Why documentation quality matters in the context of audits and denials
- How coding and CDI workflows may be affected by provider documentation practices
- What broad types of guidance are discussed for reviewing and clarifying documentation
Who Should Read This
- Hospital coders
- CDI specialists
- HIM professionals
- Coding auditors
- Revenue integrity teams
- Clinical documentation staff
Codes Discussed
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