Tackling CDI clinical validation and coding audits

December 21st, 2017

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This article is a general discussion of CDI clinical validation and coding compliance auditing in healthcare documentation workflows. It explains the relationship between the two audit types, the roles of clinicians and coders, and why both are considered important for documentation integrity, compliance, and record accuracy. The piece references CMS guidance, ICD-10-CM/PCS official guidelines, Coding Clinic, and MedLearn Matters as part of the broader audit and documentation environment.

Why This Topic Matters

It helps CDI, coding, and compliance professionals understand how audit functions differ and overlap, and why coordination between clinical review and coding review matters for documentation quality and regulatory alignment.

What You Will Learn

  • How CDI audits and coding compliance audits differ in purpose and scope
  • How clinical validation fits within CDI audit activity
  • Why documentation integrity matters for coding and compliance workflows
  • How CMS and official coding guidance relate to audit practices
  • Why combining CDI and coding audit perspectives can support quality and accuracy

Who Should Read This

  • CDI specialists
  • Medical coders
  • HIM professionals
  • Coding compliance auditors
  • Clinical documentation improvement managers
  • Compliance and audit teams

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