Soi severity of illness Study guides, Class notes & Summaries

recent drivers of CDI (p2) - correct answer - MS-DRGs 2007 to reflect SOI/ROM - POA indicators 2008 - Medicare Advantage/Part C (capitated, HCC) - some payers moving to APR DRGs - compliance reviews: RAC, Zone Program Integrity Contractors, Medicaid Integ Contractors purpose of CDI program (p2) - correct answer to initiate concurrent and, as appropriate, retrospective reviews of health records for conflicting, incomplete, or nonspecific provider documentation. goal of CDI reviews (p2)...

CCDS questions with complete solutions 2023A. Bleeding gastric ulcer A patient is admitted from the emergency department (ED) with a diagnosis of weakness and anemia. After admission and further treatment with packed red blood cells (PRBC), GI consult, and endoscopy, the physician includes the following diagnoses in the discharge summary: anemia, suspected bleeding gastric ulcer, and GERD. What would be the most appropriate principle diagnosis? A. Bleeding gastric ulcer B. Anemia C. GERD ...

CDIP Domain 1: Clinical Coding Practice Already Graded A Coding Clinic Valuable reference tool for coders that is published by AHA each quarter CPT Current Procedural Terminology MS-DRGs Medicare Severity-Diagnosis Related Groups CPT Assistant Monthly publication by the AMA that provides coding advice for CPT coding scenarios Encoder Nosology Provides coding professionals from the encoder company that are available to help answer tough coding questions History & Physical Provides the initi...

Coding Clinic Valuable reference tool for coders that is published by AHA each quarter CPT Current Procedural Terminology Brainpower Read More MS-DRGs Medicare Severity-Diagnosis Related Groups CPT Assistant Monthly publication by the AMA that provides coding advice for CPT coding scenarios Encoder Nosology Provides coding professionals from the encoder company that are available to help answer tough coding questions History & Physical Provides the in...

Denial Rate Number of Claims or line items denied / number of claims or lines items submitted Query Response Rate Number of Query Responses / Number of Queries Written Brainpower Read More Escalation Policy Provides a specific list of management and other authorities that must be contacted in the event of no response who works the working DRG Clinical documentation specialists Who assigns the final DRG Normally the coder Quality Audits A structured,...

Principal Diagnosis The disease or condition that was present on admission, was the principal reason for admission, and received treatment or evaluation during the hospital stay or visit for the reason established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care First Listed Diagnosis Used in the outpatient setting, this term is used (instead of the inpatient setting's principal diagnosis), and it is determined in accordance wi...

CDIP Domain 6: Compliance Questions and Answers Fully solved Who sets the official Guidelines for coding and reporting (ICD-10)? American Hospital Associates (AHA) American Health information management association (AHIMA) National Center for Health Statistics (NCHS) Center for Medicare and Medicaid Services (CMS) AHA Serves as a clearing house for issues related to use of ICD-10 codes services in representation and advocacy role on national classification and data issues publishe...

AHIMA American Health Information Management Association ACDIS Association of Clinical Documentation Improvement Specialists Brainpower Read More IDT Interdisciplinary Team LOS Length of Stay The RHIT, RHIA or CCS should have how many years of inpatient coding experience before becoming a CDI specialist? at least 3-5 years Hospitalists Physicians whose primary professional focus is the general medical care of hospitalized patients Timeframes fo...

CDIP Questions and Answers Rated A+ CDI program data includes: 1. All cases that were reviewed 2. Number of cases with queries 3. Nature of the query 4. Physician response to the query Queries should only be asked: 1. If there is clinical evidence that the documentation is imcomplete or does not meet one of the seven criteria for high-quality clinical documentation. 2. By an individual with solid clinical knowledge. 3. In an open-ended manner (no yes or no questions) 4. In a nonleading manner. ...

POA Present on admission Concurrent reviews CDI specialist reviews the patient record while the patient is in the hospital Brainpower Read More Ethical Conforming to accepted standards of conduct Ethical Queries Queries that do not lead the physician to a particular answer If you have two conflicting diagnoses by two providers, who should make the final decision? Attending physician Legible the record is clear enough for the reader to comprehend and e...