EDITOR’S NOTE: This is the second portion of a two-part series of articles highlighting detailed examples of two challenged denials that followed third-party healthcare audits. In our second example, a 73-year-old female presented to the hospital with syncope following a fall at a physician office: The provider assigned I67.1 (Cerebral…
EDITOR’S NOTE: This is the first in a two-part series of articles highlighting detailed examples of two challenged denials that followed third-party healthcare audits. I shouldn’t be surprised.  I have been reviewing denials by insurance companies since the late 1980s. I’ve seen the same things over and over again, such…
Electronic alerts for systemic inflammatory response syndrome (SIRS). EDITOR’S NOTE: Dr. Erica Remer reported this story live during the Sept. 24 edition of Talk Ten Tuesday. The following is an edited transcript of her reporting. Dr. Ronald Hirsch recently brought an article to my attention, and I felt compelled to share…
The CDI is more than diagnosis capture through the query process. The Association for Clinical Documentation Improvement Specialists (ACDIS) recently released a paper titled Proactive CDI: Tackling the Problem of Physician Engagement, which featured six CDI leaders outlining their thoughts and ideas on facilitating physician engagement in CDI initiatives within…
The author reports on the recent court decision to dismiss a False Claims Act lawsuit against Dallas-based Baylor, Scott & White Health. EDITOR’S NOTE: Dr. Erica Remer reported this story live during the Aug. 27 edition of Talk Ten Tuesday. The following is an edited transcript of her reporting. My…
The author shares highlights from the annual conference. I am continuing my reporting on tidbits I learned at the Association of Clinical Documentation Improvement Specialists (ACDIS) annual conference in May. As I mentioned last week, I was honored to make closing remarks on the first day. I shared my grand…
‘Déjà vu’ is a French term describing the feeling that one has lived through the present situation before.  For most health information management (HIM) professionals, many aspects of risk-adjusted coding might give rise to the phenomenon, at least as it pertains to diagnosis-related groups (DRGs)! The pandemonium regarding documentation coding…
The AHIMA World Congress (AWC) team used gap analysis to report new opportunities for Al Ain Hospital in the UAE. EDITOR’S NOTE: Dr. Lo will be a guest speaker during today’s edition of Talk Ten Tuesdays, and he offered the following thoughts with ICD10monitor ahead of the appearance. I am…
The authors discusses the lawsuit against Providence St. Joseph Health Services for alleged upcoding. Performance with a purpose must be the driving force for business operations, personal goals, work and life accomplishments, and personal choices. The concept of performance with purpose must be a fundamental foundation governing all aspects of…
The author responds to a Talk Ten Tuesday listener's comments regarding the coding of bronchoalveolar lavage. During the Talk Ten Tuesday broadcast on July 24, 2018, Stacey Elliott, an inpatient compliance specialist and a guest panelist on program, and I had a discussion regarding bronchoalveolar lavage (BAL). Stacey had a…
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