Tip of the week: Encourage physicians to provide detailed heart failure documentation
HIM Connection, February 19, 2008
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Physicians must describe heart failure (HF) as systolic, diastolic, or both on every admission or visit to obtain maximum severity in risk adjustment and Medicare Severity DRGs, says James S. Kennedy, MD, CCS, of FTI Cambrio Health Solutions in Brentwood, TN. Characteristics of patients with systolic and diastolic HF are outlined in The New England Journal of Medicine, Vol. 348, pp. 2007-2018, which is viewable after a free registration at http://content.nejm.org/cgi/content/full/348/20/2007. Most HF patients have a combination of systolic and diastolic HF; thus, describing them as likely having such is clinically congruent.
Editor's note: This tip was adapted from the February 2008 issue of Medical Records Briefing. For more information or to purchase a copy for $10, visit http://www.hcpro.com/content/203967.cfm or call 800/650-6787.
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