Health Information Management

Ensure documentation supports the codes you assign

Briefings on Coding Compliance Strategies, November 1, 2010

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Coders are under a lot of pressure to accurately assign diagnosis codes and DRGs, capture all relevant CCs and MCCs, and abide by coding guidelines and instructions. Unfortunately, when something goes wrong and a RAC, the Office of Inspector General (OIG), an auditor, or a physician disagrees with the codes assigned, coders are often the ones who take the blame, even when it’s clearly not their fault. To make matters worse, some hospitals ask coders to maximize MS-DRGs by assigning a principal diagnosis code or MCCs that would yield a higher payment, even when the clinical scenario doesn’t justify doing so. This unethical practice has, in part, led to CMS’ documentation and coding adjustment, which has resulted in decreased Medicare payments for all hospitals.

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