Health Information Management

Know when to report secondary diagnoses

HIM-HIPAA Insider, February 15, 2011

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A patient’s medical record could include a laundry list of diagnoses, but not all of these conditions may be reportable. 

Coders must determine when they can report conditions as “other” secondary diagnoses and when they must simply leave them off the claim entirely.
 
Why is this important? Coding diagnoses that don’t affect the current admission or that don’t fit reporting criteria could affect data quality, patient acuity, and reimbursement, says Gloryanne Bryant, RHIA, CCS, CCDS, regional managing director of HIM, NCAL revenue cycle, at Kaiser Foundation Health Plan, Inc. & Hospitals in Oakland, CA.
 
It also could leave a hospital vulnerable to a RAC audit, particularly when the diagnoses in question are CCs or MCCs that yield a higher-weighted DRG. However, underreporting secondary diagnoses can also be detrimental in terms of quality and reimbursement, so hospitals must find a compliant balance between the two, says Bryant.
 
Note: To read more, view the February issue of Briefings on Coding Compliance Strategies.



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