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Conflicting documentation: The mechanisms of diagnosis inconsistency

HIM-HIPAA Insider, June 1, 2015

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Coders have a very important job. The existence of a hospital depends on the work they do, both in the inpatient and outpatient arenas. They also must follow a lot of rules and a lot of guidance where the rules aren't specific enough. Beyond these lay plenty of holes in the advice/opportunities for interpretation or misinterpretation.

One of these has been raising its ugly head for about a decade, and that is the concept of "conflicting documentation." Why? Because auditors may interpret rules in different ways, and coders are caught in the middle. Even beyond that, some auditors create their own guidelines, and the rulemakers provide incorrect advice.

Coders are under pressure to maximize the relative weight of the discharge DRGs and constantly do their due diligence to find a condition documented. That condition, according to the rules, can be a principal diagnosis that leads to a higher-weighted DRG, or a secondary diagnosis that is a CC or MCC, also leading to a higher-weighted DRG. That's the nature of the beast.

Continue reading "Conflicting documentation: The mechanisms of diagnosis inconsistency" on the HCPro website. Subscribers to Briefing on Coding Compliance Strategies have free access to this article in the May issue.

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