Tips to avoid adding insult to 'injury' documentation

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April 1, 2009

During the past few years, we have seen the evolution of certain terms in the medical literature, most of which have evolved from recent professional writings. One of the most recent is the term “injury,” which is causing headaches in CDI programs and is hurting disease data streams.

Acute brain injury, acute lung injury (ALI), and acute kidney injury (AKI) were introduced into the vocabulary in an effort to help clinicians identify patients with mechanisms of organ damage that require study, treatment, and intervention. Each one of these afflictions can have a wide variance of reversible outcomes or result in total organ destruction and death.



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