Health Information Management

News: Coding Clinic wins out over SE MLN Matters article advice

CDI Strategies, November 11, 2010

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On October 14, we reported that CMS issued a controversial MLN Matters special edition (SE) article which stated that all inpatient admissions needed to have any/all ‘other’ or ‘secondary’ diagnoses documented by the attending physician.

The advice, published in article 1028, “Recovery Audit Contractor (RAC) Demonstration High-Risk Diagnosis Related Group (DRG) Coding Vulnerabilities for Inpatient Hospitals” was later rescinded as the guidance directly contradicted advice from Coding Clinic.
The new version of SE1028 has removed this language. You can read the revised article here on the CMS website.
The ICD-9-CM Official Guidelines for Coding and Reporting.indicate that “provider” is defined as a physician or other provider legally accountable for establishing a patient’s diagnosis. This could include specialists and others caring for the patient, who are not the patient’s attending physician.
Special thanks go to Robert Gold, MD, of the ACDIS advisory board for helping to bring this to the attention of CMS, and Lynne Spryszak and Shannon McCall also of the ACDIS advisory board for discovering the problematic language in the original article.

Editor’s note: This article first appeared on the ACDIS Blog. Read additional analylsis of the change in the MedicareMentor Blog

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