Health Information Management

News: Noridian issues reminder regarding selection of appropriate principal diagnosis

CDI Strategies, September 13, 2012

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The terms “admitting” diagnosis and “principal” diagnosis are not necessarily the same, warns Noridian Administrative Services, LLC., Medicare Administrative Contractor for Jurisdiction F, in a August 17 memo to providers. It cites analysis from recent Comprehensive Error Rate Testing (CERT) reports which indicate that providers are not coding the principal diagnosis and procedure to the highest level or specificity or are not selecting the most appropriate codes for the inpatient service.

When the inappropriate code is selected auditors may deny the claim or refuse to pay for inpatient care based on the lack of medical necessity, according to the memo. It reminded providers and coders (guidance which also applies to CDI specialists reviewing charts) that:
“whenever possible the medical documentation should provide sufficient evidence of the actual underlying cause of the inpatient admission not the just symptoms… Coders should review the complete medical record for the appropriate principal diagnosis, the condition known to have caused the admission once all pertinent diagnostic testing is complete.”

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