Formerly the Guide to Clinical Validation and Documentation Improvement for Coding.
Updated with 2027 coding information, the Clinical Validation and Documentation Integrity for Coding 2027 is a concise, reliable, and easy-to-follow tool for those problematic diagnoses and PCS inpatient procedures that are most often questioned by payers. This unique resource provides the extensive clinical criteria and associated documentation necessary for code assignment. This tool also describes the clinical documentation needed for determining if the condition is a complication or when a medical condition qualifies as an additional diagnosis.
Clinical Validation and Documentation Integrity for Coding 2027 also includes is an introduction to the query process and how DRGs, CCs, MCCs, POAs, and HACs affect reimbursement. CDI staff, coders, utilization review staff, and HIM managers can use this to systematically evaluate the clinical criteria that influence code assignments and patient care.
Key features and benefits of this Optum CDI coding guide:
- NEW — Expansion of surgical procedures and diagnostic conditions. Additional
- ICD-10-PCS procedures and conditions identified with ICD-10-CM diagnoses providing more insight into clinical validation and documentation integrity.
- Covers many of the most challenging inpatient medical diagnoses and procedures. Plus, the clinical criteria that support code assignment.
- Diagnosis and Procedure Documentation. Review detailed documentation requirements for ICD-10-PCS and ICD-10-CM coding. Enhance your code selection accuracy.
- Examples of physician queries. Use these examples to assist in addressing physicians fine distinctions in a patient’s treatment or condition ensuring appropriate documentation for services provided.
- Reimbursement Impacts: Tutorials on additional factors that rely on concise, accurate documentation and impact reimbursement such as complications and comorbidities (CC and MCC), hospital acquired conditions (HAC), and present on admission (POA).
- Extensive clinical tools: Includes resources for how to interpret abnormal EKGs, lab values and diagnostic test outcomes in addition to pharmacology and organism information.
- Identifies other terminology that would qualify as and translate into ICD-10-PCS specific root operations.