ࡱ> YX( b/ 0DTimes New Roman@0Wo 0DWingdingsRoman@0Wo 0 ` .  @n?" dd@  @@`` ($m    ,   c 1?@8uʚ;2Nʚ;g4@d@d0ppp@ <4!d!d 0L@<4dddd 0L@ <4BdBd. 0L2*___PPT9 z? % DRGs Impact on Reimbursement)Medical Information Management Department'3 Key Rules for Inpatient Documentation]Probable, possible, or suspected conditions Specificity Complications and Comorbid ConditionsJ  +Probable, Possible, or Suspected ConditionsWhen a diagnosis for an inpatient at the time of discharge is qualified as:  possible,  probable,  suspected,  likely,  questionable, or  rule out, the condition is coded as though the diagnosis were established.$  Chest PainWas it cardiac, GI, or musculoskeletal in origin? If cardiac, was it angina? Did a cardiac catheterization show disease? Document coronary artery disease if applicable.Reimbursement ImpactnThe following slide is intended to show the relationship between various ways cardiac symptoms could be coded. Reimbursement ImpactSyncopeWas the patient treated as if they suffered a TIA or CVA? Was the event due to an embolus, thrombus, or carotid artery stenosis?w!Reimbursement ImpacteThe following slide is intended to show the relationship between various ways syncope could be coded.Reimbursement Impact SpecificityA coder may never assign a code on the basis of an abnormal finding alone. The physician must ensure that the documentation provided is clear and concise. UHDDS Principal Diagnosis Definition   That condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care. NNUrosepsis vs. Septicemia  EThe physician needs to specify if the diagnosis of urosepsis is intended to mean 1) generalized sepsis (septicemia) caused by leakage of urine or toxic urine by-products into the general vascular circulation OR 2)urine contaminated by bacteria, bacterial byproducts, or other toxic material but without other findings (UTI)rF3  Complication or Comorbidity  Conditions that affect patient care by requiring: Clinical evaluation OR Therapeutic treatment OR Diagnostic procedures OR Extended length of stay OR Increased nursing care and/or monitoring A coder may never assign a code on the basis of an abnormal finding alone.,2K  $Rules of Medicare& Just because it has a code, that doesn t mean it s covered Just because it s covered, that doesn t mean you can bill for it Just because you can bill for it, that doesn t mean you ll get paid for it Just because you ve been paid for it, that doesn t mean you can keep the money You ll never know all the rules Not knowing the rules can land you in the slammer Larry Oday  Attorney, Vinson & Elkins.hZ(Zi' ,o    ` f3Eh` ff` MMMwww` ff3f3>?" dd@,?nKd@  d @nK` d n?" dd@   @@``PR    @ ` ` p>> p h  < (  <T 1 < "1 < S BC1DEF ?Z B 0Z @1 < S BB C DEF?rA r @\  < S B+ C DEF?v*  v @  < S BCIDEF??H\ @ I < Nxlgֳgֳ ?" @ T Click to edit Master title style! !  < Zn1 ?"``  Z* 2   < Zp1 ?"`   \*(2   < Z41 ?"`   \*(2Z  <  f`u1 ?"   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