BC Advantage - 2018 Issue 2

The Coder as the Last, Best Hope for the Right DRG

If the story doesn't make sense, there is probably something missing. There are a variety of reasons why the DRG might not tell the story of the patient encounter. Some of these include:Suboptimal medical careConfusing story because the provider wasn't clear on what was going onNo clear answer because the signs/symptoms resolved without a satisfying ultimate diagnosisWhack-a-mole medicine - the provider chases each abnormal test result and symptom without stepping back to see the big pictureClinician practicing bad medicine, often disregarding medical necessitySuboptimal documentationProvider practice of describing, instead of ascribingProviders being taught CDI "buzz words," without understanding the...

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