The CDI specialist is uniquely positioned to unify efforts to report claims data that accurately reflects the clinical scenario and the provider’s intent within the constructs of the ICD-10-CM/PCS code set. To fulfill this role, the CDI specialist must understand the role of clinical validation as it relates to payment denials and quality measure performance validation.
Although guidance on clinical validation exists within source authorities and official guidance, it often appears contradictory and leads to struggles for many CDI and coding professionals. The goal of this report is to help standardize how CDI and coding professionals define and apply clinical validation techniques to accurately reflect clinical scenarios and minimize denials.
This report will also address: - The case for clinical validation
- Timing of clinical validation
- The use of queries as a tool in addressing clinical validation
- Writing a validation query and appropriate responses
- Tracking trends and education
- And more!
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Visit our CDI Solution Center for additional resources on
training and workflow tools.
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