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CC/MCC: Tools for Capturing Accurate Clinical Documentation Presented on: Presented by: Sponsored By One of the core daily competencies of a clinical documentation improvement (CDI) specialist is to identify the clinical indicators needed to qualify a diagnosis as a complication/comorbidity (CC) or a major CC (MCC). New coders and CDI specialists often struggle to pinpoint the top opportunities, and with shifts in ICD-10-CM/PCS, the task can seem even more daunting. Agenda DRG complication/comorbidity references Uniform Discharge Data Set requirements Official Guidelines for Coding and Reporting American Hospital Association’s Coding Clinic for ICD-9-CM and Coding Clinic for ICD-10-CM/PCS Complications/comorbid conditions (CC) Cardiovascular conditions Altered mental status, encephalopathy, and common neurological situations Chronic respiratory failure and other respiratory diseases Major complications/comorbid conditions (MCC) Cardiovascular conditions Malnutrition Acute tubular necrosis (ATN) Postop respiratory failure/insufficiency ICD-10-CM Principal diagnoses that serve as their own CC/MCC (partial list) List of CC/MCC deletions from ICD-9-CM to ICD-10-CM (partial list) MS-DRG assignment shifts for surgical situations Live Q&APrice: $259 | ||||||||
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