RE: RE:[EXTERNAL] RE:"borderline hyponatremia"
I have also seen similar denials from the RAC stating the condition coded did not meet 'their' criteria.
One example is acute kidney injury - I have denials whereby the condition is stated w/o ambiguity and the Cr meets or exceeds the KDIGO literature for reporting. No query needed or issued, as the basis for coding is abundantly clear.
The RAC will state the 'coder should have issued a query' to confirm the condition...I will not issue a query to 'confirm' AKI when stated and exceeding common medical standards as this impugns my reputation, and would be considered harassment by the clinician.
Upon reviewing the claim letter, the RAC representative does not 'offer' any definition that they find 'acceptable'.
Again, this is not compliant w/ HIPAA.
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421
evanspx@sutterhealth.org
One example is acute kidney injury - I have denials whereby the condition is stated w/o ambiguity and the Cr meets or exceeds the KDIGO literature for reporting. No query needed or issued, as the basis for coding is abundantly clear.
The RAC will state the 'coder should have issued a query' to confirm the condition...I will not issue a query to 'confirm' AKI when stated and exceeding common medical standards as this impugns my reputation, and would be considered harassment by the clinician.
Upon reviewing the claim letter, the RAC representative does not 'offer' any definition that they find 'acceptable'.
Again, this is not compliant w/ HIPAA.
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421
evanspx@sutterhealth.org