Coding for quality vs reimbursement

Are there times when there are two possible P DX's are available and that one is chosen because it will have a lesser impact on quality metrics, rather than going for the higher reimbursement?

Comments

  • When we have 2 diagnoses that equally meet the definition of PDx, we are instructed to choose the one with the higher relative weight.  Regardless of dollars, as the dollars aren't always higher with a higher relative weight.  We don't consider the quality metrics in choosing the PDx.

    Betty

  • It depends upon the understanding you may have between your HIM, Quality, and CDI teams. There should be a coordinated workflow.


    Paul

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