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2019 Outpatient CDI Pocket Guide: Focusing on HCCs

Product Code: CDIPG19OP

Quick Overview

A compact, portable resource, the Outpatient CDI Pocket Guide is essential for CDI specialists, coding specialists, physician advisors, and any others involved in documentation and coding improvement.
ISBN 978-1-68308-873-8
Pages 254
PUBLICATION DATE Sep 17, 2018

Price: $165.00

2019 Outpatient CDI Pocket Guide: Focusing on HCCs

2019 Outpatient CDI Pocket Guide: Focusing on HCCs

Richard D. Pinson, MD, FACP, CCS
Cynthia L. Tang, RHIA, CCS

Let the new 2019 edition of the Outpatient CDI Pocket Guide show you how to master Hierarchical Condition Categories (HCC).

The 2019 Outpatient CDI Pocket Guide: Focusing on HCCs features an easy-to-understand approach, boiling HCCs down to a few basic principles that, when mastered, make them a breeze.

Authors Richard Pinson and Cynthia Tang explain how HCCs affect both providers and payers and clarify the chief considerations in outpatient reimbursement, documentation, and coding guidelines.

You will benefit from this guide if you are a CDI or coding specialist, risk adjustment auditor, nurse, or physician who seeks to:

  • Focus on areas of greatest impact as you expand your CDI program to the outpatient setting
  • Improve capture of HCC diagnoses that will optimize hospital and physician risk adjustments for value-based payments
  • Increase risk adjustment factor scores for Medicare Advantage health plans
  • Ensure your organization’s outpatient coding practices are compliant and meet clinical validation and documentation requirements


About the Authors

Richard D. Pinson, MD, FACP, CCS, is an educator, author, and CDI consultant with expertise in improving coding and clinical documentation; conveying diagnostic and evidence-based criteria; educating physicians, coders, and CDI specialists; and transforming physician practice patterns and behaviors. He practiced emergency medicine and internal medicine for 25 years and is a Fellow of the American College of Physicians. He has authored “Coding Corner” for ACP Hospitalist magazine for the past eight years. He is the co-author of the best-selling, authoritative CDI Pocket Guide and the Pocket Guide for Coding Professionals.

Cynthia L. Tang, RHIA, CCS, is an educator, author, and CDI consultant with expertise in health information management, coding, and clinical documentation improvement. She has more than 25 years of consulting experience in redesigning operations to improve coding and clinical documentation, promote hospital financial health, optimize reimbursement and compliance, and identify areas to improve care management and cost efficiency. She is the co-author of the best-selling, authoritative CDI Pocket Guide and the Pocket Guide for Coding Professionals.

Table of Contents

Outpatient CDI
Introduction to HCCs
Outpatient vs. Inpatient Payment Methodologies 
Risk Adjustment and HCCs 
CMS Pay for Performance (P4P) Programs
Expanding Your CDI Program

Guidelines
Outpatient Diagnostic Coding Guidelines
Outpatient Documentation Requirements
Physician Queries
Evaluation & Management (E/M) Guidelines
Regulatory Compliance

Key Diagnoses
Amputation Status
Aortic Atherosclerosis, Aneurysm, Ectasia
Cardiac Dysrhythmia
Cardiomyopathy
Chronic Kidney Disease
Depression
Diabetes Mellitus
Diabetic Complications
Heart Failure
HIV/AIDS
Malnutrition
Morbid Obesity
Neoplasms
Paralysis (Plegia and Paresis)
Pulmonary Hypertension & Heart Disease
Respiratory Failure
Skin Ulcers
Substance Use, Abuse, Dependence

HCCs
Overview
CMS-HCCs, V23.0
HCC Diagnoses
HCC Diagnoses by HCC