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Validating prolonged time in cpt coding

Health information management (HIM) is a discipline that has rapidly evolved toward roles of increasing complexity and demand in recent years and the coding profession has been one area at the center of this growth.

Mc Call, RHIA, CCS, CCS-P, CPC, CPC-I, CCDS, director of HIM and coding at HCPro.

Similarly, principal procedures are by definition definitive in nature (as opposed to diagnostic or exploratory procedures), she says.

So if two procedures meet the criteria, then the provider should select the one most closely related to the principal diagnosis, per the October 1990 AHA This concept is also pertinent for the issues involving procedures unrelated to the principal diagnosis DRGs, she notes.

A patient may undergo a procedure for a variety of different reasons, so providers would group an admission to a particular DRG based off the combination of the principal diagnosis, any present accompanying additional diagnosis (i.e., CCs or MCCs), and the principal procedure, Mc Call explains.

Therefore, if the provider reports an incorrect code as the principal diagnosis, the assigned DRG may not be correct.


  1. Clinical validation is beyond the scope of DRG coding validation, and the skills of a. within the medical record of which the coding specialist may not be aware. A time allotment can be assigned for a group discussion on each area. Clinical documentation improvement programs have gone a long way to reduce.

  2. Payments Billing Validation Methods. Division of Long Term Services and Supports. Explore documentation methods for billing validation in Appendix I-2-d. Federal Medical Assistance Percentage FMAP. Time the service begins and ends. ➢ Although. Validate service or taxonomy codes on the claim. • Check that.

  3. Sep 12, 2017. Have you ever had a patient take more time with the provider than they were. CPT codes for Prolonged Service with Direct Patient Contact.

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