With the shift to value-based care, the difference between coding validation (DRG) and CVDs is no longer distinct. The preponderance of more CVDs in which providers use a combination of clinical and coding references is one major trend that makes it difficult to determine the type of denial. For example, a coding reference may be used inappropriately to support a clinical validation.
This creates confusion that demands a dual approach to writing appeals, including determining the denial type and the most productive appeal strategy. While effective, this approach requires communication and collaboration between coding and clinical documentation improvement (CDI) staff.
Click here to find out what strategies are most effective for handling appeals and preventing denials.
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