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July 10, 2017Coding and Clinical Criteria: The Value of an
Escalation Policy
By Linda SchwabMessmer, HIT, CCS, AHIMAApproved ICD10CM/PCS Trainer, and Dots Baxter, RHEA,
CCS, AHIMAApproved ICD10CM/PCS
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What is coding and clinical criteria?
Coding and clinical criteria are specific guidelines and requirements that determine how medical diagnoses, procedures, and services are documented, classified, and reported for billing purposes.
Who is required to file coding and clinical criteria?
Healthcare providers, medical coders, and billing departments are typically responsible for filing coding and clinical criteria.
How to fill out coding and clinical criteria?
Coding and clinical criteria should be completed accurately and thoroughly according to the specific guidelines provided by relevant regulatory authorities.
What is the purpose of coding and clinical criteria?
The purpose of coding and clinical criteria is to ensure accurate and consistent documentation of medical services and diagnoses for billing, reimbursement, and quality assurance purposes.
What information must be reported on coding and clinical criteria?
Coding and clinical criteria typically require detailed information about the patient, the provider, the medical services provided, and the associated diagnoses.
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