Wiki Abstracting vs. Validating Dx code

LuckyLily

Guru
Local Chapter Officer
Messages
135
Best answers
0
Can someone shed light on the difference between abstracting a dx code from the progress note, versus validating the dx code put on claim by provider? I have always abstracted the diagnosis code from the progress note by the provided documentation, and now are being directed to validate the diagnosis that the provider put on claim. How would you validate the code?
 
Compare the code you find from the progress note with the provider claim code. Try to find the difference between the two codes and query the provider to confirm the most specific code you can use. Don't assume you're always right or always wrong, but do a little digging into that chart to correlate the information that point toward what code. Maybe some numbers got transposed? Maybe this isn't the right patient chart? Right DOS? Check all patient identifiers on every page if the codes are way different.
 
Can someone shed light on the difference between abstracting a dx code from the progress note, versus validating the dx code put on claim by provider? I have always abstracted the diagnosis code from the progress note by the provided documentation, and now are being directed to validate the diagnosis that the provider put on claim. How would you validate the code?
It's just semantics really - you're not doing anything differently from a coding perspective. If you're abstracting, then you're coding on your own. If you're validating the providers' codes, then you're just acting as an auditor . Either way, you still go through the same process - you code from the documentation. The extra step in validating is that after you code the records, you compare your code(s) with the providers' and make any corrections if necessary.
 
Top