Which action is appropriate when a possible MCC appears clinically…

Question

Which action is appropriate when a possible MCC appears clinically relevant to inpatient payment but is not clearly documented?

Accepted Answer

Query the provider for clarification when clinical indicators support the condition; do not add an undocumented MCC for payment. — Payment pressure is real, but it’s not a license to invent an MCC. If the clues are in the chart, ask the provider—that’s fair game. Adding what was never documented is the line you don’t cross.

Answer

Code the MCC immediately because higher payment always justifies the addition.

Answer

Instruct CDI to insert the MCC into the discharge summary without provider involvement.

Answer

Replace the principal diagnosis with the MCC to maximize relative weight.

Which action is appropriate when a possible MCC appears clinically relevant to inpatient payment but is not clearly documented?

Short Explanation

Full Explanation