Successfully Appealing Clinical Validation and Coding Issues in Encephalopathy


Encephalopathy remains a huge target for both clinical and coding validation. Some denials are strictly coding, some are strictly clinical, and some are a combination of both, which are harder to appeal adequately as the writer needs knowledge of both worlds. We will discuss why coding and clinical denials for encephalopathy are different and why different appeal strategies are necessary.

Join us as we share what we’ve learned over the years from appealing hundreds of coding and clinical validation denials for encephalopathy on behalf of our hospital clients. We’ll reveal payer behaviors regarding auditing and denying this diagnosis code. And, as always, we will share proven, successful appeal strategies that you can use right away.

Learning Objectives:

  • Understand common denial rationale
  • Recognize the differences between coding and clinical denials for encephalopathy
  • Discover successful strategies to compose winning appeals when the encephalopathy diagnosis is denied, even though you got it right