Challenges of Clinical Validation: Coding Guidelines vs. Billing Regulations
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Challenges of Clinical Validation: Coding Guidelines vs. Billing Regulations December 12, 2022 · Revenue Cycle · Health Data · Regulatory and Health Industry

Challenges of Clinical Validation: Coding Guidelines vs. Billing Regulations

By Richard Pinson, MD, FACP, CCS, CDIP, and Cynthia Tang, RHIA, CCS


What is clinical validation? Why is it important? What’s the big deal? Is it enough to just query the provider? One of the fundamental challenges for physicians is that they must keep abreast not only of updates to clinical criteria for numerous conditions but also with specific terminology to ensure proper code assignment. Clinical documentation integrity (CDI) programs serve to assist providers with these challenges through education and queries.

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