The chart read nobody taught you.
Outpatient trained you to code what's written. Inpatient pays you to know it's true. One live hour on the PCS and clinical validation gap that keeps good coders stuck in quality audit feedback, taught by a nurse and coder who does DRG validation on the payer side.
- The one word in an op note that sends most coders to the wrong root operation
- Why a diagnosis the provider wrote can still come off on review
- What a DRG validator checks first, and why
The outpatient habits flip sheet. Eight outpatient rules that reverse in inpatient, in your inbox the moment you register.
Registration is for the live session. There is no replay.
You already know how to code. This hour is about the chart.
You want inpatient
You hold a credential and you're ready to move up. You want to walk into the interview already speaking PCS and clinical validation.
You made the move
And it's harder than anyone said. Your quality audits come back with changes, and the feedback tells you what was wrong, never why.
You're eyeing DRG validation
You want to be the one opening the chart and asking whether it's true. That job runs on the same chart read.
It isn't an effort problem. It's the missing middle.
Correct, and it's the rule. But it stops at the page.
Too clinical a job for your coding training. Not a nurse, so the clinical training was never built for you. Most supervisors learned it on the job, one denial at a time.
Anatomy, physiology, what sepsis actually looks like. Built for nurses, and it assumes the bedside.
If this has happened to you, this hour is for you.
Your principal diagnosis got changed on a quality audit, and you coded exactly what was documented.
A CC or MCC you captured got pulled, and nobody explained why.
You were sure about a root operation. It came back marked wrong.
You've read the feedback twice and still don't know what you missed.
On November 19, you'll see why it keeps happening. Three patterns behind that feedback:
The op note that fools good coders
One word in the procedure title sends most coders to the wrong root operation. You'll see why the title is the wrong place to start.
The diagnosis that came off
The provider wrote it. The coder coded it. It still didn't survive the payer's review.
The diagnosis that moved the DRG
One secondary diagnosis can move a case from the lowest-paying DRG in its group to the highest. It's the first thing a validator checks.
Live Q and A
Bring the question your audit feedback never answered.
The rules your outpatient brain will fight.
Eight outpatient habits that reverse the moment you code inpatient. One page, side by side, so you catch them before your auditor does. It lands in your inbox with your Webex link.
Get the sheet and my seat →Taught from the payer's side of the chart.
Jesse Gallop came up through medical coding, risk adjustment, outpatient and inpatient CDI, then DRG validation, reviewing inpatient claims for Medicare, Medicare Advantage, Medicaid, and commercial plans. A nurse's clinical read, applied to the chart your auditor is reading.
Inpatient pays you to know it's true.
Save my free seat →