2020 ACDIS Outpatient Pocket Guide

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2020 ACDIS Outpatient Pocket Guide

Product Code: CDIPG20OP--

2020 ACDIS Outpatient Pocket Guide

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2020 ACDIS Pocket Guide: 

The essential CDI resource for outpatient professionals

CDI professionals need a day-to-day reference when conducting their outpatient medical record reviews – one that can provide trusted clinical indicators for compliant and effective physician clarifications, and at-a-glance, easy-to-use diagnosis and Hierarchical Condition Category (HCC) references. The 2020 ACDIS Outpatient Pocket Guide is the essential resource for outpatient coding guidance, HCC updates, compliant query best practices and standards, E/M requirements, and diagnostic definitions. 

This is the perfect resource as you look to grow your outpatient CDI program and continue to ensure your outpatient coding is in compliance.

Co-written by ACDIS’ CDI Education Director Laurie Prescott, RN, MSN, CCDS, CDIP, CRC, CCDS-O, James Manz, MD, CCDS-O, a practicing physician at the Mayo Clinic steeped in the latest physician documentation terminology, and Karen Newhouser, RN, BSN, CCDS, CCDS-O, CCS, CDIP, CCM, Clinical Documentation Integrity Content Manager for AMN Revenue Cycle Solutions, the 2020 ACDIS Outpatient Pocket Guide is a winning combination of practical, tailored CDI tips and resources, helpful references including ICD-10-CM code mappings organized by HCC, and clinical,  regulatory, and coding guidance adapted from the official sources.

Conditions covered in the 2020 ACDIS Outpatient Pocket Guide are organized by their Hierarchical Condition Category (HHC), and then in alphabetical order. Each condition listed is accompanied by a detailed clinical definition of the condition, clinical indicators that support the presenting condition, including diagnostic criteria and treatment protocols, ICD-10-CM chapter-specific documentation requirements, including the latest coding clinic guidance specific to the condition, CDI critical thinking tips and provider focused education advice related to the diagnoses.

Published: January 2020

Page count: 382 + 5 Tabs
ISBN: 978-1-68308-981-0

Table of Contents

List of Conditions


Outpatient CDI Functions

Charge Capture

Provider Evaluation and Management (E/M)

Quality Metrics

Risk Adjustment

Regulatory Guidance

Guidelines Organization

Official Coding Guidance

General Coding Guidelines

Reporting Diagnoses

Diagnostic Coding & Reporting Guidelines for Outpatient Services

Selection of the First-Listed Diagnosis

Code Assignment for Special Patient Populations: Pregnancy, Childbirth, and the Puerperium

Code Assignment for Special Patient Populations: Congenital Malformations, Deformations, and Chromosomal Abnormalities

Evaluation and Management Services

Elements of an E/M Code

Components of an E/M Level

Compliant Query Practice

Why Do We Query?

The Role of Clinical Indicators in Queries

Three Types of Query Formats

Compliant Verbal Queries

Use of Query Templates

Maintaining Compliant Practice

The Process of Clinical Validation

Reportability of Diagnoses

Hierarchical Condition Categories

General Notes and Glossary


HCC 2 Septicemia, Sepsis, Systemic Inflammatory Response Syndrome (SIRS), Shock

HCC 6 Opportunistic Infections

HCC 8 Metastatic Cancer and Acute Leukemia

HCC 9 Lung and Other Severe Cancers

HCC 10 Lymphoma and Other Cancers

HCC 11 Colorectal, Bladder, and Other Cancers

HCC 12 Breast, Prostate, and Other Cancers or Tumors

HCC 17 Diabetes with Acute Complications

HCC 18 Diabetes with Chronic Complications

HCC 19 Diabetes without Complications

HCC 21 Protein-Calorie Malnutrition

HCC 22 Morbid Obesity

HCC 23 Other Significant Endocrine and Metabolic Disorders

HCC 27 End-Stage Liver Disease

HCC 28 Cirrhosis of the Liver

HCC 29 Chronic Hepatitis

HCC 33 Intestinal Obstruction/Perforation

HCC 34 Chronic Pancreatitis

HCC 35 Inflammatory Bowel Disease

HCC 39 Bone/Joint/Muscle Infections/Necrosis

HCC 40 Rheumatoid Arthritis and Inflammatory Connective Tissue Disease

HCC 46 Severe Hematological Disorders

HCC 47 Disorders of Immunity


HCC 48 Coagulation Defects and Other Specified Hematological Disorders

HCC 51 Dementia with Complications

HCC 52 Dementia without Complications

HCC 54 Substance Use with Psychotic Complications

HCC 55 Substance Use Disorder, Moderate/Severe or Substance Use with Complications

HCC 56 Substance Use Disorder, Mild except Alcohol and Cannabis

HCC 57 Schizophrenia

HCC 58 Reactive and Unspecified Psychoses

HCC 59 Major Depressive, Bipolar, and Paranoid Disorders

HCC 60 Personality Disorders

HCC 70 Quadriplegia

HCC 71 Paraplegia

HCC 72 Spinal Cord Disorders/Injuries

HCC 73 Amyotrophic Lateral Sclerosis and Other Motor Neuron Diseases

HCC 74 Cerebral Palsy

HCC 75 Neuromuscular Disorders—Myasthenia Gravis/ Myoneural Disorders and Guillain-Barré Syndrome/ Inflammatory and Toxic Neuropathy

HCC 76 Muscular Dystrophy

HCC 77 Multiple Sclerosis

HCC 78 Parkinson’s and Huntington’s Disease

HCC 79 Seizure Disorders and Convulsions

HCC 80 Coma, Brain Compression/Anoxic Damage

HCC 82 Respirator Dependence/Tracheostomy Status

HCC 83 Respiratory Arrest

HCC 84 Cardiorespiratory Failure and Shock

HCC 85 Congestive Heart Failure

HCC 86 Acute Myocardial Infarction

HCC 87 Unstable Angina and Other Acute Ischemic Heart Diseases

HCC 88 Angina Pectoris

HCC 96 Specified Heart Arrythmias

HCC 99 Intracranial Hemorrhage

HCC 100 Ischemic or Unspecified Stroke

HCC 103 Hemiplegia/Hemiparesis

HCC 104 Monoplegia, Other Paralytic Syndromes

HCC 106 Atherosclerosis of the Extremities with Ulceration and Gangrene

HCC 107 Vascular Disease with Complications

HCC 108 Vascular Disease

HCC 110 Cystic Fibrosis

HCC 111 Chronic Obstructive Pulmonary Disease

HCC 112 Fibrosis of Lung and Other Chronic Lung Disorders

HCC 114 Aspiration and Other Specified Pneumonias

HCC 115 Pneumococcal Pneumonia, Empyema, and Lung Abscess

HCC 122 Proliferative Diabetic Retinopathy and Vitreous Hemorrhage

HCC 124 Exudative Macular Degeneration

HCC 134 Dialysis Status

HCC 135 Acute Renal Failure/Acute Kidney Injury

HCC 136 Chronic Kidney Disease (CKD) Stage 5

HCC 137 Chronic Kidney Disease (CKD) Stage 4

HCC 138 Chronic Kidney Disease (CKD) Stage 3

HCC 157 Pressure Ulcer of the Skin with Necrosis Through to Muscle, Tendon, or Bone

HCC 158 Pressure Ulcer of the Skin with Full-Thickness Skin Loss

HCC 159 Pressure Ulcer of the Skin with Partial-Thickness Skin Loss

HCC 161 Chronic Ulcer of the Skin, except Pressure

HCC 162 Severe Skin Burn or Condition

HCC 166 Severe Head Injury

HCC 167 Major Head Injury

HCC 169 Vertebral Fracture without Spinal Cord Injury

HCC 170 Hip Fracture/Dislocation

HCC 173 Traumatic Amputations and Complications

HCC 176 Complications of Specified Implanted Device or Graft

HCC 186 Major Organ Transplant or Replacement Status

HCC 188 Artificial Openings for Feeding or Elimination

HCC 189 Amputation Status, Lower Limb, Amputation Complications

Social Determinants of Health


HHS-HCC Diagnostic Classification

Key References

FY 2020 CMS HCCs

Disease Hierarchies for the 2020 Alternative Payment Condition Count Model

Acceptable Physician Specialty Types

List of Conditions

Acute Myocardial Infarction

Acute Renal Failure/Acute Kidney Injury.

Amputation Status, Lower Limb, Amputation Complications

Amyotrophic Lateral Sclerosis and Other Motor Neuron Diseases

Angina Pectoris

Artificial Openings for Feeding or Elimination

Aspiration and Other Specified Pneumonias Atherosclerosis of the Extremities with Ulceration and Gangrene

Bone/Joint/Muscle Infections/Necrosis

Breast, Prostate, and Other Cancers or Tumors

Cardiorespiratory Failure and Shock

Cerebral Palsy

Chronic Hepatitis

Chronic Kidney Disease (CKD) Stage 3

Chronic Kidney Disease (CKD) Stage 4

Chronic Kidney Disease (CKD) Stage 5

Chronic Obstructive Pulmonary Disease

Chronic Pancreatitis

Chronic Ulcer of the Skin, except Pressure

Cirrhosis of the Liver

Coagulation Defects and Other Specified Hematological Disorders

Colorectal, Bladder, and Other Cancers

Coma, Brain Compression/Anoxic Damage

Complications of Specified Implanted Device or Graft

Congestive Heart Failure

Cystic Fibrosis

Dementia with Complications

Dementia without Complications

Diabetes with Acute Complications

Diabetes with Chronic Complications

Diabetes without Complications

Dialysis Status

Disorders of Immunity

End-Stage Liver Disease

Exudative Macular Degeneration

Fibrosis of Lung and Other Chronic Lung Disorders


Hip Fracture/Dislocation


Inflammatory Bowel Disease

Intestinal Obstruction/Perforation

Intracranial Hemorrhage

Ischemic or Unspecified Stroke

Lung and Other Severe Cancers

Lymphoma and Other Cancers

Major Depressive, Bipolar, and Paranoid Disorders

Major Head Injury

Major Organ Transplant or Replacement Status

Metastatic Cancer and Acute Leukemia

Monoplegia, Other Paralytic Syndromes

Morbid Obesity

Multiple Sclerosis

Muscular Dystrophy

Myasthenia Gravis/Myoneural Disorders and Guillain-Barré Syndrome/Inflammatory and Toxic Neuropathy

Opportunistic Infections

Other Significant Endocrine and Metabolic Disorders



Parkinson’s and Huntington’s Disease

Personality Disorders

Pneumococcal Pneumonia, Empyema, and Lung Abscess

Pressure Ulcer of the Skin with Full-Thickness Skin Loss

Pressure Ulcer of the Skin with Necrosis Through to Muscle, Tendon, or Bone

Pressure Ulcer of the Skin with Partial-Thickness Skin Loss

Proliferative Diabetic Retinopathy and Vitreous Hemorrhage

Protein-Calorie Malnutrition


Reactive and Unspecified Psychoses

Respirator Dependence/Tracheostomy Status

Respiratory Arrest

Response Syndrome (SIRS), Shock, Septicemia, Sepsis, Systemic Inflammatory Rheumatoid Arthritis and Inflammatory Connective Tissue Disease


Seizure Disorders and Convulsions

Severe Head Injury

Severe Hematological Disorders

Severe Skin Burn or Condition

Social Determinants of Health

Specified Heart Arrythmias

Spinal Cord Disorders/Injuries

Substance Use Disorder, Mild except Alcohol and Cannabis

Substance Use Disorder, Moderate/Severe or Substance Use with Complications

Substance Use with Psychotic Complications

Traumatic Amputations and Complications

Unstable Angina and Other Acute Ischemic Heart Diseases

Vascular Disease with Complications

Vascular Disease

Vertebral Fracture without Spinal Cord Injury

Add Association of Clinical Documentation Integrity Specialists (ACDIS)

$20 discount on your one-year ACDIS Membership will be applied at check out.

ACDIS is a community of CDI professionals who share the latest tips, tools, and strategies to implement successful CDI programs and achieve professional growth.

ACDIS members receive: 

  • Advocacy and leadership from a peer-elected ACDIS Advisory Board, including peer-reviewed Position Papers and White Papers.
  • Weekly tips, news, and strategies in our e-newsletter, CDI Strategies
  • In-depth news and regulatory information, clinically-based articles, case studies on building successful CDI programs, and membership profiles in our bi-monthly electronic journal, the CDI Journal
  • An opportunity to network with peers and colleagues in the ACDIS Forum
  • Access to live and archived quarterly conference calls, hour-long networking discussions and an open Q&A with the ACDIS Advisory Board
  • Helpful tools accessed in our electronic Resource Library, including sample queries, policies, and archived conference presentations
  • Two free job postings a year, discounted additional posts, and the ability to post your resume on our Career Center
  • Opportunities to participate in an Official ACDIS Local Chapter in your area, under the leadership of the Chapter Advisory Board
  • Discounts to the annual ACDIS conference, CCDS certification, and CDI Boot Camps

To explore all that ACDIS has to offer, please
visit the ACDIS Web site.