What is the purpose of an encoding audit in CDI programs?

• A. To verify code accuracy and consistency with documentation and payer requirements.
• B. To train doctors in coding.
• C. To replace chart reviews.
• D. To publish hospital rates.

Answer: (A)

Encoding audits check that the codes chosen for a patient’s record truly reflect the documented clinical details and follow official coding guidelines and payer policies. This ensures the data used for billing, reporting, and analytics is accurate, supports appropriate reimbursement, and reduces the risk of overcoding, undercoding, or miscoding. By comparing the documented diagnoses and procedures to the encoded codes, auditors uncover mismatches and documentation gaps, guiding targeted coder and clinician education and improvements in the CDI processes. It’s not primarily about training clinicians in coding, nor does it replace chart reviews, and it isn’t used to publish hospital rates.