Defensible Diagnosis™: Clinical Validation for CDI Specialists
"It's just hypoxia" and "no sepsis". You were right to query. So why did the provider disagree?
Defensible Diagnosis: Clinical Validation for CDI Specialists. Two 30 minute modules. One diagnosis each. A seven pillar method for building the argument from the chart, so you can show your work to the physician, the payer and the auditor.
You know Respiratory Failure when you see it. The oxygen requirement is there. The ABG is there. The treatment escalated.
You know Sepsis when the picture builds. Fever, elevated heart rate and white count, organ dysfunction, a source of infection.
Then the physician writes back: "It's just hypoxia." "No sepsis." Or it is answered, and months later a payer denies it for insufficient clinical indicators.
You were not wrong about the diagnosis. You were missing a structure for the argument.
Study guides and books teach criteria. Query training teaches wording. Almost nothing teaches you how to assemble the clinical evidence into a case that holds up when the reviewer never saw the patient.
That is the gap these learning modules close.
Module 1: Respiratory Failure
45 minutes. One Diagnosis.
Respiratory Failure is the diagnosis where CDI specialists are most often right and still lose the argument.
You will work through:
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Acute, chronic and acute on chronic, and what each one looks like in the chart
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Hypoxic and hypercapnic picture, and when the ABG tells a different story than the note
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When supplemental oxygen is treatment and what the escalation says about what the team believes
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How to answer "it's just hypoxia" and "the COPD exacerbation explains everything" with the chart, not only criteria.
Module 2: Sepsis
45 minutes. One Diagnosis.
Sepsis is where the definition you use changes the argument you can make.
You will work through:
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Sepsis-2 and Sepsis-3 side by side: infection with systemic inflammation versus life threatening organ dysfunction from a dysregulated response to infection
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Why SIRS findings alone do not establish sepsis, and what does
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Baseline versus acute change, so a chronic abnormal value is not mistaken for new organ dysfunction
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Septic shock, bacteremia and "urosepsis": the terms that cause the most trouble in queries
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How to resolve "No sepsis" without leading the physician
Kerry Gibbons, RN, CCDS
With 16 years of nursing experience and over a decade specializing in Clinical Documentation Integrity (CDI), I've worked across diverse healthcare settings, including community hospitals, Level I trauma centers, and CDI auditing. As an ACDIS-Approved CDI Educator, I bring extensive clinical experience and real-world expertise to helping CDI professionals strengthen their clinical reasoning, documentation practices, and confidence.
I teach both modules myself, as on-demand video lessons you can watch when it suits your schedule and rewatch before reviewing a difficult case.
TESTIMONIAL
"Kerry helped me work through the grey areas on hard diagnoses that see frequent denials, and what those conditions really needed to look like in documentation."
Angie, BSN RN CCDS, Front Line CDI Specialist. Said after private mentorship with Kerry.