Third Edition

CDI Pocket Guide®for ICD-10-AM

A quick reference for CDI specialists, clinical coders and auditors. Find the coding guidelines and clinical concepts you need when reviewing a patient record.

Green spiral-bound Third Edition CDI Pocket Guide for ICD-10-AM

ClassificationICD-10-AM / ACHI / ACS Thirteenth Edition

GroupingAR-DRG Version 12.0

AuthorsJenny Fitzpatrick and Sam Heynemann

Inside the guide

What to look for in the clinical record

Start with a coding rule, a clinical condition or the DRG you’re reviewing.

Coding Guidelines

Refresh the coding rules you use during a record review, from selecting the principal diagnosis to deciding which additional diagnoses meet reporting criteria.

Key References

Review common clinical conditions, their indicators and the documentation to look for. Topics include acute kidney injury, pneumonia and malnutrition.

Complex Diagnoses

Check how a diagnosis can contribute to episode complexity within a particular DRG and compare its treatment across AR-DRG versions.

DRG Tips

Review documentation questions specific to a DRG, alongside related DRGs and their NWAU weights.

Clinician Query Examples

See how to ask for clarification when the indication for a transfusion is missing, a diagnosis is unclear or two parts of the record conflict.

AR-DRG Table

Look up an AR-DRG Version 12.0 code, its description and the corresponding 2026–27 NWAU price weight.

CDIplus

Your Pocket Guide online

Search for a diagnosis, open its clinical reference and move straight to the relevant DRG tips or clinician query examples.

Take the three-minute tour to see how it works during a record review.

The authors

Meet Jenny and Sam

The directors of Uplift Group Australia wrote the Third Edition for the Australian hospital setting.

Jenny Fitzpatrick

Jenny is a Health Information Manager and Uplift director. Her work in hospital HIM leadership, clinical coding audits and casemix informs the guide’s approach to coding quality.

Sam Heynemann

Sam is a Health Information Manager and Uplift director. His experience as a CDI specialist and coding auditor informs the guide’s focus on how clinicians document care and how coders interpret the record.

Uplift Group Australia

4B / 1 Sigma Drive, Croydon South VIC 3136

With acknowledgement to Dr Richard Pinson and Cynthia Tang, creators of the original US CDI Pocket Guide®. Explore their resources at Pinson & Tang ↗.

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