1.15.10 – Region C Recovery Audit Contractor Posts Additional Audit Issues for DRG Validation

Region C Recovery Audit Contractor Posts Additional Audit Issues for DRG Validation

Connolly Healthcare, the Medicare recovery audit contractor (RAC) for Region C, recently updated its CMS approved audit issues for RAC review.

Specifically, Connolly Healthcare recently posted at least 21 new CMS approved audit issues on its website for inpatient hospitals pertaining to DRG validation.

The issues affect providers in the states of Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee and Texas.

The issues are briefly described below:

  • Other Vascular Procedures with MCC: MS-DRG 252
  • Skin Graft and/or Debridement for Skin Ulcer or Cellulitis with CC: MS-DRG 574
  • Skin Graft and/or Debridement for Skin Ulcer or Cellulitis with MCC: MS-DRG 573
  • Wound Debridement and Skin Graft Except Hand, for Musculo-Connective Tissue Disorders without CC/MCC: MS-DRG 465
  • Other Digestive System O.R. Procedures with MCC: MS-DRG 356
  • Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders with CC: MS-DRG 623
  • Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders with MCC: MS-DRG 622
  • Other Digestive System O.R. Procedures with CC: MS-DRG 357
  • Other Hepatobiliary or Pancreas O.R. Procedures with MCC: MS-DRG 423
  • Skin Graft and/or Debridement Except for Skin Ulcer or Cellulitis without CC/MCC: MS-DRG 578
  • Skin Graft and/or Debridement Except for Skin Ulcer or Cellulitis with MCC: MS-DRG 576
  • Skin Graft and/or Debridement for Skin Ulcer or Cellulitis without CC/MCC: MS-DRG 575
  • Wound Debridement and Skin Graft Except Hand, for Musculo-Connective Tissue Disorders with CC: MS-DRG 464
  • Wound Debridement and Skin Graft Except Hand, for Musculo-Connective Tissue Disorders with MCC: MS-DRG 463
  • O.R. Procedure with Diagnoses of Other Contact with Health Services with CC: MS-DRG 940
  • O.R. Procedure with Diagnoses of Other Contact with Health Services with MCC: MS-DRG 939
  • Other Circulatory System O.R. Procedures: MS-DRG 264
  • Cardiac Pacemaker Revision Except Device Replacement without CC/MCC: MS-DRG 262
  • Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders without CC/MCC: MS-DRG 624
  • Cardiac Pacemaker Revision Except Device Replacement with MCC: MS-DRG 260
  • Upper Limb and Toe Amputation for Circulatory System Disorders with CC: MS-DRG 256

All of the above issues include a statement that medical necessity is excluded from review at this time.