12.11.09 – Region C Recovery Audit Contractor Posts New 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. In their website, Connolly Healthcare recently posted at least 24 new CMS approved audit issues for inpatient hospitals pertaining to DRG validation.
The issues affect the majority of providers where the RAC has been implemented for Region C. The issues are briefly described below:
|
APPROVED ISSUE |
MS-DRG |
| Upper limb and toe amputation for circulatory system disorders with MCC |
255 |
| Cirrhosis and alcoholic hepatitis with MCC |
432 |
| Septicemia without mechanical ventilation 96+ hours without MCC |
872 |
| Nonextensive O.R. procedure unrelated to principal diagnosis without CC/MCC |
989 |
| Nonextensive O.R. procedure unrelated to principal diagnosis with MCC |
987 |
| Other respiratory system O.R. procedures without CC/MCC |
168 |
| Extensive O.R. procedure unrelated to principal diagnosis without CC/MCC |
983 |
| Other respiratory system O.R. procedures with CC |
167 |
| Other digestive system diagnoses with CC |
394 |
| Inflammatory bowel disease with CC |
386 |
| Major gastrointestinal disorders and peritoneal infections without CC/MCC |
372 |
| Other respiratory system O.R. procedures with MCC |
166 |
| Major small and large bowel procedures without CC/MCC |
331 |
| Major small and large bowel procedures with CC |
330 |
| Major small and large bowel procedures with MCC |
329 |
| Major chest procedures without CC/MCC |
165 |
| Major chest procedures with MCC |
163 |
| Major chest procedures with CC |
164 |
| Respiratory system diagnosis with ventilator support 96+ hours |
207 |
| Septicemia without mechanical ventilation 96+ hours with MCC |
871 |
| Extensive O.R. procedure unrelated to principal diagnosis with MCC |
981 |
| Extensive O.R. procedure unrelated to principal diagnosis with CC |
982 |
| Nonextensive O.R. procedure unrelated to principal diagnosis with CC |
988 |
| Coagulation disorders: MS-DRG |
813 |
All of the above issues include a statement that medical necessity is excluded from review at this time. For more information on the new issues, see the CMS approved audit issues for Region C, which can be found here.
