Connolly Healthcare posted 29 DRGs for review of medical necessity on Friday, August 27 and edited some posts on their website today, leaving some MSDRGs posted in multiple issues, some of which are contradictory. An example is MSDRG 314, which as of 4:00pm ET appears in three different issues posted:

• Medical Necessity: Circulatory System Disorders -- lists MSDRGs 314, 315, 316.
• Other Circulatory System Diagnoses W MCC: MS-DRG 314 -- also lists MSDRG 314 specifically, all by itself, previously listed for DRG Validation only.
• Cardiovascular Diseases (At this time Medical Necessity excluded from review, except DRG 292, 293, 302, 308, 313, 314 and 316) - also previously listed for DRG Validation only.

Also, MSDRG 315 is listed twice, with the newer one listing approval for medical necessity, but the older listing has not yet been edited to remove the phrase excluding medical necessity:

• Other Circulatory System Diagnoses with CC: MS-DRG 315 -- the older listing, still excluding medical necessity.
• Medical Necessity: Circulatory System Disorders -- lists 314, 315 and 316, specifically for medical necessity and DRG Validation.

CMS May Review

We have been told that CMS has been made aware of the confusion and has promised to look into the matter.

Stay tuned - we will report more as the story develops...

About the Author

Ernie de los Santos is the chief information officer for eduTrax®. He joined the company at its inception and has been responsible for the creation, development and maintenance of the eduTrax® portals - a set of Web site devoted to providing knowledge, resources and compliance aids for U.S. healthcare professionals who are involved in revenue cycle management.

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