Updated on: June 22, 2012

CGI Follows Connolly, Adds Review of Inpatient Admission Orders Plus 88 More DRG Validation Issues

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Original story posted on: July 22, 2010

ernieFollowing the lead of Connolly Healthcare, CGI, the RAC for CMS Region B, has posted an approved issue to review Inpatient Admission Orders.

 

CGI is the second RAC to post the issue. The wording is identical to Connolly’s posting of the same issue and is listed as follows:

 

Name: Inpatient Admissions without a Physician's Inpatient Admit Order

Description: Admissions to the inpatient setting require a physician's order in order to qualify and be paid as an inpatient stay.   


More DRG Validations Posted

 

CGI also posted 88 new DRG Validation issues, plus more issues for Automated Review. Medical necessity reviews are still not included in any issues posted by CGI or any of the four RACs.


CGI added these 17 new issues that include another 88 DRG Validations:

 

  • Prosthetic Additions When Billed With Initial Or Preparatory Knee Prosthesis
  • Date of Death-DME
  • Musculoskeletal Fractures 533, 534, 537, 538, 562 and 563
  • Nervous System Disorders MS-DRG 052, 053, 054, 055, 056, 057, 058, 059, 060, 061, 062, 063, 067, 068, 069, 070, 071, 072, 073, 074, 077, 078, 079, 080, 081, 082, 083, 084, 085, 086, 088, 089, 090, 091, 092, 093, 097, 098, 099, 101 and 102
  • Other Digestive System O.R. Procedures MS-DRGs 356, 357, 358
  • Other Respiratory System O.R. Procedures MS-DRG 168
  • Pancreas, Liver and Shunt Procedures MS-DRGs 405, 406, 407
  • Percutaneous Cardiovascular Procedures MS-DRGs 247, 249, 251
  • Permanent Cardiac Pacemaker Implant MS-DRG 242, 243, and 244
  • Respiratory 175, 176, 180, 181, 182, 183, 184, 185, 186, 187, 188, 192, 196, 197, 198, 199, 200, 201, 202, 203, 204, 205, 206
  • Spinal Fusion 490 & 491
  • Stomach, Esophageal and Duodenal Procedures MS-DRGs 326, 327 and 328
  • Place of service improper payments involving same day services in ambulatory service center (ASC) and an office setting
  • Amputation for Musculoskeletal System and Connective Tissue Disorders MS-DRGs 474, 475, 476
  • Inpatient Admissions without a Physician's Inpatient Admit Order
  • Major Chest Procedures MS-DRG 165
  • Major Gastrointestinal Disorders and Peritoneal Infections MS-DRGs 371, 372, 373

 

Me Too


CGI's "Me Too" posting of the same issue comes only a few days after Connolly’s posting of the Physician Orders tissue. We don't expect it will be long before HDI and DCS post their own "Me Three" and "Me Four" issues.


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.

 

Contact the Author
<ernie@edutrax.net>

 

ED. NOTE: Register to listen to Ernie de los Santos on Monitor Monday this coming Monday, July 26, 2010, 10 AM ET, for a complete wrap up on these recently posted approved issues. Go to www.monitormondays.com

 

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