Connolly Consulting Associates, the recovery audit contractor (RAC) for Region C, recently added another 25 MS-DRG validations to its approved list of issues. This brings its total to 104 MS-DRGs. Of the newly released MS-DRGs, 22 out of the 25 are surgical and 16 are with MCC or with CC.
The three recently approved medical MSDRGs are listed below:
|
MS-DRG |
Description |
|
315 |
Other Circulatory System Diagnosis w/ MCC (post-acute care transfer MS-DRG) |
|
933 |
Extensive Burns or Full-thickness Burns with Mechanical Ventilation 96+ Hours Without Skin Graft |
|
934 |
Full Thickness Burn without Skin Graft or Inhalation Injury |
The 22 recently approved surgical MS-DRGs are listed below:
|
MS-DRG |
Description |
|
133 |
Other Ear, Nose, Mouth, and Throat Operating Room Procedures with CC/MCC |
|
226 |
Cardiac Defibrillator Implant without Cardiac Catheterization with MCC |
|
237 |
Major Cardiovascular Procedures with MCC or Thoracic Aortic Aneurysm Repair |
|
243 |
Permanent Cardiac Pacemaker Implant w/ CC (post-acute care transfer MS-DRG) |
|
246 |
Percutaneous Cardiovascular Procedure with Drug-Eluting Stent w/ MCC or 4 or More Vessels/Stents |
|
253 |
Other Vascular Procedures w/ CC |
|
329 |
Major Small and Large Bowel Procedures with MCC (post-acute care transfer MS-DRG) |
|
358 |
Other Digestive System O.R. Procedures without CC/MCC (post-acute care transfer MS-DRG) |
|
415 |
Cholecystectomy Except by Laparoscope without C.D.E. w/ MCC |
|
424 |
Other Hepatobiliary or Pancreas O.R. Procedures w/ CC |
|
486 |
Knee Procedures with Principal Diagnosis of Infection w/ CC |
|
577 |
Skin Graft and/or Debridement Except for Skin Ulcer or Cellulitis w/ CC |
|
616 |
Amputation of Lower Limb for Endocrine, Nutritional, and Metabolic Disorders w/ MCC (post-acute care transfer MS-DRG) |
|
617 |
Amputation of Lower Limb for Endocrine, Nutritional, and Metabolic Disorders w/ CC (post-acute care transfer MS-DRG) |
|
675 |
Other Kidney and Urinary Tract Procedures without CC/MCC |
|
717 |
Other Male Reproductive System O.R. Procedures Except Malignancy with CC/MCC |
|
749 |
Other Female Reproductive System O.R. Procedures with CC/MCC |
|
803 |
Other O.R. Procedures of the Blood and Blood-Forming Organs w/ CC |
|
823 |
Lympthoma and Nonacute Leukemia with Other O.R. Procedures w/ MCC |
|
829 |
Myeloproliferative Disorder or Poorly Differentiated Neoplasms with Other O.R. Procedure with CC/MCC |
|
941 |
O.R. Procedure with Diagnoses of Other Contact with Health Services without CC/MCC |
|
969 |
HIV with Extensive O.R. Procedure w/ MCC |
Action Steps
Start performing data analytics soon on these MS-DRGs to determine your volumes and potential recoupment at risk. According to the November 2009 Comprehensive Error Rate Testing (CERT) Report, the average inpatient hospital MS-DRG paid claims error rate is 6.1 percent. To determine a good estimate of dollars at risk, run a revenue report of the volumes in each MS-DRG and multiply that number by 6.1 percent. Next, start performing probe audits and track improper payments to determine whether you are over or under the project recoupment.
About the Author
Carol Spencer, RHIA, CCS, CHDA is a senior healthcare consultant with Medical Learning, Inc. (MedLearn®) in St. Paul, Minn. MedLearn is a nationally recognized expert in healthcare compliance and reimbursement. Founded in 1991, MedLearn delivers actionable answers that equip healthcare organizations with coding, chargemaster, reimbursement management and RAC solutions.
(www.connollyhealthcare.com/RAC).