Updated on: January 29, 2013

RAC ALERT: Region C RAC Posts 24 New Issues for Coding & DRG Validation

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Original story posted on: December 3, 2009

nbeckley

ED. NOTE:  In the article below that an astute reader has brought to our attention that MSDRG 372 has the description of MSDRG 373, and we anticipate that Connolly will address this on their Web site shortly as our reader has asked them to provide clarification on this matter. We regret any confusion caused by not immediately identifying the discrepancy in the way that Connolly stated the MSDRG issue on their Web site's listing of approved issues.

It should also be noted that Connolly originally posted "twenty-five issues" due to the listing of MSDRG 983 twice, which has been corrected on their Web site, and RACMonitor references have been updated to reflect Connolly's correction."

Connolly Healthcare, the Region C Recovery Audit Contractor posted twenty-four new issues to their Web site Friday in what is the beginning of the much anticipated complex medical review process for the RAC program.  This initial set of issues has been approved by CMS for DRG validation, and the topics come as no surprise to industry insiders who have studied the reports and findings in the RAC Demonstration.

The twenty-four issues are listed below, but perhaps more importantly do you have an action plan for immediate steps to take to ensure you receive notification of the ADR request at your facility?  First of all, ensure that your contact address is listed with Connolly.  Instructions are provided on their website.  Secondly review the "sample" ADR request letter that Connolly also posted that provides instructions and timelines for complying with the ADR request.  And last, but not least, stay tuned to the RACMonitor for expert insight into compliance with the complex review of medical records as our editorial panelists tackle the issues and provide guidance to our readers.

The issues posted by Connolly yesterday:

  • Upper Limb and Toe Amputation for Circulatory System Disorders with MCC: MS-DRG 255
  • Cirrhosis and Alcoholic Hepatitis with MCC: MS- DRG 432
  • Septicemia without Mechanical Ventilation 96+ Hours without MCC: MS-DRG 872
  • Nonextensive O.R. Procedure Unrelated to Principal Diagnosis without CC/MCC - MS-DRG 989
  • Nonextensive O.R. Procedure Unrelated to Principal Diagnosis with MCC: MS-DRG 987
  • Other Respiratory System O.R. Procedures without CC/MCC: MS-DRG 168
  • Extensive O.R. Procedure Unrelated to Principal Diagnosis without CC/MCC: MS-DRG 983
  • Other Respiratory System O.R. Procedures with CC: MS-DRG 167
  • Other Digestive System Diagnoses with CC: MS-DRG 394
  • Inflammatory Bowel Disease with CC: MS-DRG 386
  • Major Gastrointestinal Disorders and Peritoneal Infections without CC/MCC: MS-DRG 372
  • Other Respiratory System O.R. Procedures with MCC: MS-DRG 166
  • Major Small and Large Bowel Procedures without CC/MCC: MS-DRG 331
  • Major Small and Large Bowel Procedures with CC: MS-DRG 330
  • Major Small and Large Bowel Procedures with MCC: MS- DRG 329
  • Major Chest Procedures without CC/MCC: MS-DRG 165
  • Major Chest Procedures with MCC: MS-DRG 163
  • Major Chest Procedures with CC: MS-DRG 164
  • Respiratory System Diagnosis with Ventilator Support 96+ Hours: MS-DRG 207
  • Septicemia without Mechanical Ventilation 96+ Hours with MCC: MS-DRG 871
  • Extensive O.R. Procedure Unrelated to Principal Diagnosis with MCC: MS-DRG 981
  • Extensive O.R. Procedure Unrelated to Principal Diagnosis with CC: MS-DRG 982
  • Nonextensive O.R. Procedure Unrelated to Principal Diagnosis with CC - MS-DRG 988
  • Coagulation Disorders: MS-DRG 813

This announcement comes on the heels of an earlier CMS RAC missive this week in which the medical records request limits originally set in October of 2008, have been revised, which may result in a higher number of records being requested for some providers, as detailed in the RACMonitor Alert earlier this week by Cheryl Servais, MPH, RHIA.

Nancy J. Beckley, MB, MBA, CHC

Nancy Beckley is founder and president of Nancy Beckley & Associates LLC, providing compliance planning and outsourced compliance services to rehab providers in hospitals, rehab agencies, and private practices. Nancy is certified in healthcare compliance by the Healthcare Compliance Certification Board. She is on the board of the National Association of Rehabilitation Providers and Agencies. She previously served on the CMS Professional Expert Technical Panel for Comprehensive Outpatient Rehabilitation Facilities. Nancy is a familiar voice on Monitor Mondays, where she serves as a senior national correspondent.

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