The Recovery Audit Contractor for Medicare's Region B, CGI Federal, late Wednesday posted 87 new DRG Validations in 10 approved issues, capping a 10-day period that witnessed a total of 126 new DRG Validations and new patient E & M codes from all four RACs.Region A
The RAC for Region A, DCS Healthcare Services, posted several new issues, mostly for Automated Review:
Blood Transfusions
Bronchoscopy Services
Duplicate Claims- Part B
Global Billing of Radiology or Diagnostic Tests
Global Surgery - Pre and Post-Operative Visits
Global vs. TC/PC Split Reimbursement
IV Hydration
MS-DRG Validation for Severe Sepsis
MS-DRG Validation for Cardiac Valve Procedures
MS-DRG Validation for Coronary Bypass
MS-DRG Validation for Lysis of Adhesions
MS-DRG Validation for Excisional Debridement
National Correct Coding Initiative -Part B
Neulasta
New Patient Visits
Newborn/Pediatric Codes
Once in a Lifetime
Parenteral Nutritional Additives with Premix Solutions
Technical Component of Radiology
Untimed Codes
Initial/Preparatory Knee Disarticulation Prosthesis
Manual Wheelchair Accessories Billed w/Power Wheelchair Bases
Region B
Late Wednesday, June 23, CGI Federal added 10 new issues, including 87 DRGs.
DRG Validation for Skin Disorders
DRG Validation for Neoplasm Surgery
DRG Validation for Major and Large Bowel Procedures
DRG Validation for Kidney and Urinary Tract Disorders
DRG Validation for Female Reproductive Disorders
DRG Validation for Endocrine, Nutritional & Metabolic Disorders
DRG Validation for Disorders Related to Injuries/Toxicity
DRG Validation for Cervical Spinal Fusion
Region C
Connolly Healthcare added two DRG Validations and one issue for Automated Review. These include the following:
Lymphoma and Nonacute Leukemia with MCC
Percutaneous Cardiovascular Procedure with Drug-Eluting Stent w/o MCC
Zoledronic acid (Zometa) - Dose vs. Units Billed
Region D
HealthDataInsights (HDI) added a single issue for Automated Review: Incorrect Patient Status -Acute
When will Medical Necessity Reviews begin? No one knows but the RACs, and so far, they aren't talking.
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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