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.
Medical necessity reviews are still not included in any issues posted by the RACs. The new issues are listed below.
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.
Ernie de los Santos is the Founder of the California-based blog network, The RAC Shadow, where he maintains a free database of all RAC Approved Issues. This post orginally appeared at RACMonitor.com.