Mentor Moment: Recovery Auditors focus on renal, urinary tract infections
Case Management Weekly, March 28, 2012
Recovery Auditor findings indicate that many patients with renal or urinary tract infections admitted for inpatient services did not meet medical necessity and should have been treated as observation patients, according to guidance in a recent MLNMatters.
The article addresses the importance of physician documentation in these cases and describes the appropriate measures physicians and staff must take to ensure medical necessity. If a physician orders inpatient services, but it is later determined these services were not medically necessary, providers may report condition code 44, but only prior to discharge and with the patient’s knowledge. Providers may not revise a bill in this manner after a patient has been discharged.
This article is adapted from a recent post on the Case Management Mentor blog.
- Differentiate between types of wound debridement
- Complications from immobility by body system
- OB services: Coding inside and outside of the package
- Don’t forget the three checks in medication administration
- Note similarities and differences between HCPCS, CPT® codes
- What does case-mix index mean to you?
- Pneumonia with a negative chest x-ray: Clinical diagnoses, physician documentation, and coding guidelines
- ICD-10 tip: Coding for infectious and parasitic diseases
- ICD-10-CM coma, stroke codes require more specific documentation
- Fracture coding in ICD-10-CM requires greater specificity
- Initiative launched to prevent physician, medical trainee suicides
- I Have to Learn This, Too?
- How surviving a disaster changes the disaster plan
- Gap analysis: Three big issues
- Ensure compliance when reporting cirrhosis and alcoholic hepatitis with an MCC
- CMS seeks comment on Medicaid HCBS
- CMS launches new online tool to make Quality Payment Program easier for clinicians
- Assessing weapons in your healthcare facility
- Analyzing nurse staffing: Understanding FTEs
- A clarification on billing for CAH swing bed services