Case Management

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.

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