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Tip: Pay attention to MACs, not just RACs

CDI Strategies, October 15, 2009

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• 061, 062, and 063: Stroke-related DRGs
• 064, 065, and 066: Intracranial hemorrhage DRGs
• 067 and 068: Non-specific CVA DRGs
• 069: Transient ischemic attack (TIA)

• Untimely discharge summaries
• Incomplete or conflicting physician documentation (i.e., stroke vs. TIA)
• Failure to query the attending physician
• Inaccurate coding

1. Stress the importance of a completed discharge summary with physicians. Under the Medicare Hospital Conditions of Participation, records must contain a “final diagnosis with completion of medical records within 30 days following discharge.”
   
   “Work with your coding staff—they can tell you whose documentation is bad,” Krauss says. Focus your education on physicians that fail to provide completed discharge summaries. 

2. Develop a hospital specific policy for incomplete or conflicting physician documentation. Work with your HIM/coding staff to determine what constitutes incomplete documentation. For example, many coders won’t report a diagnosis that only appears once in the medical record, whereas some CDI specialists would consider that sufficient based on the presence of clinical indicators.
   
   “Set clear expectations, or it perpetuates adversarial relationships,” Krauss says.

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