Health Information Management

News: Trailblazer blames lack of documentation for MS-DRG 246 denials

CDI Strategies, February 16, 2012

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Fifty-eight percent of claims billed with MS-DRG 246, percutaneous cardiovascular procedure with drug-eluting stent, with MCC or four-plus vessels/stents, were denied by Trailblazer Health Enterprises, LLC, the Medicare Administrative Contractor for Jurisdiction 4(Texas, New Mexico, Colorado, and Oklahoma). Of those, 88% of the claims were denied due to lack of sufficient documentation, the contractor stated in a January 23 notice.

The contractor states that 54% of denials were due to lack of documentation supporting the inpatient admission; 34% of claims indicated that all services could have been provided on an outpatient basis; 6% of records had no physician order for the inpatient admission; 3% indicated there was insufficient documentation to make a decision; and another 3% indicated that the physician order was for observation not an inpatient admission.
The notice provides detailed reasons for the denials, offers tips to help facilities improve documentation, and offers clinical scenarios to illustrate best documentation practices.
“Please remember, the quality of the information in a document is often more important than the volume of information. Including all of the needed information in the record is crucial. The more types of supporting records Medicare receives, the clearer the clinical picture will be. The more complete the record, the less likely Medicare will deny services or recoup money,” the notice states.

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