Revenue Cycle

Connolly posts 25 new RAC issues for non-medical necessity DRG validation

Recovery Auditor Report, March 18, 2010

Connolly Healthcare added 25 RAC issues for non-medical necessity DRG validation reviews review to its CMS-approved list on March 16, 2010 for providers in Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee and Texas.

According to the Connolly Web site, the new issues are as follows:
  • Cardiac defibrillator implant without cardiac catheterization with MCC: MS-DRG 226. DRG validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary’s medical record. Reviewers will validate for MS-DRG 226, previously DRG 515, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG.
  • Cholecystectomy except by laparoscope without C.D.E. with CC: MS-DRG 415. DRG validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary’s medical record. Reviewers will validate for MS-DRG 415, previously DRG 197 and 198, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG.
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