Health Information Management

Healthcare News: Trailblazer cites insufficient documentation as chief reason for MS-DRG 470 denials

JustCoding News: Inpatient, February 29, 2012

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Trailblazer Health Enterprises, LLC, the Medicare administrative contractor (MAC) for Jurisdiction 4 (i.e., Colorado, New Mexico, Oklahoma, and Texas) stated in a February 21 notice that about 68% of reviewed claims billed with MS-DRG 470 (joint replacement or reattachment of lower extremity without MCC) resulted in denials.

The MAC cited missing or insufficient documentation as the reason for 96% of these denials—for example, documentation to substantiate the presence of end-stage joint disease and preoperative conservative measures taken.

Access the Trailblazer website for additional detail and to view examples of documentation that may help support payment for joint replacement care.

To learn more about how to improve documentation for joint replacements, including a clinical example, access Trailblazer’s February 14 notice, “Joint Replacement Documentation.

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