February 8th Connolly Healthcare - the RAC for Region C - added 19 new CMS approved issues. The issues are listed below by provider category, with the new issues in red.
For DME provider claims:
Wheelchair bundling
Urological Bundling
For DMEMAC claims:
Budesonide - Dose vs. Billed Units
J7605 Arformoterol, (Brovana)
Q4099 Formoterol fumarate (perforomist)
For outpatient hospital and physician claims:
Blood tranfusions
Untimed codes
IV hydration therapy
Bronchoscopy services
Once in a lifetime procedures
J2505: Injection, Pegfilgrastim, 6 mg
Pediatric codes exceeding age parameters
Medically Unlikely Edit List
Nebulizer, Demonstration and Evaluation Units Billed
Adenosine - Dose vs. Units billed
Barium Swallow Studies Units Billed
For non-medical necessity DRG validation reviews:
Upper Limb and Toe Amputation for Circulatory System Disorders with MCC: MS-DRG 255
Cirrhosis and Alcoholic Hepatitis with MCC: MS- DRG 432
Septicemia without Mechanical Ventilation 96 Hours without MCC: MS-DRG 872
Nonextensive O.R. Procedure Unrelated to Principal Diagnosis without CC/MCC - MS-DRG 989
Nonextensive O.R. Procedure Unrelated to Principal Diagnosis with MCC: MS-DRG 987
Other Respiratory System O.R. Procedures without CC/MCC: MS-DRG 168
Extensive O.R. Procedure Unrelated to Principal Diagnosis without CC/MCC: MS-DRG 983
Other Respiratory System O.R. Procedures with CC: MS-DRG 167
Other Digestive System Diagnoses with CC: MS-DRG 394
Inflammatory Bowel Disease with CC: MS-DRG 386
Major Gastrointestinal Disorders and Peritoneal Infections without CC/MCC: MS-DRG 372
Other Respiratory System O.R. Procedures with MCC: MS-DRG 166
Major Small and Large Bowel Procedures without CC/MCC: MS-DRG 331
Major Small and Large Bowel Procedures with CC: MS-DRG 330
Major Small and Large Bowel Procedures with MCC: MS- DRG 329
Major Chest Procedures without CC/MCC: MS-DRG 165
Major Chest Procedures with MCC: MS-DRG 163
Major Chest Procedures with CC: MS-DRG 164
Respiratory System Diagnosis with Ventilator Support 96 Hours: MS-DRG 207
Septicemia without Mechanical Ventilation 96 Hours with MCC: MS-DRG 871
Extensive O.R. Procedure Unrelated to Principal Diagnosis with MCC: MS-DRG 981
Extensive O.R. Procedure Unrelated to Principal Diagnosis with CC: MS-DRG 982
Nonextensive O.R. Procedure Unrelated to Principal Diagnosis with CC - MS-DRG 988
Coagulation Disorders: MS-DRG 813
Peritoneal Adhesiolysis with MCC: MS-DRG 335 (At this time, Medical Necessity excluded from review)
Nonextensive Burns: MS-DRG 935 (At this time Medical Necessity excluded from review)
Other Kidney and Urinary Tract Procedures with CC: MS-DRG 674 (At this time Medical Necessity excluded from review)
Full Thickness Burn with Skin Graft or Inhalation Injury with CC/MCC: MS-DRG 928 (At this time Medical Necessity excluded from review)
O.R. Procedure with Principal Diagnoses of Mental Illness: MS-DRG 876 (At this time Medical Necessity excluded from review)
Infectious and Parasitic Diseases with O.R. Procedure without CC/MCC: MS-DRG 855 (At this time Medical Necessity excluded from review)
Infectious and Parasitic Diseases with O.R. Procedure with CC: MS-DRG 854 (At this time Medical Necessity excluded from review)
Postoperative or Posttraumatic Infections with O.R. Procedure without CC/MCC: MS-DRG 858 (At this time Medical Necessity excluded from review)
Infectious and Parasitic Diseases with O.R. Procedure with MCC: MS-DRG 853 (At this time, Medical Necessity excluded from review)
Postoperative or Posttraumatic Infections with O.R. Procedure with CC: MS-DRG 857 (At this time, Medical Necessity excluded from review)
Postoperative or Posttraumatic Infections with O.R. Procedure with MCC: MS-DRG 856 (At this time Medical Necessity excluded from review)
Wound Debridements for Injuries with CC: MS-DRG 902 (At this time Medical Necessity excluded from review)
Wound Debridements for Injuries with MCC: MS-DRG 901 (At this time Medical Necessity excluded from review)
Wound Debridements for Injuries without CC/MCC: MS-DRG 903 (At this time Medical Necessity excluded from review)
Other Kidney and Urinary Tract Procedures with MCC: MS-DRG 673 (At this time Medical Necessity excluded from review)
Pulmonary Edema and Respiratory Failure: MS-DRG 189 (At this time, Medical Necessity excluded from review).
Heart Failure and Shock with MCC: MS-DRG 291 (At this time, Medical Necessity excluded from review).
Psychoses: MS-DRG 885 (At this time, Medical Necessity excluded from review).
Major Joint Replacement or Reattachment of Lower Extremity without MCC: MS-DRG 470 (At this time, Medical Necessity excluded from review).
Rehabilitation with CC/MCC: MS-DRG 945 (At this time, Medical Necessity excluded from review).
Pneumothorax without CC/MCC: MS-DRG 201 (At this time, Medical Necessity excluded from review).
Cardiac Defibrillator Implant with Cardiac Catheterization with Acute Myocardial Infarction/Heart Failure/Shock with MCC: MS-DRG 222 (At this time, Medical Necessity excluded from review).
Percutaneous Cardiovascular Procedure with Non Drug-Eluting Stent with MCC or 4+ Vessels/Stents: MS-DRG 248 (At this time, Medical Necessity excluded from review).
Spinal Fusion Except Cervical with MCC: MS-DRG 460 (At this time, Medical Necessity excluded from review).
Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with MCC: MS-DRG 216 (At this time, Medical Necessity excluded from review).
Fractures of Femur with MCC: MS-DRG 533 (At this time, Medical Necessity excluded from review).
Knee Procedures without Principal Diagnosis of Infection with CC/MCC: MS-DRG 488 (At this time, Medical Necessity excluded from review).
Minor Small and Large Bowel Procedures with MCC: MS-DRG 344 (At this time, Medical Necessity excluded from review.
Other O.R. Procedures for Multiple Significant Trauma with MCC: MS-DRG 957 (At this time, Medical Necessity excluded from review).
Permanent Cardiac Pacemaker Implant with MCC: MS-DRG 242 (At this time, Medical Necessity excluded from review).
Amputation for Circulatory System Disorders Except Upper Limb and Toe with CC: MS-DRG 240 (At this time, Medical Necessity excluded from review).
Cardiac Defibrillator Implant without Cardiac Catheterization without MCC: MS-DRG 227 (At this time, Medical Necessity excluded from review).
Extracranial Procedures with CC: MS-DRG 038 (At this time, Medical Necessity excluded from review).
Respiratory System Diagnosis with Ventilator Support < 96 Hours: MS-DRG 208 (At this time, Medical Necessity excluded from review).