Region A

The RAC for Region A, DCS Healthcare Services, posted several new issues, mostly for Automated Review:


Blood Transfusions

Bronchoscopy Services

Duplicate Claims- Part B

Global Billing of Radiology or Diagnostic Tests

Global Surgery – Pre and Post-Operative Visits

Global vs. TC/PC Split Reimbursement

IV Hydration

MS-DRG Validation for Severe Sepsis

MS-DRG Validation for Cardiac Valve Procedures

MS-DRG Validation for Coronary Bypass

MS-DRG Validation for Lysis of Adhesions

MS-DRG Validation for Excisional Debridement

National Correct Coding Initiative -Part B


New Patient Visits

Newborn/Pediatric Codes

Once in a Lifetime

Parenteral Nutritional Additives with Premix Solutions

Technical Component of Radiology

Untimed Codes

Initial/Preparatory Knee Disarticulation Prosthesis

Manual Wheelchair Accessories Billed w/Power Wheelchair Bases


Region B

Late Wednesday, June 23, CGI Federal added 10 new issues, including 87 DRGs.


DRG Validation for Skin Disorders

DRG Validation for Neoplasm Surgery

DRG Validation for Major and Large Bowel Procedures

DRG Validation for Kidney and Urinary Tract Disorders

DRG Validation for Female Reproductive Disorders

DRG Validation for Endocrine, Nutritional & Metabolic Disorders

DRG Validation for Disorders Related to Injuries/Toxicity

DRG Validation for Cervical Spinal Fusion


Region C

Connolly Healthcare added two DRG Validations and one issue for Automated Review. These include the following:


Lymphoma and Nonacute Leukemia with MCC

Percutaneous Cardiovascular Procedure with Drug-Eluting Stent w/o MCC

Zoledronic acid (Zometa) – Dose vs. Units Billed


Region D

HealthDataInsights (HDI) added a single issue for Automated Review: Incorrect Patient Status -Acute


When will Medical Necessity Reviews begin? No one knows but the RACs, and so far, they aren’t talking.


About the Author

Ernie de los Santos is the chief information officer for eduTrax®. He joined the company at its inception and has been responsible for the creation, development and maintenance of the eduTrax® portals – a set of Web site devoted to providing knowledge, resources and compliance aids for U.S. healthcare professionals who are involved in revenue cycle management.


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