Three RACs have all posted new issues in the past two weeks. Medical necessity reviews are still not approved. The new issues are listed below:

Region A


The RAC for Region A (DCS) posted several new issues, mostly for Automated Review:


Blood Transfusions

Bronchoscopy Services

Duplicate Claims – Part B

Global Billing of Radiology or Diagnostic Tests in the Facility Setting

Global vs. TC/PC Split Reimbursements

IV Hydration

MSDRGs 177, 189, 193, 291, 438, 441, 444, 592, 602, 682, 689, 691, 693: MS-DRG Validation for Severe Sepsis

MSDRGs 216, 217, 218, 219, 220, 221: MS-DRG Validation for Cardiac Valve Procedures

MSDRGs 234, 236: MS-DRG Validation for Coronary Bypass

MSDRGs 335, 336, 337, 350, 351, 352, 353, 354, 355: MS-DRG Validation for Lysis of Adhesions

MSDRGs 463, 464, 465, 573, 574, 575, 901, 902, 903: MS-DRG Validation for Excisional Debridement

National Correct Coding Initiative – Part B


New Patient Visits

Newborn/Pediatric Codes

Once In A Lifetime

Parenteral Nutrition Additives with Premix Solutions

Technical Component of Radiology

Untimed Codes

Initial/Preparatory Knee Disarticulation Prosthesis

Manual Wheelchair Accessories Billed With Power Wheelchair Basesp>


Region C


Connolly added two DRG Validations and one issue for Automated review:


Lymphoma and Nonacute Leukemia with MCC: MS-DRG 840

Percutaneous Cardiovascular Procedure with Drug-Eluting Stent without MCC: MS-DRG 247


Region D


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 ain’t sayin’.


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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