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Connolly Posts 19 New DRG Validation Issues

February 9, 2010 — Connolly Healthcare, the RAC for Region C (south & southeastern states), posted 19 new approved issues for review on their RAC Issues page, on Monday, February 8, 2010. Following the format they have been using to date, the listed issues include only single MS-DRGs, but are still not listed in any particular order.

All of the new issues are approved for DRG Validation, affecting all thirteen of the Region C states (AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, SC, TN, TX).

Top Ranked, High Dollar DRGs Added

Give their demonstrated proclivity to review high-dollar DRGs, these additions are not surprising, coming from Connolly.

See our recent analysis done for RAC Monitor, HERE.

We will shortly post another analysis of their approved issues list, analyzing the posted issues by DRG Relative Weights and by DRG Rank (in terms of the number of discharges, nationwide). Of the 52 DRGs with Relative Weights of better than 5.0, Connolly just added four (4) more to their list. Six(6) of the 19 new issues are ranked (by number of discharges)  in the top 100 DRGs nationwide.

Three States Added to Previously Posted Issues

Notably, Arkansas, Lousiana and Mississippi were added to the states affected lists for all previously approved DRG Validation issues, now bringing them fully under the magnifying glass of the RAC. These three states were added to the posted DRG Validation issues on February 2.

Still No Medical Necessity Reviews

None of the posted issues are approved for review of Medical Necessity, and such reviews do not appear to have been approved for any of the RACs, to date. However, it is likely that the existing DRG Validation issues will all be approved for medical necessity review in short order, since the CMS RAC Review Phase-In Strategy allows for such approvals in calendar 2010.

More Useful Lists Available

Find links to all the RAC New Issues Pages here. For more useful lists, see below.

Use the links below to see details of the newly posted issues, in our database (Editor’s Note: this list appears here in the reverse order as posted by Connolly):

1	MS-DRG 208: Respiratory System Diagnosis with Ventilator Support
2	MS-DRG 038: Extracranial Procedures with CC
3	MS-DRG 227: Cardiac Defibrillator Implant without Cardiac Catheterization without MCC
4	MS-DRG 240: Amputation for Circulatory System Disorders Except Upper Limb and Toe with CC
5	MS-DRG 242: Permanent Cardiac Pacemaker Implant with MCC
6	MS-DRG 957: Other O.R. Procedures for Multiple Significant Trauma with MCC
7	MS-DRG 344: Minor Small and Large Bowel Procedures with MCC
8	MS-DRG 488: Knee Procedures without Principal Diagnosis of Infection with CC/MCC
9	MS-DRG 533: Fractures of Femur with MCC
10	MS-DRG 216: Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with MCC
11	MS-DRG 460: Spinal Fusion Except Cervical with MCC
12	MS-DRG 248: Percutaneous Cardiovascular Procedure with Non Drug-Eluting Stent with MCC or 4+ Vessels/Stents
13	MS-DRG 222: Cardiac Defibrillator Implant with Cardiac Catheterization with Acute Myocardial Infarction/Heart Failure/Shock with MCC
14	MS-DRG 201: Pneumothorax without CC/MCC
15	MS-DRG 945: Rehabilitation with CC/MCC
16	MS-DRG 470: Major Joint Replacement or Reattachment of Lower Extremity without MCC
17	MS-DRG 885: Psychoses
18	MS-DRG 291: Heart Failure and Shock with MCC
19	MS-DRG 189: Pulmonary Edema and Respiratory Failure

Find a list of all their posted issues HERE.  (Registration required.)

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Tags: CMS, connolly, Connolly Healthcare, medical coding, rac, rac new issues, RAC New Issues Alerts, rac region c, recovery audit contractor

This entry was posted on Tuesday, February 9th, 2010 at 1:28 pm and is filed under Medical Coding News, RAC New Issues Alerts. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.