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Three of the four RACs posted new issues recently. The Region A RAC, DCS, posted 39 new DRG Validations issues, plus an approved issue to review Evaluation & Management (E&M) codes for New Patient visits, mirroring the same issues already approved for other RACs.

Despite recent reports that issues including review of Medical Necessity have already been approved by CMS in at least one region, none of the RACs have yet to post any such approved issues.

The new issues are listed below, including links to their descriptions on eduTrax®. To see those pages, you will need to login to the eduTrax main site. Registration on the site is still free.

Region A

1	Blood Transfusions
2	Bronchoscopy Services
3	Duplicate Claims – Part B
4	Global Billing of Radiology or Diagnostic Tests in the Facility Setting
5	Global Surgery – Pre and Post-Operative Visits
6	Global vs. TC/PC Split Reimbursements
7	IV Hydration
8	MSDRGs 177, 189, 193, 291, 438, 441, 444, 592, 602, 682, 689, 691, 693: MS-DRG Validation for Severe Sepsis
9	MSDRGs 216, 217, 218, 219, 220, 221: MS-DRG Validation for Cardiac Valve Procedures
10	MSDRGs 234, 236: MS-DRG Validation for Coronary Bypass
11	MSDRGs 335, 336, 337, 350, 351, 352, 353, 354, 355: MS-DRG Validation for Lysis of Adhesions
12	MSDRGs 463, 464, 465, 573, 574, 575, 901, 902, 903: MS-DRG Validation for Excisional Debridement
13	National Correct Coding Initiative – Part B
14	Neulasta
15	New Patient Visits
16	Newborn/Pediatric Codes
17	Once In A Lifetime
18	Parenteral Nutrition Additives with Premix Solutions
19	Technical Component of Radiology
20	Untimed Codes
21	Initial/Preparatory Knee Disarticulation Prosthesis
22	Manual Wheelchair Accessories Billed With Power Wheelchair Bases

Region C

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

1	Lymphoma and Nonacute Leukemia with MCC: MS-DRG 840
2	Percutaneous Cardiovascular Procedure with Drug-Eluting Stent without MCC: MS-DRG 247
3	Zoledronic acid, (Zometa) – Dose vs. Units Billed

Region D

HDI added a single issue for Automated review, concerning Discharge Status:

1	Incorrect Patient Status – Acute

Every wonder about what difference a Discharge Status code makes for your reimbursement? Take a look at the Transfer DRG Assistant® at the eduTrax site. The complete tool includes all DRGs, all the Discharge Codes with explanations, and can show you an estimated difference in reimbursement based upon length of stay, the DRG assigned, and the appropriate status code, which is determined by where a patient may (or may not) wind up going after discharge from your facility.

When Will Medical Necessity Reviews Begin?

No one knows but the RACs, and so far, they ain’t sayin’.

BUT — If you would like to be notified immediately whenever they do get posted, simply to the click here to subscribe for free to the eduTrax RAC New Issues Alert Service®.

We post new issues, as in this article, and will send out an email notice immediately when medical necessity issues begin posting on the RAC websites.