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DRG 312 Reviews Put Providers 'In a Squeeze'

James Carroll, for HealthLeaders Media, October 2, 2012

Avoiding denials

  • Ensure that all services were medically necessary on an impatient basis instead of a less intensive setting
  • Documentation should include dates of service billed such as physician progress notes, physical examinations, assessments, diagnostic tests and laboratory test results, history and physical, nurse's notes, consultations, surgical procedures, orders and discharge summary and any other documentation to support the inpatient admission
  • Include documentation of services, medication and medical interventions performed in the emergency department
  • For elective surgical procedures, include documentation to support the necessity of the procedure including pre-surgical interventions and outcomes

Hospitals should also run a risk analysis for not only the first approved DRG (i.e., MS-DRG 312), but for all eight of the approved DRGs, looking specifically at their average length-of-stay to find their weaknesses and help assess the additional documentation request (ADR) rate, suggests Twist. The remaining approved DRGs are as follows; no dates have been announced:

  • MS-DRG 069, transient ischemia
  • MS-DRG 377, G.I. hemorrhage W MCC
  • MS-DRG 378, G.I. hemorrhage W CC
  • MS-DRG 379, G.I. hemorrhage W/O CC/MCC
  • MS-DRG 637, diabetes W MCC
  • MS-DRG 638, diabetes W CC
  • MS-DRG 639, diabetes W/O CC/MCC

James Carroll is associate editor for the HCPro Revenue Cycle Institute.
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