Cahaba GBA Medical Review Update December 2010

on Wednesday, 29 December 2010. All News Items

Upcoming Reviews

Inpatient - Cahaba GBA announced a widespread probe review of DRG 064, Intracranial Hemorrhage or Cerebral Infarction with MCC, in October. They recently released an addendum to that notification adding DRG 065 - Intracranial Hemorrhage or Cerebral Infarction with CC and DRG 066 Intracranial Hemorrhage or Cerebral Infarction without CC or MCC to the probe of DRG 064 for bill type 11X. This will be a full claim review and claims will be reviewed for medical necessity, such as compliance with CMS guidelines, contractor LCDs, correct billing and coding.

Inpatient - Cahaba GBA will soon be conducting a widespread probe review of DRG 313 Chest Pain, for bill type 11X. This will be a full claim review and claims will be reviewed for medical necessity, such as compliance with CMS guidelines, contractor LCDs, correct billing and coding.

Documentation Articles

OutpatientDocumentation for Intravenous (IV) Infusions  – Per a recent article on the What’s New page of the Cahaba GBA website, start and stop times or total hours infused must be documented in order to bill for Intravenous (IV) infusion. If there is documentation of an infusion, but no documentation of start and stop times or total infusion hours, providers should only bill for an IV push.

OutpatientDocumentation of Hyperbaric Oxygen Therapy (HBO) use in Diabetic Wounds of the Lower Extremity – Cahaba published an article in November concerning the documentation requirements for HBO for diabetic wounds (see MMP’s November KIK Newsletter for a summary of that article). A revised article was recently released by Cahaba. The first article indicated at least one x-ray result was required to be in the medical record to support the ulcer grade. The revised article states the qualifying Wagner Stage should be clearly supported by the physical exam and/or diagnostic evidence (e.g. imaging study, bone biopsy, etc.) in the medical record.”

All the Documentation articles and Probe Review results notifications and announcements can be found on the Part A What’s New page of the Cahaba GBA website at http://www.cahabagba.com/

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