MLN Matters® SE1028: RAC Coding Vulnerabilities for Inpatient Hospitals – Revised

on Wednesday, 17 November 2010. All News Items

CMS recently released a MLN Matters® article titled “Recovery Audit Contractor (RAC) Demonstration High-Risk Diagnosis Related Group (DRG) Coding Vulnerabilities for Inpatient Hospitals.” This article “reminded” hospital providers that:

  • “All inpatient admissions must have the principal diagnosis specifically identified by the attending physician.”
  • “All inpatient admissions must have all “other” or “secondary” diagnoses identified by the attending physician.”
  • Providers should “comply with CMS’ inpatient hospital policy and Coding Clinic guidance.”

 The guidance in this article was in direct conflict with Coding Clinic from the 1st Quarter of 2004 that indicates that codes may be assigned from other physicians as long as “there is no conflicting information from the attending physician.”

 This past Friday October 29, 2010 CMS released a revised MLN Matters® Number: SE1028. In the revised article the conflicting guidance has been removed from the article.

 The entire revised MLN Matters® article can be accessed at: http://www.cms.gov/MLNMattersArticles/downloads/SE1028.pdf

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