CMS has issued its fourth Medicare Quarterly Provider Compliance Newsletter.  Inside, CMS identified seven common hospital billing errors with respect to coding that affects DRG assignment.

CMS noted the MS-DRG codes that its recovery auditors targeted for validation:

  • 040: Peripheral/Cranial Nerve and Other Nervous System Procedures with Major Complication and Comorbidity (MCC)
  • 064: Intracranial Hemorrhage or Cerebral Infarction with MCC
  • 065: Intracranial Hemorrhage or Cerebral Infarction with Complication and Comorbidity (CC)
  • 066: Intracranial Hemorrhage or Cerebral Infarction without CC or MCC
  • 189: Respiratory Failure
  • 237: Major Cardiovascular Thoracic Aortic Aneurysm Repair Procedures with CC or MCC
  • 252: Other Vascular Procedures with MCC
  • 377: Gastrointestinal Hemorrhage with MCC
  • 378: Gastrointestinal Hemorrhage with CC
  • 379: Gastrointestinal Hemorrhage without CC or MCC
  • 467: Revision of Hip or Knee Replacement with CC
  • 481: Hip and Femur Procedures except Major Joint with CC
  • 486: Knee Procedures with Principal Diagnosis of Infection with CC
  • 488: Knee Procedures without Principal Diagnosis of Infection with CC or MCC

For each of the errors, CMS cited relevant manual provisions for quick reference.  In general, providers can avoid these errors by following the guidance found in those provisions.  The Quarterly Provider Compliance Newsletter is available by clicking here.