Approved Issues

Issue Name:	Pulmonary Edema and Respiratory Failure: MS-DRG 189 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 189, previously DRG 087, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Heart Failure and Shock with MCC: MS-DRG 291 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 291, previously DRG 127, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Psychoses: MS-DRG 885 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 885, previously DRG 430, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Major Joint Replacement or Reattachment of Lower Extremity without MCC: MS-DRG 470 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 470, previously DRG 544, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Rehabilitation with CC/MCC: MS-DRG 945 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 945, previously DRG 462, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Pneumothorax without CC/MCC: MS-DRG 201 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 201, previously DRG's 094 and 095, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Cardiac Defibrillator Implant with Cardiac Catheterization with Acute Myocardial Infarction/Heart Failure/Shock with MCC: MS-DRG 222 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 222, previously DRG 535, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Percutaneous Cardiovascular Procedure with Non Drug-Eluting Stent with MCC or 4+ Vessels/Stents: MS-DRG 248 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 248, previously DRG 555 and 556, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Spinal Fusion Except Cervical without MCC: MS-DRG 460 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 460, previously DRG 497 and 498, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with MCC: MS-DRG 216 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 216, previously DRG 104, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Fractures of Femur with MCC: MS-DRG 533 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 533, previously DRG 235, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Knee Procedures without Principal Diagnosis of Infection with CC/MCC: MS-DRG 488 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 488, previously DRG 503, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Minor Small and Large Bowel Procedures with MCC: MS-DRG 344 (At this time, Medical Necessity excluded from review.
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 344, previously DRG 152 and 153, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Other O.R. Procedures for Multiple Significant Trauma with MCC: MS-DRG 957 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 957, previously DRG 486, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Permanent Cardiac Pacemaker Implant with MCC: MS-DRG 242 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 242, previously DRG 551 and 552, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Amputation for Circulatory System Disorders Except Upper Limb and Toe with CC: MS-DRG 240 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 240, previously DRG 113, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Cardiac Defibrillator Implant without Cardiac Catheterization without MCC: MS-DRG 227 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 227, previously DRG 515, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Extracranial Procedures with CC: MS-DRG 038 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 038, previously DRG 533 and 534, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Respiratory System Diagnosis with Ventilator Support < 96 Hours: MS-DRG 208 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS DRG 208, previously DRG 566, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Other Vascular Procedures with MCC: MS-DRG 252 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 252, previously DRG 479, 553 and 554, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Skin Graft and/or Debridement for Skin Ulcer or Cellulitis with CC: MS-DRG 574 (At this time Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 574, previously DRG 263 and 264, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Skin Graft and/or Debridement for Skin Ulcer or Cellulitis with MCC: MS-DRG 573 (At this time Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 573, previously DRG 263 and 264, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Wound Debridement and Skin Graft Except Hand, for Musculo-Connective Tissue Disorders without CC/MCC: MS-DRG 465 (At this time Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 465, previously DRG 217, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Other Digestive System O.R. Procedures with MCC: MS-DRG 356 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 356, previously DRG 170 and 171, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders with CC: MS-DRG 623 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 623, previously DRG 287, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders with MCC: MS-DRG 622 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 622, previously DRG 287, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Other Digestive System O.R. Procedures with CC: MS-DRG 357 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 357, previously DRG 170 and 171, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Other Hepatobiliary or Pancreas O.R. Procedures with MCC: MS-DRG 423 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 423, previously DRG 201, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Skin Graft and/or Debridement Except for Skin Ulcer or Cellulitis without CC/MCC: MS-DRG 578 (At this time Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 578, previously DRG 265 and 266, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Skin Graft and/or Debridement Except for Skin Ulcer or Cellulitis with MCC: MS-DRG 576 (At this time Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 576, previously DRG 265 and 266, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Skin Graft and/or Debridement for Skin Ulcer or Cellulitis without CC/MCC: MS-DRG 575 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 575, previously DRG 263 and 264, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Wound Debridement and Skin Graft Except Hand, for Musculo-Connective Tissue Disorders with CC: MS-DRG 464 (At this time Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 464, previously DRG 217, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Wound Debridement and Skin Graft Except Hand, for Musculo-Connective Tissue Disorders with MCC: MS-DRG 463 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 463, previously DRG 217, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	O.R. Procedure with Diagnoses of Other Contact with Health Services with CC: MS-DRG 940 (At this time Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 940, previously DRG 461, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	O.R. Procedure with Diagnoses of Other Contact with Health Services with MCC: MS-DRG 939 (At this time Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 939, previously DRG 461, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Other Circulatory System O.R. Procedures: MS-DRG 264 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 264, previously DRG 120, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Cardiac Pacemaker Revision Except Device Replacement without CC/MCC: MS-DRG 262 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate MS-DRG 262, previously DRG 117, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) PIM Ch. 6.5.3, Section A-C DRG Validation Review 3) ICD-9-CM Addendums and Coding Clinics

Issue Name:	Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders without CC/MCC: MS-DRG 624 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 624, previously DRG 287, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) PIM Ch. 6.5.3, Section A-C DRG Validation Review 3) ICD-9-CM Addendums and Coding Clinics

Issue Name:	Cardiac Pacemaker Revision Except Device Replacement with MCC: MS-DRG 260 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 260, previously DRG 117, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Upper Limb and Toe Amputation for Circulatory System Disorders with CC: MS-DRG 256 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 256, previously DRG 114, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Vol. 1, 2 & 3, coding manuals 2) ICD-9-CM Addendums and Coding Clinics 3) PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Other Kidney and Urinary Tract Procedures with MCC: MS-DRG 673 (At this time Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 673, previously DRG 315, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Wound Debridements for Injuries without CC/MCC: MS-DRG 903 (At this time Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 903, previously DRG 440, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Wound Debridements for Injuries with MCC: MS-DRG 901 (At this time Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 901, previously DRG 440, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Wound Debridements for Injuries with CC: MS-DRG 902 (At this time Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 902, previously DRG 440, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Postoperative or Posttraumatic Infections with O.R. Procedure with MCC: MS-DRG 856 (At this time Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 856, previously DRG 579, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Postoperative or Posttraumatic Infections with O.R. Procedure with CC: MS-DRG 857 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claims, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 857, previously DRG 579, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Infectious and Parasitic Diseases with O.R. Procedure with MCC: MS-DRG 853 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 853, previously DRG 578, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Postoperative or Posttraumatic Infections with O.R. Procedure without CC/MCC: MS-DRG 858 (At this time Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 858, previously DRG 579, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Infectious and Parasitic Diseases with O.R. Procedure with CC: MS-DRG 854 (At this time Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 854, previously DRG 578, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Infectious and Parasitic Diseases with O.R. Procedure without CC/MCC: MS-DRG 855 (At this time Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 855, previously DRG 578, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	O.R. Procedure with Principal Diagnoses of Mental Illness: MS-DRG 876 (At this time Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 876, previously DRG 424, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Full Thickness Burn with Skin Graft or Inhalation Injury with CC/MCC: MS-DRG 928 (At this time Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 928, previously DRG 506 and 507, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Other Kidney and Urinary Tract Procedures with CC: MS-DRG 674 (At this time Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 674, previously DRG 315, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Nonextensive Burns: MS-DRG 935 (At this time Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 935, previously DRG 510 and 511, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Peritoneal Adhesiolysis with MCC: MS-DRG 335 (At this time, Medical Necessity excluded from review)
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 335, previously DRG 150 and 151, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: 1) ICD-9-CM Addendums and Coding Clinics 2) ICD-9-CM Vol. 1, 2 & 3, coding manuals 3) PIM Ch 6.5.3, Section A-C DRG Validation Review

Issue Name:	Barium Swallow Studies Units Billed
Description:	Barium Swallow Studies can only be billed with a unit of (1) per patient per date of service. Provider Type Affected: Physician (Carrier) / Outpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virgin Islands, Virginia (Physician/Carrier Only), West Virginia (Physician/Carrier Only)
Additional Information:	Additional information can be found in the following manuals/publications: http://www.carefirst.com/pages/mdmedicare/pdf/Modified%20Barium%20Swallow-00-01-R4.pdf http://www.trailblazerhealth.com/Tools/Local%20Coverage%20Determinations/Default.aspx?id=2875&DomainID=1 https://coverage.cms.fu.com/lcd/view_article_popup_front.asp?article_number=37880&article_version=3&contractor_id=59 http://www.cms.hhs.gov/apps/ama/license.asp?file=/NationalCorrectCodInitEd/downloads/Hospital_Outpatient_Services_MUE_Table.zip

Issue Name:	Adenosine - Dose vs. Units billed
Description:	Adenosine represents 30 mg per unit and should be billed 1 unit for every 30 mg per patient per date of service. Provider Type Affected: Outpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virgin Islands
Additional Information:	Additional information can be found in the following manuals/publications: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6323.pdf http://www.cms.hhs.gov/transmittals/downloads/R1669CP.pdf http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5718.pdf

Issue Name:	Nebulizer, Demonstration and Evaluation Units Billed
Description:	Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPS device can only be reported as one unit per day of service per patient. Provider Type Affected: Outpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virgin Islands
Additional Information:	Additional information can be found in the following manuals/publications: http://www.cms.hhs.gov/PhysicianSelfReferral/Downloads/cms1502FC.pdf https://www.cahabagba.com/part_a/education_and_outreach/newsletter/0307_fi.pdf

Issue Name:	Q4099 Formoterol fumarate (perforomist)
Description:	By description HCPCS Code Q4099 represents 20 micrograms. Patients are allowed a maximum of two vials of formoterol (20 micrograms each) per day. Provider Type Affected: DME
Date of Service:	10/01/2007 - Open
States Affected:	Suppliers who bill CIGNA Government Services
Additional Information:	Additional information can be found in the following manuals/publications: http://www.cignagovernmentservices.com/jc/pubs/news/2008/0408/cope7438.html https://www.noridianmedicare.com/dme/news/docs/2008/04_apr/nebulizers_instructions.html http://www.medicarenhic.com/dme/medical_review/mr_bulletins/mr_bulletin_current/041708_neb.pdf http://www.cignagovernmentservices.com/jc/coverage/fees/2ndQRTR08Drug.pdf http://www.cignagovernmentservices.com/jc/coverage/fees/3rdQRTR08Drug.pdf http://www.cignagovernmentservices.com/jc/coverage/fees/4thQRTR08Drug.pdf

Issue Name:	J7605 Arformoterol, (Brovana)
Description:	By definition Arformoterol, (Brovana) represents 15 micrograms. Patients are allowed a maximum of two vials of arformoterol (15 micrograms) per day. Provider Type Affected: DME
Date of Service:	10/01/2007 - Open
States Affected:	Suppliers who bill CIGNA Government Services
Additional Information:	Additional information can be found in the following manuals/publications: http://www.medicarenhic.com/dme/medical_review/mr_bulletins/mr_bulletin_current/perforomistbrovan%20200708%2Epdf http://www.medicarenhic.com/dme/medical_review/mr_bulletins/mr_bulletin_current/041708_neb.pdf http://www.medicarenhic.com/dme/medical_review/mr_lcds/mr_lcd_current/L11499_2009-01-01_PA_2009-01.pdf

Issue Name:	Budesonide - Dose vs.Billed Units
Description:	Budesonide should be billed one unit of service for each vial dispensed regardless of vial dose for a maximum of 62 units per month. Provider Type Affected: DME
Date of Service:	10/01/2007 - Open
States Affected:	Suppliers who bill CIGNA Government Services
Additional Information:	Additional information can be found in the following manuals/publications: http://www.cignagovernmentservices.com/jc/pubs/news/2007/1007/cope6608.pdf http://www.medicarenhic.com/dme/medical_review/mr_bulletins/mr_bulletin_current/120408_bud.pdf http://www.edssafeguardservices.eds-gov.com/admin/viewdoc.asp?fn=Nebulizers_-_Policy_Article_-_Effective_01-01-2007.pdf

Issue Name:	Medically Unlikely Edit List
Description:	A Medically Unlikely Edit (MUE) applies to all HCPCS/CPT codes that are above the maximum units of service that a provider would report for the same beneficiary, on same date of service, and same provider. An error was made in billing these services because more units were billed for a beneficiary than what is medically likely. Provider Type Affected: Outpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virgin Islands
Additional Information:	Additional information can be found in the following manuals/publications: http://www.cms.hhs.gov/NationalCorrectCodInitEd/08_MUE.asp#TopOfPage http://www.cms.hhs.gov/NationalCorrectCodInitEd/Downloads/MUE_Prov_Sup_PUB_LTR_9_2008.pdf https://www.cahabagba.com/part_b/education_and_outreach/newsletters/2007/july/July2007NL.pdf

Issue Name:	Upper Limb and Toe Amputation for Circulatory System Disorders with MCC: MS-DRG 255 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 255, previously DRG 114 principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Cirrhosis and Alcoholic Hepatitis with MCC: MS- DRG 432 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 432, previously DRG 202, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Septicemia without Mechanical Ventilation 96+ Hours without MCC: MS-DRG 872 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 872, previously DRG 576, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Nonextensive O.R. Procedure Unrelated to Principal Diagnosis without CC/MCC - MS-DRG 989 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 989, previously DRG 477, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Nonextensive O.R. Procedure Unrelated to Principal Diagnosis with MCC: MS-DRG 987 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary’s medical record. Reviewers will validate for MS-DRG 987, previously DRG 477, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Other Respiratory System O.R. Procedures without CC/MCC: MS-DRG 168 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 168, previously DRG 076/077, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Extensive O.R. Procedure Unrelated to Principal Diagnosis without CC/MCC: MS-DRG 983 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 983, previously DRG 468, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Other Respiratory System O.R. Procedures with CC: MS-DRG 167 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 167, previously DRG 076, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Other Digestive System Diagnoses with CC: MS-DRG 394 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 394, previously DRG 188, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Inflammatory Bowel Disease with CC: MS-DRG 386 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 386, previously DRG 179, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Major Gastrointestinal Disorders and Peritoneal Infections with CC: MS-DRG 372 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 372, previously DRG 572, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Other Respiratory System O.R. Procedures with MCC: MS-DRG 166 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 166, previously DRG 076, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found in the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Major Small and Large Bowel Procedures without CC/MCC: MS-DRG 331 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 331, previously DRG 570, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found on the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Major Small and Large Bowel Procedures with CC: MS-DRG 330 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 330, previously DRG 569, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found on the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Major Small and Large Bowel Procedures with MCC: MS- DRG 329 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 329, previously DRG 149, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found on the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Major Chest Procedures without CC/MCC: MS-DRG 165 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS-DRG 165, previously DRG 075, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found on the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Major Chest Procedures with MCC: MS-DRG 163 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS DRG 163, previously DRG 075, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found on the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Major Chest Procedures with CC: MS-DRG 164 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS DRG 164, previously DRG 075, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found on the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Respiratory System Diagnosis with Ventilator Support 96+ Hours: MS-DRG 207 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS DRG 207, previously DRG 565, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found on the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Septicemia without Mechanical Ventilation 96+ Hours with MCC: MS-DRG 871 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS DRG 871, previously DRG 576, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found on the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Extensive O.R. Procedure Unrelated to Principal Diagnosis with MCC: MS-DRG 981 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS DRG 981, previously DRG 468, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found on the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Extensive O.R. Procedure Unrelated to Principal Diagnosis with CC: MS-DRG 982 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS DRG 982, previously DRG 468, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found on the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Nonextensive O.R. Procedure Unrelated to Principal Diagnosis with CC - MS-DRG 988 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS DRG 988, previously DRG 477, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found on the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Coagulation Disorders: MS-DRG 813 (At this time, Medical Necessity excluded from review).
Description:	DRG Validation requires that diagnostic and procedural information and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary's medical record. Reviewers will validate for MS DRG 813, previously DRG 397, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG. Provider Type Affected: Inpatient Hospital
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas
Additional Information:	Additional information can be found on the following manuals/publications: ICD-9-CM for Hospitals Vol. 1, 2 & 3, Coding Guidelines, Section II, A, B, C, D, E, F, G, H ICD-9-CM Addendums and Coding Clinics PIM Ch. 6.5.3, Section A-C DRG Validation Review

Issue Name:	Wheelchair Bundling
Description:	Bundling guidelines for wheelchair bases and options/accessories indicate certain procedure codes are part of other procedure codes and, as a result, are not separately payable. Provider Type Affected: DME
Date of Service:	10/01/2007 - Open
States Affected:	Suppliers who bill CIGNA Government Services
Additional Information:	Additional information can be found in the following manuals/publications: http://www.cms.hhs.gov/mcd/viewarticle_pdf.asp?article_id=20284&article_version=32&contractor_id=140 Search by the above listed “Issue Name”

Issue Name:	Urological Bundling
Description:	Certain procedure codes are part of other procedure codes and are not separately payable. Provider Type Affected: DME
Date of Service:	10/01/2007 - Open
States Affected:	Suppliers who bill CIGNA Government Services
Additional Information:	Additional information can be found in the following manuals/publications: http://rsimedsupply.com/Permanent%20Urinary%20Retentionl.pdf Search by the above listed “Issue Name”

Issue Name:	Clinical Social Worker (CSW) Services
Description:	Clinical Social Worker (CSW) services rendered during an Inpatient Hospital stay are not separately payable under Medicare Part B; they are included in the facility’s Prospective Payment System (PPS) payment. CSW providers are expected to seek reimbursement from the facility. Provider Types Affected: CSW Providers
Date of Service:	10/01/2007 - Open
States Affected:	Florida
Additional Information:	Additional information can be found in the following manuals/publications: Medicare Benefit Policy Manual: Pub 100-02, Ch 15, § 170 CMS Med Learn Matters Article #: SE0439 Search by the above listed “Issue Name”

Issue Name:	Blood Transfusions
Description:	CPT codes 36430, 36440, 36450, and 36455 (excluding claims with any modifiers) should be billed as one (1) per session, regardless of the number of units transfused on that date of service. Provider Types Affected: Outpatient Hospital and Physician
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Florida, Georgia, South Carolina
Additional Information:	Additional information can be found in the following manuals/publications: Federal Register, Volume 67, No.212, 66868 Program Memorandum Intermediaries, Transmittal A-01-50, April 12, 2001, page 1 CMS Pub 100-04, Ch. 4, § 231.8

Issue Name:	Untimed Codes
Description:	CPT Codes (excluding modifiers KX, and 59) where the procedure is not defined by a specific timeframe (untimed codes), the provider should enter a one (1) in the units billed column per date of service. Provider Types Affected: Outpatient Hospital and Physician
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Florida, Georgia, North Carolina, South Carolina
Additional Information:	Additional information can be found in the following manuals/publications: CMS Pub 100-04, Transmittal 1019, dated 8.3.06, pages 7-11 CMS Pub 100-04, Ch. 5, § 20.2

Issue Name:	IV Hydration Therapy
Description:	Based on the definition of CPT 90760 (excluding claims modifier-59 ), the maximum number of units should be one (1) per patient per date of service. Beginning 1.1.09, code 90760 was replaced with code 96360. Provider Types Affected: Outpatient Hospital and Physician.
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Florida, Georgia, South Carolina
Additional Information:	Additional information can be found in the following manuals/publications: CMS Pub 100-4 Ch. 12, pages 31-32 CMS Pub 100-20, Transmittal 419, page 7 MLN Matters, MM6349 R/T RC Release Date 12.19.08, page 4

Issue Name:	Bronchoscopy Services
Description:	CPT Codes 31625, 31628 and 31629 should be billed with a maximum number of units of one (1) per patient per date of service (excluding claims with modifier 59) should only be reported with one unit per date of service. Provider Types Affected: Outpatient Hospital and Physician.
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Georgia, South Carolina
Additional Information:	Additional information can be found on the following website(s): http://www.thoracic.org American Medical Association's (AMA) Current Procedural Terminology (CPT) for 2007, 2008 and 2009.

Issue Name:	Once in a lifetime procedures
Description:	By virtue of the description of the CPT code, these codes can be performed only once per patient lifetime. Claims with modifier-58 will be excluded from your audit with dates of service starting 1/1/09. Starting 1/1/09 this code was allowed to be billed more than once if the provider used the modifier. Provider Types Affected: Outpatient Hospital and Physician.
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Colorado, Florida, Georgia, North Carolina, New Mexico, Oklahoma, South Carolina, Texas
Additional Information:	Additional information can be found on the following manuals/publications: American Medical Association's (AMA) Current Procedural Terminology (CPT) for 2007, 2008 and 2009

Issue Name:	Pediatric codes exceeding age parameters
Description:	Newborn/Pediatric CPT codes being applied/billed for patients which exceed the age limit defined by the CPT code. Provider Types Affected: Outpatient Hospital and Physician.
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Florida, North Carolina, South Carolina
Additional Information:	Additional information can be found on the following manual/publication: American Medical Association's (AMA) Current Procedural Terminology (CPT) for 2007, 2008 and 2009

Issue Name:	J2505: Injection, Pegfilgrastim, 6 mg.
Description:	Claims for J2505 should be submitted so that the units billed represent the number of multiples of 6mg administered, not the total number of mgs. Provider Types Affected: Outpatient Hospital and Physician.
Date of Service:	10/01/2007 - Open
States Affected:	Alabama, Colorado, Florida, Georgia, North Carolina, New Mexico, Oklahoma, South Carolina, Texas
Additional Information:	Additional information can be found in the following manuals/publications: CMS Manual System, Publication 100-04 Medicare Processing Manual, Transmittal 949 (dated May 12, 2006 MLN Matters Number MM5912, Release Date: January 18, 2008 MLN Matters Number MM4380, Release Date: May 12, 2006