Newly approved Recovery Auditor issues – 04/06/2016

HDI posts two new issues in two categories

HealthDataInsights (HDI) posted two new issues in two categories to its CMS list for providers in Region D. (See link for individual state applicability.)

According to the HDI website, the new issues are:

For outpatient hospitals:

• Multi-use vial wastage: Trastuzumab (Herceptin) – Outpatient. Multi-use vials are not subject to payment for discarded amounts of drug or biological. Per, the manufacturer label, J9355 Injection, Trastuzumab, 10mg (Herceptin) is only supplied in a multi-use vial. Providers should only bill the units associated with the dose administered to the patient.

For inpatient acute care hospital:

• DRG Validation Cardiac Procedures. Diagnosis-related group (DRG) assignment for inpatient acute care reimbursement is dependent upon accurate coding of diagnoses and procedures. Coding professionals should only assign and report codes that are clearly and consistently supported by explicit physician documentation in the health record. Based on CMS Region D Data Analysis, Claims with cardiac procedures MSDRGs having a probability for billing and reimbursement error(s) are identified for complete DRG Validation review.