Issues Under Review

Note: Issues for Part B providers that are approved for audits in the District of Columbia (“DC”) apply to the DC metro area, including the counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia.


Issue NumIssue NameType of ReviewProvider TypeDescending OrderState(s) ImpactedDate PostedDetails
A000382009 MS-DRG Coding and Medical Necessity Validation: Severe Sepsis MS DRGs 177, 189, 193, 291, 438, 441, 444, 592, 602, 682, 689, 691, 693 (Initially, medical necessity validation was allowed but limited to MS-DRGs 291, 682, and 689) Subsequently, CMS instructed that no medical necessity review would be allowed for this issue. Accordingly, review of all DRGs in this issue continues to be limited to DRG Validation audit only. Complex Inpatient Hospital CT, DC, DE, MA, ME, NH, NJ, NY, PA, RI, VT 6/17/2010 Details
A000562010 MS-DRG Validation: Cardiac Valve Procedures (Medical Necessity Excluded) Complex Inpatient Hospital CT, DC, DE, MA, ME, NH, NJ, NY, PA, RI, VT 6/17/2010 Details
A000582010 MS-DRG Validation: Coronary Bypass Procedures (Medical Necessity Excluded) Complex Inpatient Hospital CT, DC, DE, MA, ME, NH, NJ, NY, PA, RI, VT 6/17/2010 Details
A000612010 MS-DRG Validation: Lysis of Adhesions (Medical Necessity Excluded) Complex Inpatient Hospital CT, DC, DE, MA, ME, NH, NJ, NY, PA, RI, VT 6/17/2010 Details
A000452009 MS-DRG Validation: Excisional Debridement Complex Inpatient Hospital CT, DC, DE, MA, ME, NH, NJ, NY, PA, RI, VT 6/17/2010 Details
A000212009 Global vs. TC/PC Split Reimbursements Automated Outpatient Hospital, Critical Access Hospital, Physician / Non-physician Practitioner CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VT 6/17/2010 Details
A000182009 IV Hydration - JA Automated Outpatient Hospital, Physician / Nonphysician Practitioner CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VT 6/17/2010 Details
A000172009 Bronchoscopy Services - Issue closed. Automated Outpatient Hospital, Physician / Nonphysician Practitioner CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VT 6/17/2010 Details
A000162009 Blood Transfusion - Issues closed. Automated Outpatient Hospital, Physician / Nonphysician Practitioner CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VT 6/17/2010 Details
A000152009 Untimed Codes - Region A - Issue retired. Automated Outpatient Hospital, Physician / Nonphysician Practitioner CT, DC ,DE, MA, MD, ME, NH, NJ, NY, PA, RI, VT 6/17/2010 Details
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