Approved Issues

Issue NumIssue NameType of ReviewProvider TypeDescending OrderState(s) ImpactedDate PostedDetails
0001 Complex Inpatient Hospital MS-DRG Coding Validation Complex IPH Region 1 2/1/2017 Details
0008 Complex Medical Necessity Bariatric Surgery Complex Outpatient Hospital Region 1 2/1/2017 Details
0009 Automated Cataract Surgery Once in a Lifetime Automated Outpatient Hospital, ASC Region 1 2/1/2017 Details
0011 Inappropriate billing of Home Health E&M codes during Inpatient Automated Professional Services (Physician/ non Physician Practitioner Region 1 2/1/2017 Details
0007 Automated Zoledronic Acid Billed units greater than or equal to > 5. (Note: 1 unit = 1mg of medication) Automated Outpatient Hospital Region 1 2/1/2017 Details
0006 Regadenoson (Lexiscan) billed with Units Greater Than 4 Automated Outpatient Hospital Region 1 2/1/2017 Details
0025 Automated Nebulizers Not in Accordance with Billing Requirements Automated DME by Supplier, DME by Physician Region 5 2/2/2017 Details
0016 Automated CPM Billed without Total Knee Replacement Automated DME by Supplier, DME by Physician Region 5 2/2/2017 Details
0002 Complex Cataract Removal Complex Ambulatory Surgery Center (ASC); Outpatient Hospital Region 1, Excludes MI and IN 2/7/2017 Details
0021 Complex Medical Necessity Tracheotomy Suction Catheters, Suction Pumps, Catheters and Other Related Supplies/Equipment. Complex DME by Supplier and DME by Physician Region 5 2/8/2017 Details
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