Some hospitals are incorrectly reporting lymphoma and leukemia MS-DRGs for patients who are admitted and treated for anemia and dehydration, according to the Medicare Quarterly Provider Compliance Newsletter.
Recovery Auditors (RA) validated the following MS-DRGs for principal and secondary diagnoses and procedures as affecting or potentially affecting MS-DRG assignment:
- MS-DRG 820-822, lymphoma and leukemia with major OR procedure with MCC, with CC, and without CC or MCC
- MS-DRG 823-825, lymphoma and nonacute leukemia with other OR procedure ith MCC, with CC, and without CC or MCC
- MS-DRG 840-842, lymphoma and nonacute leukemia with MCC, with CC, and without CC or MCC
RAs found that hospitals were assigning codes for the malignancy as the primary diagnosis when the patient was admitted for conditions such as dehydration and anemia. As a result, facilities incorrectly reported the malignancy MS-DRG.
CMS provides specific case examples in the newsletter as well as guidance on correctly coding these scenarios.
