Under the Hospital Payment Monitoring Program, IPRO analyzed the New York State Inpatient Medicare Prospective Payment System (PPS) DRGs billed in New York State for calendar year 2006. IPRO's data analyses identified the top 10 Medicare Denied DRGs in NYS as follows: DRG 174 (GI Hemorrhage with CC), DRG 182 (Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders, Age >17 with CC), DRG 296 (Nutritional & Miscellaneous Metabolic Disorders, Age >17 w/ CC), DRG 316 (Renal Failure), DRG 087 (Pulmonary Edema and Respiratory Failure), DRG 079 (Respiratory Infections and Inflammations, Age Greater than 17 with CC), DRG 141 (Syncope and Collapse w/CC), DRG 089 (Simple Pneumonia and Pleurisy, Age >17 with CC), DRG 468 (Extensive OR Procedure Unrelated to Principal Diagnosis)and DRG 320 (Kidney and Urinary Tract Infections, Age>17 w/ CC).
To assist hospitals in their efforts to reduce payment error, IPRO has developed the educational coding materials for the Top Ten Denied DRGs. These coding materials may be used by hospitals for their ongoing educational training programs, and for internal auditing and monitoring activities to ensure the accuracy and consistency of DRG assignments and completeness of medical record documentation.
Click on each DRGs to view the coding materials: