As paid vs. as it should have been
| Ln | Code | Description | Paid | Should be | Variance | Result |
|---|---|---|---|---|---|---|
| 1 | DRG 690 |
Kidney and urinary tract infections without MCC
N39.0 · Urinary tract infection, site not specified
|
$5,504.60 | $5,504.60 | — | Correct |
Determination
Reviewed with no variance. Every line was paid at the allowable on file.
How it was coded
Remedy: None — the claim was billed and priced as the record supports
Reviewed for level, severity and unit count. Nothing billed above what the record carries.
Prior authorization
Authorization on file and matched to the claim. Nothing billed beyond it.
Policy applied
Knowledge CenterClinical validation of the complications and comorbidities reported on the admission
v3.1 was extracted from CPP-047_inpatient-drg-validation_v3.1.md. Passages are quoted only on the policy the finding rests on.
Present-on-admission reporting for the secondary diagnoses
No source document for v2.0 is in the index, so this policy can be cited here but not quoted. Upload it.
Coverage on the date of service
v6.1 was extracted from CPP-080_eligibility-enrolment-retroactive-termination_v6.1.md. Passages are quoted only on the policy the finding rests on.