Administrative Memos

200109

FROM: Theodore O. Will, Chief Executive Officer
DATE: May 21, 2001
SUBJECT: Short Stay Hospitalization for Intravenous Infusion or Injection of Therapeutic or Prophylactic Substances (ICD-9-CM Procedure Code)
IPRO CONTACTS:

Andrea Goldstein, Vice President, Medicare/Federal Health Care Assessment, ext. 364 and Kathy Terry, Ph.D., Senior Director, Data Analysis and Evaluation, ext. 261

Enclosed please find a copy of IPRO's Aggregate Data Report in regard to Short Stays associated with ICD-9-CM Procedure Code 99.29 (Intravenous Infusion or Injection of Therapeutic or Prophylactic Substances). This report is based on IPRO's analysis of calendar year (CY) 1998 New York State Medicare inpatient claims data for patients with same or next day discharges. These analyses revealed several procedures having high volume discharges. ICD-9-CM Procedure Code 99.29 was one of the procedures identified and outlier hospitals were targeted for study.

IPRO's analysis showed that 16 out of 217 hospitals had at least 50 claims for this procedure code with at least ten percent of these claims being either same or next day discharges. IPRO reviewed a sample of CY 1998 inpatient discharges from these 16 hospitals to determine the medical necessity of the inpatient admission. The aggregate error rate for this project was 28.3%, with 20.7% of these cases denied for failure to provide sufficient medical record documentation to support admission necessity. The remaining 7.6% of the aggregate error rate was attributed to technical denials (i.e., charts not submitted by the hospital).

We have enclosed a copy of your hospital-specific report with this mailing (Attachment II) for the 16 hospitals selected for IPRO assessment. If your hospital had denials, a list of these denied cases is also provided (Attachment III). In addition, we encourage all hospitals to take a proactive approach and conduct routine monitorings of your same and next day discharges to insure that these admissions are medically necessary on an inpatient basis, as reflected by the documentation in the medical records. To assist you in your endeavors, we have also included a copyrighted reprint of an article from the Journal of Health Care Compliance, "Tactics Add to Your Power When Dealing With Physicians".

As a result of our study, IPRO recommend that all hospitals:

Conduct routine monitoring of short stay hospitalizations to ensure that inpatient acute care is required and that medical record documentation reflects this need.
Review denied cases for hospital-specific issues to identify process improvements.
Review medical record submission timeliness with responsible parties to ensure elimination of future technical denials.

Should you have any questions with regard to IPRO's PEPP activities or this report, please feel free to contact Andrea Goldstein or Dr. Kathy Terry.