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DCS Healthcare Announced 11 New Issues for Medical Necessity Review

DCS Healthcare added 11 new approved issues for medical necessity reviews for providers in Region A states. The recently approved new issues may be reviewed for providers in Pennsylvania, the District of Columbia, New Jersey, Delaware, New York, Connecticut, Vermont, Maine, Massachusetts, New Hampshire, and Rhode Island, excluding Maryland. The new issues include:

MS-DRG 885 psychoses

• MS-DRG 188 pleural effusion without CC-MCC

• MS-DRG 087 traumatic stupor and coma, coma less than one hour without CC-MCC

• MS-DRG 918 poisoning-toxic effects of drugs without MCC

• MS-DRG 283 acute myocardial infarction, expired w MCC

• MS-DRG 534 fractures of femur without MCC

• MS-DRG 294 deep vein thrombophlebitis with CC-MCC

• MS-DRG 281 acute myocardial infraction, discharged alive with CC

• MS-DRG 280 acute myocardial infraction, discharged alive with MCC.

• MS-DRG 123 neurological eye disorders.

DCS also approved a new issue for providers in Maryland:

• APR-DRG 203 chest pain (All severity and risk of mortality levels)


If you need assistance in preparing for, or defending against RAC audits, or implementing a compliance program geared toward identifying and correcting potential risk areas related to RAC audits, please contact a Wachler & Associates attorney at 248-544-0888.

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