Why would a coder or coding manager automatically review and/or revise patients assigned to DRG 469 and/or DRG 470?

Question

Quizplus · Accepted Answer

DRG 469 and 470 are considered high-risk DRGs for coding errors and fraudulent activities. Therefore, a coder or coding manager may automatically review and/or revise patients assigned to these DRGs to check if there are any incorrect codes assigned or data that can affect the reimbursement of the hospital. This helps to ensure accurate reimbursement and avoid potential audits or penalties. However, the federal government may also review these DRGs for fraud and abuse, which makes option B partially true.

Why Would a Coder or Coding Manager Automatically Review And/or