Acute Care Inpatient Review Criteria Guidelines

  • More than 350 guidelines that contain acute care inpatient review criteria with MS-DRG and APR-DRG Length of Stay data.
  • Evidence-based, with comprehensive reference links.
  • Provides utilization management and claims departments with essential information to assist in medically-necessary benefit determinations.
  • Includes a section entirely devoted to Managing Unplanned Readmissions, which includes issues, innovative programs, resources and strategies needed to manage CMS targeted readmission diagnoses and avoid financial penalties.
  • Detailed review criteria by MS-DRG focus on medical necessity and appropriateness of care.
  • Search guidelines by DRG, CPT/HCPCS, ICD-9 or keyword.


Guidelines

  • MDC 0 - Stem Cell and Organ Transplantation
  • MDC 1 - Diseases and Disorders of the Nervous System
  • MDC 10 - Diseases and Disorders of the Endocrine, Nutritional and Metabolic Diseases and Disorders
  • MDC 11 - Diseases and Disorders of the Kidney and Urinary Tract; Dialysis
  • MDC 12 - Diseases and Disorders of the Male Reproductive System
  • MDC 13 - Diseases and Disorders of the Female Reproductive System
  • MDC 14 - Diseases and Disorders of Pregnancy, Childbirth and Puerperium
  • MDC 15 - Diseases and Disorders of Neonates (Perinatal Period)
  • MDC 16 - Diseases and Disorders of the Blood and Blood Forming Organs and Immunological Disorders
  • MDC 17 - Myeloproliferative Disorders
  • MDC 18 - Diseases and Disorders of the Infectious and Parasitic Diseases
  • MDC 19 - Diseases and Disorders of the Mental Diseases and Disorders
  • MDC 20 - Diseases and Disorders of the Eye
  • MDC 21 - Diseases and Disorders of the Alcohol/Drug Use or Induced Mental Disorders
  • MDC 22 - Diseases and Disorders of the Injuries, Poison and Toxic Effect of Drugs
  • MDC 23 - Diseases and Disorders - Burns
  • MDC 24 - Factors Influencing Health Status; Genetic Disorders
  • MDC 25 - Multiple Significant Trauma
  • MDC 26 - Human Immunodeficiency Virus Infection
  • MDC 26 - Addenda
  • MDC 27 - Unplanned Readmissions: Management Strategies
  • MDC 3 - Diseases and Disorders of the Ear, Nose, Mouth and Throat
  • MDC 4 - Diseases and Disorders of the Respiratory System
  • MDC 5 - Diseases and Disorders of the Circulatory System
  • MDC 6 - Diseases and Disorders of the Digestive System
  • MDC 7 - Diseases and Disorders of the Hepatobiliary System and Pancreas
  • MDC 8 - Diseases and Disorders of the Musculoskeletal System and Connective Tissues
  • MDC 9 - Diseases and Disorders of the Skin, Subcutaneous Tissue and Breast