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 2 - Diseases and Disorders of the Eye
• 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