Pediatric RAC Denials: Pneumonitis
We are currently receiving a significant number of Medicaid RAC DRG Clinical Validation denials for pneumonitis. As we all know, the coding of a documented diagnosis of "pneumonitis" results in a "pneumonia" code on the claim. The rationale provided within the denial letters does not seem to acknowledge that "pneumonitis" was the documented diagnosis as the referenced clinical practice guidelines included within the letter are specific to pneumonia. Are other pediatric programs facing this challenge and have you found any successful tactics through your own appeal processes? Thank you.