Diagnosis Related Group (DRG) 470 Checklist

Published 04/30/2020

Providers can use this checklist as an audit tool to help assure that they are submitting all required documentation.  


Diagnosis Related Group (DRG 470) Checklist  Yes  No  N/A
Is there a physician order or intent to admit inpatient status present?      
Does the documentation present support date of service as billed, or correct beneficiary?      
Is the operative procedure included in the documentation submitted?      
Is there documentation of failed conservative measure/treatments?      
Is there documentation of pain impacting the functional ability of beneficiary despite conservative treatment?      
Are there  X-ray, T or MRI results submitted to support operative procedure performed?      
Was all of the claim billed correctly?      

Disclaimer: This checklist was created as an aid to assist providers. This aid is not intended as a replacement for the documentation requirements published in national or local coverage determinations, or the CMS’s documentation guidelines. It is the responsibility of the provider of services to ensure the correct, complete, and thorough submission of documentation.

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