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Physician coding errors led to millions in overpayments for stroke patients


Physicians haven't properly coded for stroke patients who transferred from traditional Medicare to Medicare Advantage, leading to inflated payments to Medicare Advantage organizations, according to a Sept. 16 report from HHS' Office of Inspector General.

Select diagnosis codes for acute stroke that map to the ischemic or unspecified stroke hierarchical condition categories are at high risk of being miscoded, according to the OIG. For its audit, OIG reviewed claims for 582 transferred enrollees who received a high-risk acute stroke diagnosis code in 2014 or 2015 to see if medical records support the submitted codes.

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