Diagnosis-Related Group Audit Form
Diagnosis-Related Group Audit Form for auditing DRG coding and documentation quality. Please complete all sections for a thorough review.
Encounter or Case Number
*
Date of Audit
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reviewed DRG Code
*
Primary Diagnosis Description
*
Secondary Diagnoses / Complications (if any)
Procedures Coded (if applicable)
DRG Assignment Accuracy
*
Correct
Incorrect
Documentation Sufficiency
*
Sufficient
Insufficient
Audit Comments / Recommendations
Reviewer Name
*
Submit Audit
Should be Empty: