Most Common DRG’s with Recommendations 2018: Part 1
Kim Carrier RHIT, CDIP, CCS, CCS-P
Director of Coding Quality Assurance
AHIMA Approved ICD-10-CM/PCS Trainer
In 2018, HIA Reviewed 39,828 inpatient records. Even with this large number of records, the DRG’s with recommendations are the ones that coders typically see during audits. This is part 1 of a series as we look at the top 5 DRG’s with recommendations over the next week.
#1 DRG with the most recommendations
DRG 871—Septicemia w/o MV 96+ hours with MCC
For this DRG there were several different DRG’s that were recommended.
The majority of the recommendations from DRG 871 (Septicemia w/o MV 96+ hours with MCC) were to DRG 872 (Septicemia w/o MV 96+ hours w/o MCC) with the recommendation to delete the reported MCC or query for clarification to support the MCC that had been reported.
- Verify that the MCC reported is clearly documented and supported in the medical record. If there’s a chance that the condition is not present or was ruled out, a query is necessary to obtain clarification. When only 1 MCC is present on a record it is always best practice to double check to insure that it can’t be removed in an audit.
DRG 698 (Other kidney & urinary tract diagnosis with MCC) was also the recommended DRG on several cases reviewed. These all required clarification from the MD to support the diagnosis of sepsis or just the re-sequencing of the urinary tract infection to the PDX spot. Not all of these in this DRG required a query.
- Verify that the diagnosis of sepsis is clearly documented and supported before reporting as the PDX. If there is any question at all on this diagnosis, a query should be sent.
- Reasons for queries before reporting sepsis as the PDX may be to clarify if the diagnosis was present on admission or if this was ruled out. Oftentimes coders will see documentation of sepsis after admission. Even if the clinical indicators are present at the time of admission, if the diagnosis isn’t made until later in the stay a query is needed.
- Another common documentation issue that coders see is sepsis and bacteremia being used in the medical record interchangeably and then the discharge summary is completed with only bacteremia. Coders should obtain further clarification from the physician to determine if sepsis was ruled out and the patient only has bacteremia or if sepsis was present for this patient.
The third most recommended change was to DRG 853 (Infection & parasitic diseases with O.R. procedure with MCC) with the addition of PCS code that may or may not have required a query. This one is a huge difference in reimbursement.
- Coders should review the entire medical record to look for procedures that were performed. There may not be a formal operative note in the record however, the orders and progress notes should give the coder a clue to look further or query the physician.
Another common finding within the records reviewed for DRG 871 is missing or incorrect reporting of mechanical ventilation. The coder should know where to find the mechanical ventilation sheets and “best practice” is to double check vent times in a patient with sepsis as the PDX. Missing or incorrectly reporting is a huge difference in reimbursement.
Be on the lookout for Part 2 of this series tomorrow!
Happy Coding!
The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
Popular Posts
Part 14: Spinal Fusion Coding — Spinal Fusion Series Summary
We have finished with the step-by-step coding tidbits on coding of spinal fusions. If you were not able to catch Parts 1-13 of this series focused on spinal fusions, please visit hiacode.com/topics/series/spinal-fusion-coding/.
Part 13: Spinal Fusion Coding — Harvesting of Autograft for Spinal Fusion
In Part 12, we focused on intra-operative peripheral neuro monitoring used during spinal fusion surgery. In Part 13, we are going to focus on harvesting of autograft and is it coded. Remember in Part 6, we learned that autograft is bone from the patient.
Part 12: Spinal Fusion Coding — Intra-Operative Peripheral Neuro Monitoring
In Part 11, we focused on identifying the computer assisted navigation used during spinal fusion surgery. In Part 12, we are going to focus on intra-operative peripheral neuro monitoring.
Part 11: Spinal Fusion Coding — Computer Assisted Navigation
In Part 10, we focused on identifying whether or not hardware from a previous spinal fusion is coded. In Part 11, we are going to discuss computer assisted navigation.
Part 10: Spinal Fusion Coding — Removing Hardware from Previous Fusion
In Part 9, we focused on identifying if decompression was also performed and if so, on which body part. In Part 10, we are going to focus on identifying if hardware was removed from a previous fusion site.
Subscribe to our weekly newsletter
Latest News
Part 14: Spinal Fusion Coding — Spinal Fusion Series Summary
We have finished with the step-by-step coding tidbits on coding of spinal fusions. If you were not able to catch Parts 1-13 of this series focused on spinal fusions, please visit hiacode.com/topics/series/spinal-fusion-coding/.
Part 13: Spinal Fusion Coding — Harvesting of Autograft for Spinal Fusion
In Part 12, we focused on intra-operative peripheral neuro monitoring used during spinal fusion surgery. In Part 13, we are going to focus on harvesting of autograft and is it coded. Remember in Part 6, we learned that autograft is bone from the patient.
Part 12: Spinal Fusion Coding — Intra-Operative Peripheral Neuro Monitoring
In Part 11, we focused on identifying the computer assisted navigation used during spinal fusion surgery. In Part 12, we are going to focus on intra-operative peripheral neuro monitoring.
Part 11: Spinal Fusion Coding — Computer Assisted Navigation
In Part 10, we focused on identifying whether or not hardware from a previous spinal fusion is coded. In Part 11, we are going to discuss computer assisted navigation.
Part 10: Spinal Fusion Coding — Removing Hardware from Previous Fusion
In Part 9, we focused on identifying if decompression was also performed and if so, on which body part. In Part 10, we are going to focus on identifying if hardware was removed from a previous fusion site.
Part 9: Spinal Fusion Coding — Was A Decompression Done During Spinal Fusion?
In Part 8, we focused on identifying if a discectomy was performed, and if so, if it was a partial or a total discectomy. In Part 9, we are going to focus on identifying if a decompression was performed, and if so, was it of the spinal cord, spinal nerves or both?
Part 8: Spinal Fusion Coding — Discectomy During Spinal Fusion
In Part 7, we focused on identifying any instrumentation that may be used during a spinal fusion. In Part 8, we are going to focus on identifying if a discectomy is performed and if this is an excision or a resection of the disc.
Part 7: Spinal Fusion Coding — Identify Any Instrumentation or Device Used
In Part 6, we focused on identifying the type of bone graft product used for the spinal fusion. In Part 7, we are going to focus on identifying any instrumentation or device used.
Part 6: Spinal Fusion Coding — Identify the Type of Bone Graft Used for Fusion
In Part 5, we focused on identifying the approach being used for the spinal fusion. In Part 6, we are going to focus on identifying the type of bone graft used for the spinal fusion.
Part 5: Spinal Fusion Coding — Identifying the Approach Being Used for Fusion
In Part 4, we focused on determining the spinal column being fused. In Part 5, we are going to focus on identifying what approach is being used to complete the spinal fusion (anterior, posterior or both).
HIA Launches Buddy Up Program for New Hires
This past year, HIA implemented “Buddy Up,” a program designed to help the new hire have a smooth transition into their new HIA roles with the assistance of a “buddy.” What is a Buddy? The Buddy is simply a peer who can guide the new hire in order to make them feel more comfortable. We are very proud of this program and have many success stories that we would like to share. Take a look at the wonderful feedback we have received below.
Part 4: Spinal Fusion Coding — Identifying the Column Being Fused
In Part 3, we focused on determining the level of the fusion(s) and how to determine the number of vertebrae fused. In Part 4, we are going to focus on identifying which column is being fused (anterior, posterior or both).
Part 3: Spinal Fusion Coding — Determine the Level(s) or Region of Fusion and Number of Vertebrae Fused
In Part 1, we learned the diagnoses associated with the need for spinal fusions, and in Part 2 the need to identify if the fusion is an initial or refusion of the vertebrae. In Part 3, we are going to focus on determining the level(s) of fusion, as well as the number of vertebrae fused.
Part 2: Spinal Fusion Coding — Initial Fusion or Refusion
In Part 2, we are going to look at the differences between initial fusion and a refusion. In ICD-9, there were specific codes to show if the fusion was an initial fusion, or if it was a refusion. In ICD-10-PCS, initial fusions and refusion procedures are coded to the same root operation “fusion.”
Part 1: Spinal Fusion Coding — Diagnoses Responsible
This is Part 1 of a 14 part series focusing on education for spinal fusions. Spinal fusion coding is a tough job for coders. There are so many diseases/disorders that result in the need for spinal fusion, and even more choices in reporting the ICD-10-PCS codes.
What’s the Best Defense? A Good Offense
The official definition from the Centers for Medicare & Medicaid Services (CMS) states that a Medicare overpayment is a payment that exceeds amounts properly payable under Medicare statutes and regulations. When Medicare identifies an overpayment, the amount becomes a debt you owe the Federal government.
Query Tip: Writing a Query Question – Simple and Concise is the Key
The question asked in a physician query may be the most important element of the document. Query questions need to be as simple and concise as possible. The physician should have no doubt what the coder is asking.
Coding Tip: Coding Complications of Transplanted Organs
Coding complications of transplanted organs has always been a coding dilemma. With the implementation of ICD-10-CM that didn’t change. However, coders have multiple directives to help in determining what a complication of the transplant is vs. non-transplant conditions and diseases.
Find Your Routine: Take Advantage of Educational Opportunities
We interviewed our most productive coders, reviewers and members of our education team, asking them what steps they take to find a rhythm that works for them. This week, we talked with Beth Martilik, MA, RHIA, CDIP, CCS, Assistant Director of Education, about the steps she takes to find her routine.
Coding Tip: Atrial Fibrillation
With the implementation of ICD-10-CM came more codes for reporting many different conditions and diseases, and atrial fibrillation is one of those. For many years there was only one code available for reporting this condition, even when the physician further specified the type of atrial fibrillation that the patient had. In ICD-10-CM, there are four codes to report atrial fibrillation.
Coder Q&A with Pat Macc: Mucoid Casts and Mucus Plugs
We have a case where the physician removes mucoid casts found during bronchoscopy. We have also seen mucus plugs removed during bronchoscopy. The MD performs bronchial washings then removes a large amount of tenacious and thick mucoid casts via bronchoscopy. Is this coded drainage, extirpation or excision? What body part is used?
Query Tip: How to Be More Efficient
The key to making the query process more efficient is to look for words or documentation while reviewing the record that may signal a potential query opportunity and to note the finding at that time. By the time a coder reaches the end of a record, documentation may have been found to eliminate the need for the query.
Coder Q&A with Pat Macc: Metastatic Cancer
Question: This patient is noted to have “Lymphangitic carcinomatosis of lungs with mediastinal lymph nodes.” How would I code the diagnosis? Would I code metastatic cancer to the lung (C78.01) or metastatic cancer to the lymph nodes (C77.1)?
Coder Q&A with Pat Macc: Collapse of an Endograft
This would be considered a “mechanical” complication of the stent graft since the MD states it is a fracture of the endograft and it is folded over on itself. I would change T82.898A TO T82.598A for Other mechanical complication of other cardiac and vascular devices and implants, initial encounter. I did not use “displacement” because the surgeon did not state that the graft was displaced, only that it collapsed upon itself causing obstruction.
Find Your Routine: Be Flexible, Not Frustrated
We interviewed our most productive coders and reviewers, asking them what steps they take to find a rhythm that works for them. This week, we talked with Valerie Abney, CDIP, RHIT, CCS, about the steps she takes to find her routine.
Coding Tip: Periprosthetic Fracture Reporting and Sequencing
Osteoporosis alone is responsible for over a million fractures every year. Stress fractures are not as common but they do occur. There are more than 1 million total joint replacements in the U.S. each year, so there was a need to create codes for injuries that occur around or near the prosthesis. These are called “periprosthetic” fractures.
OIG Takes Notice of Coding Errors
Back in April, the Office of the Inspector General (OIG) published a report detailing its findings from a review of two groups of high-risk diagnosis codes, acute stroke and major depressive disorder. The objective was to determine whether selected diagnosis codes submitted to the Centers for Medicare and Medicaid Services for use in CMS’s risk adjustment program complied with Federal requirements.
Coder Q&A with Pat Macc: Coding for Newborn
There seems to be differences of opinions on the issue of a 40w0day gestation Can you clarify if P08.21 should be assigned for 40w0day infant or if it would not be assigned unless the infant’s gestation age was 40w1day or greater?
Query Tip: When to Query for Sepsis
Coders may find situations where a patient is documented as meeting SIRS or sepsis criteria, or has some clinical indicators reflective of possible sepsis, but the physician never documents sepsis as a diagnosis. Should the coder always query for sepsis in these instances?