DRG 793 (Full term neonate with major problems and DRG 794 (Neonate with other significant problems) are reported together.

DRG 793 (Full term neonate with major problems and DRG 794 (Neonate with other significant problems) are reported together.
DRG 193 (Simple pneumonia and pleurisy with MCC). DRG 193 seems to always be in the top 5 and a focus for denials.
DRG 189 (Pulmonary edema and respiratory failure). This should be no surprise to coders that DRG 189 is in the top DRG’s with recommendation.
DRG 291 (Heart failure with shock with MCC). This should be no surprise to coders that DRG 291 is in the top DRG’s with recommendation. It seems to always be in the top 5 and a focus for denials.
DRG 177 (Respiratory infections and inflammations with MCC) and 178 (Respiratory infections and inflammations with CC). This should be no surprise to coders that DRG 177 is in the top DRG’s with recommendation.
Sepsis is and will most likely always be a troubled area for coders. There are multiple reasons for this and we will look at a few of these. There are many different criteria being used to validate the diagnosis of sepsis.
During a recent review of spinal fusion cases at a client, we found coding issues on the cases in which both an anterior interbody fusion, anterior open approach was done on one day and two days later, the patient was brought back for a posterior fusion, posterior open approach. Below are some of the recommendations we made along with education explanations.
This is Part 5 of a five part series on the new 2022 CPT codes. For the remaining areas we will just briefly summarize the section. Due to the intricate nature of these sections in CPT, it is recommended that the coder read the entire section notes associated with the new codes.