Effective Coding Under MS-DRGs - American Health Information ...

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Effective Coding Under MS-DRGs Notes/Comments/Questions MS-DRG Statistics • CMI Statistics • Total CMI • Total CMI w/o Pre-MDC • Medicine CMI w/o OB-Peds • Medicine CMI w/o OB-Peds, IP Psychiatry, Ventilators, and Rehabilitation • Surgery CMI w/o OB-Peds • Surgery CMI w/o OB-Peds, and Pre-MDC • OB-Neonatal CMI • Medicine RW analysis – compared to all Medicine DRG (OB-Peds- Vents Excluded) • Medicine DRG w/RW >0.9 • Medicine DRG w/RW >0.6 but
Effective Coding Under MS-DRGs Notes/Comments/Questions Other MS-DRG Metrics • Complex to Simple Pneumonia • Pneumonia to COPD • Acute Respiratory Failure to COPD/CHF • COPD to Asthma • Sepsis to UTI/Pneumonia • Stroke to TIA • Sepsis to Other Respiratory Diagnosis with ventilator over 96 hours • Pathological Fracture to Medical Back • MI with CC or MCC to MI without CC • Cardiac Cath with MCC to Cardiac Cath w/o • DVT with CC to DVT w/o CC • GI bleed with CC to GI bleed without CC Example: Complex to Simple Pneumonia Ratio Volume of 177, 178, 179 Volume of 177, 178, 179, 193, 194, 195 National Medicare volumes available at: http://www.cms.hhs.gov/AcuteInpatientPPS/downloads/FY2008Table7A.zip in the final rule or can be calculated from the MedPAR 23 Example: CC Capture Rate in UGI Hemorrhage MS-DRG Medicare Statistics UGI Hemorrhage 377 378 379 UGI Hem w/MCC UGI Hem w/CC UGI Hem w/o CC 19.2% 44.8% 36.0% 285.1 – Acute Blood Loss Anemia is a CC Most patients admitted with an Upper GI bleed have acute blood loss anemia An obvious query opportunity Others include DVT (hypercoagulable disorder) and neurodegenerative disorders (dementia with behavioral manifestations) 24 AHIMA 2008 Audio Seminar Series 12 CPT ® Codes Copyright 2007 by AMA. All Rights Reserved
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Page 3 and 4: Faculty Sharalyn Milliken, RN, JD,
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Page 7 and 8: Effective Coding Under MS-DRGs Note
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Page 43 and 44: Appendix DRG Documentation Tips ...
Page 45 and 46: Definition of Terms: Acute Respirat

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