Wiki MS-DRG Question

[ebholte]

I am a CPC-A that does ICD coding. My employer asked me today about a release for a MS-DRG and whether or not we needed this. We are a hospice company so when I asked our billing dept if they knew anything about this, no one seems to know. Can anyone first explain what this is? And second explain what determines whether your company needs this or if it's just helpful?
I would greatly appreciate anyone's knowledge on this.

 

[kristincoder]

DRG's

MS-DRG's are diagnosis related groups that hospitals use to code their inpatient stays.

For example: A patient is admitted with congestive heart failure.

The hospital coder will go through the patient's entire record for that particular stay and assign a DRG for congestive heart failure. The DRG will cover the expenses for taking care of the patient based on similar congestive heart failure cases. The price for the DRG is calculated based on what it usually costs to treat a patient with congestive heart failure.

If you are working in a hospice facility you should not have to use DRG's. You can certainly research the definition of a DRG to further explain but I hope this helps a little.

 

[ebholte]

That makes sense from what I remember from school regarding this.

THANK YOU SO MUCH!

 

[Daniel Rowden]

MS-DRGs are specifically developed by Medicare however other entities use these as well and there are other DRG systems as well such as APR-DRG. In hospice care however Medicare does not use MS-DRGs as those are intended for Inpatient Acute care.

This is a link to Medicare's manual on Hospice claims:

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c11.pdf