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DRG Question...

  1. Default DRG Question...
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    Anybody have some experiance with DRG's? I have a patient that had a shoulder scope with rotator cuff repair, extensive debridement, claviculectomy and suprascapular neuroplasty. Patient had diabetes with a pump, major cardio history and became unresponsive during their stay due to overmedication. My software gives me 497, I'm looking at 512 or 502. Any ideas?

    Now if I can just figure out how to put the DRG on the bill!
    Bruce Crandall, CPC
    North Carolina Specialty Hospital
    Durham, NC
    www.ncspecialty.com

  2. #2
    Location
    Columbia, MO
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    12,565
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    you do not put the DRG on the claim. The software will assign your claim to a DRG based on you dxs. If you are using 3M there is a DRG maximizer function that will guide you thru diagnosis placement to get the maximum DRG allowed. However you must also follow coding guidelines. Was the pt admitted due to the overmedication? if so you principle dx is poisoning followed by the unresponsiveness. If the patient was admitted for other reasons the the reason for the admit is first followed by the poisoning and the result. So the difference in DRG assignment may be how you are looking at the principle dx.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    Quote Originally Posted by mitchellde View Post
    you do not put the DRG on the claim. The software will assign your claim to a DRG based on you dxs. If you are using 3M there is a DRG maximizer function that will guide you thru diagnosis placement to get the maximum DRG allowed. However you must also follow coding guidelines. Was the pt admitted due to the overmedication? if so you principle dx is poisoning followed by the unresponsiveness. If the patient was admitted for other reasons the the reason for the admit is first followed by the poisoning and the result. So the difference in DRG assignment may be how you are looking at the principle dx.
    That's the problem I'm having. This is essentially an outpatient procedure and I can't find a (well documented) reason for the inpatient admission. 3M doesn't give me an option for the 502 or 512 DRG in the maximizer. Soooo I'll have to query the Dr for a better Dx or go with what 3M says I guess!

    Thanks Debra!
    Last edited by BCrandall; 04-23-2010 at 09:15 AM. Reason: added
    Bruce Crandall, CPC
    North Carolina Specialty Hospital
    Durham, NC
    www.ncspecialty.com

  4. #4
    Location
    Columbia, MO
    Posts
    12,565
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    Ah so what you need to know is did then admit after the unresponsive episode or for the procedure. So the documentation does not indicate that the pt was admitted for the purpose of the procedure or the purpose of the unresponsiveness? You might look at the time of the admission vs the time of the procedure.

    Debra A. Mitchell, MSPH, CPC-H

  5. Default
    Oddly enough I just got the inpatient scheduling order! The Dr wanted this as an inpatient. The episode happened after the surgery so I guess being inpatient was a good thing in this case.
    Bruce Crandall, CPC
    North Carolina Specialty Hospital
    Durham, NC
    www.ncspecialty.com

  6. #6
    Location
    Columbia, MO
    Posts
    12,565
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    Good for the patient anyway. So you will have to use the shoulder dx as your principle. Could be this was due to the diabetes status then? You mentioned the pt had a pump. All good reasons, good luck!

    Debra A. Mitchell, MSPH, CPC-H

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