MCC/CC capture for Surgical cases

ddouthitddouthit
in CDI Talk Archive
We have just finished reviewing our last PEPPER report and I have been tasked with researching our low outlier for Surgical DRGS with CC or MCC.
Based on our physician documentation, it appears we are capturing everything physician is documenting, so now onto improving physician documentation.
I would like suggestions on CC/MCCs that CDI can concentrate on to perhaps catch diagnoses we are missing. We do an extremely high volume of joint replacements and spinal procedures.

Thanks,
Dorie

Comments

  • don.cdi.rn@gmail.comdon.cdi.rn@gmail.com
    edited May 2016
    Did you take a look & drill down to the base DRG's and examine your distribution of with / without secondaries? With a high volume of joints as an example (MCC split, as I recall about 90% w/o MCC), it would be worth looking at those individual base DRGs to really make sure that you have outliers.

    The Final rule does provide volumes of DRGs nationally from which you can see the national volume for each DRG -- it is table 7A or B (the FY2010 data processed through the FY2011 grouper). From there it is easy to calculate a percentage for each DRG in the base set (PNA being the base, then the triplet that belongs there as an example).

    Don



    Donald A. Butler, RN, BSN
    Manager, Clinical Documentation
    Vidant Medical Center, Greenville NC
    DButler@vidanthealth.com ( mailto:mDButler@vidanthealth.com )


  • mdomineseymdominesey
    edited May 2016
    The way I have explaining this to some (not all) is that we should avoid MCCs on DRG 470 - Major Joint replacement -

    Why?

    An MCC in this DRG can mean one of two things - either the patient came in with a major acute issue that the physician somehow missed (most of these replacements being elective - not urgent), or, the hospital or the surgeon made one of their chronic conditions acute, or gave them a complication that caused the MCC!

    The opportunity in this DRG is for severity and risk. Going after the MCC is really not that beneficial. Educating surgeons on what documentation is necessary before they can do a major joint is more important and affects a greater risk of $$. Pre-payment reviews are happening everywhere, MACs are withholding money for procedures already completed, because the hospital record did not include documentation of the necessity of the procedure.

    Kindest Regards,

    Mark



    Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP
    Clinical Documentation Excellence
    Sr. Clinical Documentation Improvement Specialist
    Sibley Memorial Hospital

    Information Technology
    5255 Loughboro Rd NW
    Washington DC, 20016-2695

    W: 202.660.6782
    F: 202.537.4477
    mdominesey@sibley.org

    http://www.sibley.org


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