Q&A: Driving the Bus for DRG Assignment

dvitalone1dvitalone1
in CDI Talk Archive
Did anyone read this article in the ACDIS Blog? In Quantim I put 402.91 as PDx then 428.21 as secondary dx and DRG 293 Heart failure w/o cc/mcc comes up. Am I misunderstanding this article? Does anyone get something different in their encoder?

Thanks!

Comments

  • annnd2009@gmail.comannnd2009@gmail.com
    edited May 2016
    Don't have article but guessing...
    Was it including anything about kidney disease? If you have40491
    HTML heart and chronic kidney unspecified it will take your specified
    chf as mcc

  • ssalinasssalinas
    edited May 2016
    No the article had some errors in it. When the principal dx in 402.91, no heart failure dx will count as a CC or MCC - they are excluded. The DRG will be 293.

    However if the patient has CKD (any stage), HTN and the CHF is due to HTN, then you can code 404.91 and the dias or syst heart failure will move the DRG to 292 or 291 depending severity of the heart failure. 428.x0 or 428.x2 will move it to DRG 292. 428.x1 or 428.x3 will move it to DRG 291.

    Bottom line - it is important to query for the CHF and HTN connection whenever CKD is in the picture.

    Sharon Salinas, CCS
    Barlow Respiratory Hospital
    213-250-4200 Extension 3336


  • tkreilingtkreiling
    edited May 2016
    I am glad you asked this because I was wondering the same thing. I heard this same at the conference too but when I came back to put this in our encoder still came up with 293. Wasn't sure if I was misunderstanding it also.
    Thanks.



Sign In or Register to comment.