Is the grouper alway right???

judithbates

I had asked a question of our coders after reviewing the final coding for a patient that is ESRD on HD and failed kidney TXP. The patient was admitted for laparoscopic R (native) nephrectomy. My question was why his ESRD was not a MCC. I was told that there is no control over the grouper...
I can understand if there is some coding rule in this...Just wanted to make see if others encounter the almighty grouper question...

Judi Bates RN BSN CCDS

paxneros

There are some instances in Renal Disorders and Diabetes where ESRD is not an MCC.

Thanks,

NBrunson, RHIA,CDIP,CCS,CCDS

rmhosler1

For these reasons, I have started also utilizing the grouper. I find
that there are differences between the coding software we use as a CDS
and the grouper. Since the grouper appears to be the "standard" why not
utilize both. I have found it to be a very useful tool. I have found
that to get to the outcome I want as a CDS I need to ask the physician
the questions the grouper needs answered regarding a particular
diagnosis.

I find the reference material in the grouper to be a great resource
also.

I just feel that it is hard to talk "apples to apples" if I am talking
"apples to oranges" by not having all the information needed to obtain
the DRG/comorbidities.



Mary A. Hosler, MSN RN
Alumnus CCRN
McLaren Bay Region
1900 Columbus Ave.
Bay City, Michigan 48708
(989) 891-8072
mary.hosler@mclaren.org

lprescott

In this case I would assume (and I am not a coder) the patient is being admitted for a laparscopic nephrectomy. the principal diagnosis would be renal failure? Your comments don't elaborate as for the reason for the nephrectomy? Renal failure can not be an MCC for renal failure?

As for the question, is the grouper always right? the grouper is only as good as the person using it. I admit the grouper leads me through unknown issues but a coder uses the grouper thoughtfully understanding how the coding guidelines influence choices. I can use the grouper with my limited coding knowledge and our inpatient coder can use the grouper and we might just get different final DRGs. When we discuss it, it almost always comes down to a coding guideline and the coder is right almost always.

Laurie L. Prescott RN, MSN, CCDS, CDIP
lprescott@morehead.org

don.cdi.rn@gmail.com

No, the grouper is not always right. Most often, we stray off the path by not appropriately utilizing the grouper or answering it's questions. In this case, I suspect the grouper is correct ...

The order of reference / guidance for coding is:
1 -- the ICD-9 manual
2 -- annual coding guidelines
3 -- coding clinics

NO grouper is official guidance, though every grouper attempts to incorporate all of the guidance in the above 3 sources.

When you have a question, refer back to the above. Should be able to look up in the ICD-9 manual to find out which specific codes are excluded as MCC/CC with certain PDX's -- which is where I suspect the root of your problem or question is.

I absolutely agree, many of the CDI software packages also require occasional forays into the grouper & 3 references above to know we are getting it correct.

Don
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evanspx@sutterhealth.org

YES: The grouper is always correct, but only if the coding rules are applied properly. (Grouper logic and application of coding rules independent functions and issues).


Logic of grouper for MS-DRG is set by CMS and can't be altered. However, one can derive 'wrong' DRG by not using valid PDX, secondary codes, not following guidelines, so forth.

But, as far as validity of grouper, the logic may not be altered.

Paul

don.cdi.rn@gmail.com

Thanks Paul, you described it better than I did (and as I reviewed my response it seems I was slightly in error of my understanding). I was trying to express essentially the same concept -- the user can get to the wrong place by not applying guidelines, not choosing an appropriate and valid PDX, etc.

Don
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