DRG 885 Psychoses

cmorellcmorell
in CDI Talk Archive
I have heard that DRG 885 Psychoses should not be billed from an acute inpatient hospital that does not have an inpatient psychiatric unit.
The implication that is would be an improper payment for the setting.

I have googled, searched MLN Matters, CMS.gov, Connolly website, and the Federal Register. I cannot find any documentation or studies to support that. I do note on the Connolly website it is among the DRGs for validation including setting but again, cannot find anything regarding denials for the wrong setting etc.

Is the assertion above correct?
Thanks!

Charlie Morell

Comments

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    False - if a pt is admitted with this diagnosis to an acute (general) medical floor, the PDX drives the MS-DRG.

    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.637.9002
    Fax:  415.600.1325
    Ofc:  415.600.3739
    evanspx@sutterhealth.org




  • jolene.filejolene.file
    edited May 2016
    Hi Charlie!
    I agree with Paul, that the DRG is driven by the principal diagnosis. However, I do recall also hearing that the principal dx. for an acute care hospital should not be a psy diagnosis unless the facility has a designated psy or senior diagnositic unit. It does make sense to me. When a pt. has an overdose or abuse issue, that would probably be the principal dx. not the psy diagnosis.

    I don't know of any references to support the statement. Maybe it is a billing rule. Sorry can't be more help.

    Jolene File,RHIT,CCS,CPC-H,CCDS
    Documentation Improvement Specialist-Coder
    Hays Medical Center
    jolene.file@haysmed.com

    IMPORTANT: This communication contains information from Hays Medical Center which may be confidential and privileged. If it appears that the communication was addressed or sent to you in error, you may not use or copy this communication or any information contained therein, and you may not disclose this communication or the information contained therein to anyone else. In such circumstances, please notify me immediately by reply email or by telephone. Thank you.

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    I would ask to see the official (billing) or (Medicare) reference specifically prohibiting a small, general hospital lacking a designated psychiatric unit from admitting and treating, and subsequently coding and billing, for a patient presenting with an acute psychotic condition. There must be many such small, community-based hospitals lacking such dedicated units that admit and treat such patients - ergo, I think this 'must' be (hopefully) a myth?

    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.637.9002
    Fax:  415.600.1325
    Ofc:  415.600.3739
    evanspx@sutterhealth.org




  • cmorellcmorell
    Good point, Paul! I am a pretty good googler and I couldn't find anything. I do see DRG 885 listed on the RAC DRG Review Lists but cannot see specific case study information or find even an anecdotal tale of a denial due to setting.
    I have found others who "heard it too" but perhaps it is an urban myth like tea has more caffeine that coffee. Perhaps, I need to check snopes.com
    Thanks everyone, at least I know you will all keeps ears and eyes out for such a thing...

    Have a great weekend!
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