APR-DRG's

katysuegood@gmail.com · January 2014

Arizona is moving to an APR-DRG system in October (yup. Just in time for I-10). I am not very familiar with this grouping system beyond using the SOI/ROM metrics and am wondering if anyone can provide some insight. We recently moved to an all-payer review system so we are already reviewing these records though as of yet they are not being paid on a DRG.
Is there anything I should know about APR-DRG's in regards to the grouper or related reimbursement?

Thanks!

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

evanspx@sutterhealth.org · January 2014

Katy: Write me privately and I can e-mail you some materials....I am PTO for about a week, may be some delay...you can call my cell next Monday, if you wish.

APR is MUCH more complicated, but more clinically 'accurate', than 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

katysuegood@gmail.com · January 2014

Will do, thanks paul!

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

lindenbm@bellsouth.net · January 2014

Paul,

I would be interested in these materials also.

Thank you,

Mary Lindenboom
Clinical Documentation Manager
Flagler Hospital
Saint Augustine, FL
904-819-4254
Mary.lindenboom@flaglerhospital.org

ssalinas · January 2014

I am sure the info Paul provides will be excellent as the Medicaid program (MediCal) in California went to APR-DRGs last July but a very quick tutorial follows:

1. Do not think in terms of MS-DRG MCC/CCs

2. Code everything

3. Make sure the diagnoses that affect the APR-DRG are on the bill. Reordering diagnoses may/will be necessary.

Sharon Salinas, CCS
Barlow Respiratory Hospital
2000 Stadium Way, Los Angeles CA 90026
Tel: 213-250-4200 ext 3336
ssalinas@barlow2000.org

evanspx@sutterhealth.org · January 2014

I sent out some basic APR-DRG methodology - the most recent version I have, which is V30.0. A bit dated, but explains some APR-DRG principles.

Sharon's observations are spot - my only other advice is try to attend an APR-DRG seminar and also use the APR-DRG grouper to the fullest extent possible.

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

evanspx@sutterhealth.org · January 2014

Meant to say "Sharon's observations are spot ON"

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

katysuegood@gmail.com · January 2014

Thanks Sharon.

Can you remind me how many codes are reported on the final bill?

Thanks!

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

ssalinas · January 2014

Hopefully your software permits submission of up to 18 codes since I believe that is what CMS will accept these days. However it also depends on how many the payer's software accepts so you would want to verify that number.

Anyone have better info?

Sharon Salinas, CCS
Barlow Respiratory Hospital
2000 Stadium Way, Los Angeles CA 90026
Tel: 213-250-4200 ext 3336
ssalinas@barlow2000.org

katysuegood@gmail.com · January 2014

Does the 18 codes include procedures as well?

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

ddouthit · January 2014

Per MLN Matters(r) Number: MM6851, CMS allows for the submission of 25 ICD9 diagnosis codes and up to 25 procedure codes.

Dorie Douthit RHIT,CCS
AHIMA-Approved ICD-10-CM/PCS Trainer
ddouthit@stmarysathens.org

ssalinas · January 2014

You are correct!

Thanks,

Sharon Salinas, CCS
Barlow Respiratory Hospital
2000 Stadium Way, Los Angeles CA 90026
Tel: 213-250-4200 ext 3336
ssalinas@barlow2000.org

katysuegood@gmail.com · January 2014

Thanks everyone!

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

katysuegood@gmail.com · January 2014

Absolutely Karen!
Our team does review neonates/PEDS but have not focused on the coding/DRG grouper side of this since we currently are not being paid on a DRG.

I would love to hear your input as far as what they should be aware of.

Thanks!

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

katysuegood@gmail.com · January 2014

Thank you so much, I REALLY appreciate it

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

gspatafore · May 2017

Hi Karen,

I am also interested in this information. Our LOS is much higher than the GMLOS for neonates. We are thinking we may be missing opportunities but are new to reviewing this population. Any information would be helpful.

Thanks,

Gina

APR-DRG's

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