Multiple Trauma DRG

jolene.filejolene.file
in CDI Talk Archive
I do not have access to a DRG analyzer and wondered if someone could help me understand why a case with rib fxs, lumbar & thoracic fxs, scapula fx, traumatic pneumothorax, and a lung contusion would not group to a multiple trauma DRG (963-965). No major procedures performed. Just wondering if I am missing something. Thanks for any help you can provide.

Comments

  • jolene.filejolene.file
    edited April 2016
    I am sorry, I didn't get my name on the request below. If any of you can help me understand the DRG grouping for multiple trauma, I would appreciate your assistance. Thanks!

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

  • annnd2009@gmail.comannnd2009@gmail.com
    edited April 2016
    Hi,

    I can not help much- I'm not the expert on trauma but...

    here is where the grouper takes you (DRG options) with the info provided...I don't know if the number of ribs or the exact level of the vertebral fractures would change it ?



    Ann
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    Sure, Do you have access to a DRG expert book or one of the other DRG books?

    The multiple trauma DRG is tricky. In order to land in this DRG you have to have trauma Pdx and then 2 additional diagnoses that each fall into separate 'significant body site' categories. If you look in the DRG Expert you will see that the list of potential trauma diagnoses is very extensive BUT when you get to the 'significant body sites', they significantly trim down the diagnoses that will qualify. For example most closed fractures will not count as a acceptable diagnoses to meet criteria as one of your significant body site diagnoses. They only list fairly severe injuries in these categories.
    The other issue is that you have to have 2 dx from SEPARATE body site areas. In the case you have listed here, the rib, pneumo and contusion will all be in the chest category (the pneumo would count as a severe enough injury, I do not believe the rib fx or contusion would). The spinal and scapula fx are also not severe enough injuries to be listed as a significant enough injury I do not believe.

    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


  • jolene.filejolene.file
    edited April 2016
    Hi Katy!
    I don't have access to the DRG Expert but do understand what you are talking about that the trauma must be in 2 or more body systems. Guess I was thinking of the chest for pneumthorax & lung contusion and the musculoskeletal for the fractures of ribs, vertebra. Didn't want to miss something.

    Thanks to all of you for helping me to confirm that the case is grouped correctly.

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

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    You were on the right track. The vertebra fx would be in the 'pelvis and spine' body site category but I believe only spinal fx with spinal cord injury are deemed significant enough to count.
    This DRG trips up are team all the time.

    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


  • vanessa.falkoffvanessa.falkoff
    edited April 2016
    My reference is from a consultant and it indicates that there must be a traumatic injury to two different "body site categories." I would think that the lumbar fx would qualify under pelvis/spine and the other injuries under chest, but it may be that all of these injuries are falling into one "body site."
    The reference calls for 4 or more open rib fx or 7 or more closed rib fx to qualify.
    Hope this is helpful.

    Vanessa Falkoff RN
    Clinical Documentation Coordinator
    University Medical Center of Southern Nevada
    1800 W Charleston Blvd
    Las Vegas, NV
    vanessa.falkoff@umcsn.com
    office 702-383-7322

    Compassion * Accountability * Respect * Integrity


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