Unrelated DRG help

rfoster@kdhcd.org · January 2016

Good morning,

I wanted to find out if anyone else is seeing MORE unrelated procedure DRGs (981-989) post ICD 10 than prior? I ran a report and compared to last year this same time there are at least 10 more cases that coded out to unrelated compared to last year for a 2 month period. I questioned the coders, the coders are stumped too as to why the encoder is coding it that way. Is anyone else running into this trouble? I thought ICD 10 was supposed to reduce these rather than create more. And some of these procedures do relate to the PDx. So I am confused. See the example below:

Pt has cirrhosis of the liver with bleeding esophageal varices. The coder picked the procedure code 06L34CZ which is what is recommended as per guidelines found in Faye Brown. It ended up coding out to DRG 981. Coder can't explain why and has tried multiple times to get the encoder to pick a different DRG, but it always ends up in this DRG.

Any help would be greatly appreciated! Thank you!

Rebekah Foster PHN, BSN, CCDS
CDI Supervisor
Kaweah Delta Medical Center
400 W. Mineral King
Visalia, CA 93221
559-624-5085

kerryseekircher · January 2016

Hi-
I am seeing this as well.
Take a look at the cases and make sure that the correct approach and location are being applied as this can make the difference between medical vs. surgical drg.
Thanks,
Kerry

Kerry Seekircher, RN, BS, CCDS, CDIP
Clinical Documentation Program Manager
Northern Westchester Hospital
400 East Main Street
Mount Kisco, NY 10549
Email: kseekircher@nwhc.net
Phone: 914-666-1243
Fax: 914-666-1013

kerryseekircher · January 2016

On that note-removal of a right IJ HD catheter-external or perc approach?
I've spent way too much time on this case and need some help: )
Thanks,
Kerry

Kerry Seekircher, RN, BS, CCDS, CDIP
Clinical Documentation Program Manager
Northern Westchester Hospital
400 East Main Street
Mount Kisco, NY 10549
Email: kseekircher@nwhc.net
Phone: 914-666-1243
Fax: 914-666-1013

evanspx@sutterhealth.org · January 2016

I have coded the scenario stated and generated the Same DRG. (Unrelated).

The new Fiscal Year has been generating a few odd-ball DRGs, such as this, in my opinion.

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: 415.412.9421

evanspx@sutterhealth.org

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, January 26, 2016 8:44 AM
To: Evans, Paul
Subject: RE: [cdi_talk] Unrelated DRG help

Hi-

I am seeing this as well.

Take a look at the cases and make sure that the correct approach and location are being applied as this can make the difference between medical vs. surgical drg.

Thanks,

Kerry

Kerry Seekircher, RN, BS, CCDS, CDIP

Clinical Documentation Program Manager

Northern Westchester Hospital

400 East Main Street

Mount Kisco, NY 10549

Email: kseekircher@nwhc.net

Phone: 914-666-1243

Fax: 914-666-1013

-----Original Message-----

From: CDI Talk [mailto:cdi_talk@hcprotalk.com]

Sent: Monday, January 25, 2016 12:26 PM

To: Seekircher, Kerry

Subject: [cdi_talk] Unrelated DRG help

Good morning,

I wanted to find out if anyone else is seeing MORE unrelated procedure DRGs (981-989) post ICD 10 than prior? I ran a report and compared to last year this same time there are at least 10 more cases that coded out to unrelated compared to last year for a 2 month period. I questioned the coders, the coders are stumped too as to why the encoder is coding it that way. Is anyone else running into this trouble? I thought ICD 10 was supposed to reduce these rather than create more. And some of these procedures do relate to the PDx. So I am confused. See the example below:

Pt has cirrhosis of the liver with bleeding esophageal varices. The coder picked the procedure code 06L34CZ which is what is recommended as per guidelines found in Faye Brown. It ended up coding out to DRG 981. Coder can't explain why and has tried multiple times to get the encoder to pick a different DRG, but it always ends up in this DRG.

Any help would be greatly appreciated! Thank you!

Rebekah Foster PHN, BSN, CCDS

CDI Supervisor

Kaweah Delta Medical Center

400 W. Mineral King

Visalia, CA 93221

559-624-5085

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rfoster@kdhcd.org · January 2016

Glad to hear its not just our facility that is seeing that. We are even seeing Art lines ending up in the OR category. No matter what way we run that code it comes out as an OR procedure with certain Dx. Very odd. Wonder when that will change? Thanks for the feedback, even if its just to know you all are seeing it too.

Rebekah Foster, PHN, BSN, CCDS
CDI Supervisor

evanspx@sutterhealth.org · January 2016

"Everyone' (coders, CDI) are anecdotally noting that procedures, such as A-lines, are now impacting the DRG structure in ways not anticipated. As I am no longer a coding manager, I confess I have not fully investigated the root cause(s). However, I am coding A-lines (and banding of esophageal Varices) and now noting apparent issues with DRG assignment that seem to have occurred w/ cases for this Fiscal Year.

I do not know if these changes were anticipated by CMS and are part of the current DRG grouper logic?

I believe more information must be forthcoming on such issues?

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: 415.412.9421

evanspx@sutterhealth.org

rfoster@kdhcd.org · January 2016

Let's hope so. In the meantime, I guess we just continue coding A-lines, banding of varices, and assigning unrelated DRGs... but man, that just chaps my hide that we can't find a better assignment with some of these scenarios! Thanks!

Rebekah Foster, PHN, BSN, CCDS
CDI Supervisor

kerryseekircher · January 2016

Thanks Jeff-that is what I am recommending. I hope we are right!

Kerry Seekircher, RN, BS, CCDS, CDIP
Clinical Documentation Program Manager
Northern Westchester Hospital
400 East Main Street
Mount Kisco, NY 10549
Email: kseekircher@nwhc.net
Phone: 914-666-1243
Fax: 914-666-1013

evanspx@sutterhealth.org · January 2016

External is approach.

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: 415.412.9421

evanspx@sutterhealth.org

Unknown · January 2016

Having removed some IJ lines, it's not an open or percutaneous procedure. Even if it were tunneled, it's removal of sutures and PUL-L-L-L-L!! (gently!)

Robert S. Gold, MD
CEO, DCBA, Inc
4611 Brierwood Place
Atlanta, GA 30360
(770) 216-9691 (Office)
(404) 580-0204 (Cell)

evanspx@sutterhealth.org · January 2016

Very, Very, Concerning to me, as well. I anticipate perhaps an "oooppps" moment from CMS and perhaps some revised billing with takebacks? I'd really like to speak to this issue as someone more informed, but I have not had time to dive so deeply into this particular issue.

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: 415.412.9421

evanspx@sutterhealth.org

kerryseekircher · January 2016

Thanks Paul!

Kerry Seekircher, RN, BS, CCDS, CDIP
Clinical Documentation Program Manager
Northern Westchester Hospital
400 East Main Street
Mount Kisco, NY 10549
Email: kseekircher@nwhc.net
Phone: 914-666-1243
Fax: 914-666-1013

kerryseekircher · January 2016

Thanks Dr. Gold : )

Kerry Seekircher, RN, BS, CCDS, CDIP
Clinical Documentation Program Manager
Northern Westchester Hospital
400 East Main Street
Mount Kisco, NY 10549
Email: kseekircher@nwhc.net
Phone: 914-666-1243
Fax: 914-666-1013

katysuegood@gmail.com · January 2016

I've got one!!!

I have a patient that came in with massive ascites (leaking out of an umbilical hernia) 2/2 ESLD 2/2 ETOH + Hepatitis C. She had a paracentesis.

The coder has B19.20 (viral hepatitis C) as Pdx and she has the procedure coded as OW9G3ZZ (drainage of peritoneal cavity, perc approach) as Ppx.

We landed in DRG982 (extensive OT procedure unrelated to principle)

Is that right?

Also, I ran a report for these DRG's. We have seen a 4-fold increase since I-10!!!

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

Unknown · January 2016

The hepatitis was not the focus of the admission nor the procedure. The ascites should be first unless there is direction to precede. Looks like K70.11 for alcoholic cirrhosis with ascites should be principal followed by the specific viral hepatitis. That would take the DRG to where it deserves to be.

Robert S. Gold, MD
CEO, DCBA, Inc
4611 Brierwood Place
Atlanta, GA 30360
(770) 216-9691 (Office)
(404) 580-0204 (Cell)

katysuegood@gmail.com · January 2016

Yes. This was my first thought. But even if I put the alcoholic cirrhosis of liver with ascites (k7031) as Pdx, I still end up in 982?

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

Unknown · January 2016

With K70.11 and 0W9G3ZZ, I get DRG 434.

Robert S. Gold, MD
CEO, DCBA, Inc
4611 Brierwood Place
Atlanta, GA 30360
(770) 216-9691 (Office)
(404) 580-0204 (Cell)

mluciano · January 2016

I get DRG 434 as well with PDX of K70.11 or K70.31 & 0W9G3ZZ
The encoder we use is by Clintegrity (Quantim).

Mayra Luciano, BS, BSN, RN
Clinical Dcoumentation Improvement Specialist
Brookhaven Memorial Hospital Medical Center
101 Hospital Road
Patchogue, NY 11772
631 438 5268
mluciano@bmhmc.org

lspryszak · January 2016

There are several DRG shifts due to what I also think are "glitches" in the ICD-10 DRG groupings.

As Paul noted, arterial catheter insertions (percutaneous approach) is one. Another one is PDx (any hepatobiliary PDx) with TIPS procedure. Apparently a TIPS procedure is only indexed to MDC 5 (Circulatory) so you end up with an unrelated surgical DRG.

I work as a remote CDS and my facility has chosen NOT to code arterial catheters unless inserted in the OR (which is then almost always a teriary procedure, not affecting the DRG). They only code the 'monitoring' PCS code.

ssalinas · January 2016

Question from a coder to the clinical experts: Does 'ascites 2/2 ESLD 2/2 ETOH + hepatitis C" = cirrhosis? Would a query be necessary to get to cirrhosis? I understand that it most likely is but can we make that jump without asking the provider?

katysuegood@gmail.com · January 2016

Ahhhh!!! I figured out the issue! There is an additional procedure code driving the DRG

We have two procedure codes coded.

Ppx: 0W9G3ZZ (paracentesis)
Spx: 0WHG33Z(placement of peritoneal catheter). I am not sure this one is right? We placed a tunneled peritoneal catheter under u/s guidance. She has the 6th character device code as an infusion device??

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 2016

Ok. I think this is the issue.

As I said, the coder had two procedures coded:
Ppx: 0W9G3ZZ (paracentesis)
Spx: 0WHG33Z(placement of peritoneal catheter).- driving us into the 'unrelated' DRG

I think the second one is incorrect. I think 0WHG33Z would be used for a peritoneal dialysis catheter as this is an infusion device. I 'think' that for a tunneled peritoneal cathester for long-term drainage of ascites would be 0W9G30Z (drainage of peritoneal cavity with drainage device, perc)

Does that sounds right?

This puts us in DRG 442

Thanks so much for all the discussion!

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

Unrelated DRG help

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