MST coding

vivian.gannon

I am interested in feedback regarding a case that was coded to MST 956. The patient was admitted with closed fracture of femur (820.0) and had partial hip replacement (81.52). On hospital day 5 the patient pulled out his foley, causing hematuria. Urology was consulted due to difficulty reinserting foley and MD documents ' urethral cath trauma, difficult cath d/t urethral trauma' for the following 4 consecutive days. Pt has 26 secondary Dx's, none relating to any other trauma.
The direction in the DRG Expert instructs us to select Pdx from the Trauma Diagnosis List in DRG 963, AND at least 2 different diagnoses from 2 different Significant Body Site categories, AND the OR procedure.
Can the fracture be the Pdx and also selected for one of the 2 sites? Is the urethral trauma coded to 867.0 and as such becomes the second Body Site category?

Any help will be much appreciated.



Vivian E. Gannon RN CCM CCDS
Clinical Documentation Specialist
Chesapeake Regional Medical Center
Chesapeake Virgina 23320
vivian.gannon@chesapeakeregional.com

NormaB

You will need to have the hip fx as your PDx and can add 867.0 for the injury to the urethra or "foley trauma".

I will let the rest of the group answer you question further regarding the DRG sites. (I'm a tad encoder dependent. )

NTB

mary.a.dunn

I would think that since the urethral "trauma" was not present on admission and so not the reason for the admission you can not try to "bundle" it with the femur fracture to get a trauma DRG. The urethral trauma can be a complication though.
Good question

NormaB

That is correct the injury would be a POA of "No".

laura.jansen

YES, that would code to the MST MDC based on the following guidelines.


There are 2 clinical scenarios which allow for the assignment of a DRG from MDC 24 Multiple Significant Trauma:

1. a PDx from the Trauma Diagnosis List (TDL)
and
Two secondary diagnoses derived from
two different Trauma Body Site Categories.
-OR-
2. a PDx from one Trauma Body Site (Categories 1- 8)
and
an additional secondary diagnosis from a different Trauma Body Site Category.


The femur fx would be the pdx & the urethral trauma would be a secondary diagnosis which will code to MST. Both injuries do not have to be POA

lspryszak

I agree with this - the two injuries do NOT have to both be POA and POA has nothing to do with the MST designation. If someone came in with a traumatic head injury (for example) and then during the stay fell out of bed and fractured their femur, the fractured femur would be the 2nd body site category --> MST.

lspryszak

Also: if the second body site injury is "driving" the MST DRG, then that secondary diagnosis cannot also be a CC or MCC - you'll need something else.

Example

PDx: traumatic subarachnoid hemorrhage
Secondary dx injury to urethra/bladder (traumatic foley removal)
DRG 965 MST w/out CC/MCC

Normally the urethra/bladder injury would be a CC but since it's determining the DRG it can't "double dip" and be the CC, too.