DRG issue with 3M

gail.spratlin@eamc.orggail.spratlin@eamc.org
in Clinical & Coding
There seems to be an issue with coding an OB record when the patient has a third degree perineal laceration and has a repair of that laceration (ODQR0ZZ). This is pushing the DRG to 988: Non-extensive OR Procedure unrelated to the Principle Diagnosis with CC. This doesn't seem to accurately reflect this case. Any guidance?

Comments

  • gail.spratlin@eamc.orggail.spratlin@eamc.org
    There seems to be an issue with coding an OB record when the patient has a third degree perineal laceration and has a repair of that laceration (ODQR0ZZ). This is pushing the DRG to 988: Non-extensive OR Procedure unrelated to the Principle Diagnosis with CC. This doesn't seem to accurately reflect this case. Any guidance?
    I didn't sent my contact info on the previous message.

    Gail Spratlin RN CCDS
    East Alabama Medical Center
    Opelika, Alabama 36801
    Gail.spratlin@eamc.org
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    This has been recognized as an issue with this year's version of the Grouper. ACDIS Advisory Board has communicated this concern to CMS and 3M.

    Paul

    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.412.9421



    evanspx@sutterhealth.org




  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    I'd have to say I do not feel that a repair of a 3rd or 4th degree tear should fall into an "Unrelated DRG" - I continue to believe this is an oversight by 3M/CMS that should be recognized and corrected. The fairly common condition occurs with frequency and requires surgical repair, but it is related to pregnancy and delivery.

    It will be interesting to see how this progresses.

    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.412.9421



    evanspx@sutterhealth.org





  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Jeff: I understand, not taking issue with your statement.

    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.412.9421



    evanspx@sutterhealth.org





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