septic shock s/p SROM

I have a question.  We had a patient that had a SROM at 17 weeks.  She chose not to induce and wait for the "heartbeat to stop".  After 11 days she delivered the baby, but started to hemorrhage.  A D&C was done.  That same day her BP dropped and she developed respiratory failure.  She was intubated and placed on Levo and vasopressin.  The physician did document respiratory failure and septic shock.  She had to be taken back to the OR for a hysterectomy.  Later that day she was transferred to another facility for higher level of care.  The coder got a DRG of 767 which has a very low LOS and weight. 

  My question is are we missing something?  This was a very sick patient, but the DRG doesn't seem to reflect that.  I don't usually review OB charts, but since this patient ended up in our ICU I did review it.

Thanks,

Karen

Comments

  • If you review the MSDRG weights for OB charts,  you will see that all of the Relative Weights are 'low'.   I've never understood the rationale, but the DRG system awards low $$ to OB charts as compared to other populations.

    Paul

  • Hi Karen,

    MS-DRG's were designed for Medicare patients and do not accurately reflect OB/PEDS populations. There are very limited options for MS-DRG's in the OB realm and they all carry a low RW. Chances are this record will not be paid on an MS-DRG (do you know the payer/payment structure in this case?). I would focus less on the MS-DRG and look at the APR-DRG to ensure SOI/ROM are accurately reflected. 

    Let me know if you have additional questions,


    Katy

  • Karen,

    Do you have access to what the SOI and ROM are for this patient? As others stated MS-DRG's aren't really designed for for anyone other than the traditional Medicare population. On these types of patients it's best to look at the SOI and ROM.

    Thanks,

    Jeff

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