No Procedure DRG for pacemaker insertion with PDX of PNA

jwright@chmed.orgjwright@chmed.org
in Clinical & Coding
Hi,

I have a patient that was admitted with Pneumonia but ended up with a pacemaker insertion for tachy-brady syndrome.  The coders tell me the DRG is not going to a 'unrelated OR procedure DRG" but instead is going to the Pneumonia as the PDX (DRG 194) with no Procedure DRG. Can anyone elaborate why? Do you believe this is correct? Wondering if there is a coding rule that we are missing??? 

Amber

Comments

  • katysuegood@gmail.comkatysuegood@gmail.com

    I do not know the methodology behind the DRG mapping, but in 3M this is what I get as well.


    Katy

  • jwright@chmed.orgjwright@chmed.org
    Bummer!!
  • rmendozarmendoza
    Can you not use the tachy-brady syndrome as PDX? It is present on admission and more resources has been utilized.
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org

    DRG 194 is a valid DRG and no reason to 'avoid' if the correct PDX is used and the procedures are properly applied. 


  • evanspx@sutterhealth.orgevanspx@sutterhealth.org

    What are the precise codes used for the PDX as well as the procedures?  I will map and tell you what I generate.


    Paul

  • jwright@chmed.orgjwright@chmed.org
    Actually the pt had influ A with PNA. Here are the codes. The Sick Sinus syndrome was not an issue until day 5.

    02HK3JZ Pacer Insertion
    J10.00 Influenza with unspecified PNA
    N17.9  AKI
    E87.1  Hyponatremia
    I49.5  Sick Sinus Syndrome
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    The PCS codes are not complete? You need something like:  0JH606Z as two codes are required for PM Insertion - one for the lead(s) and one for the pacemaker device. The code I added is for Ins PM Dual Chamber SubQ.    The PCS code you used will not generate any Surgical MSDRG, regardless of diagnosis codes applied; the issue is not the PDX, but procedure codes.
  • jwright@chmed.orgjwright@chmed.org
    Paul,
    My Bad! I left off the 0jh604z. This was a "Permanent Right Ventricular Pacemaker Implant" (single chanber). Using this I am still not able to pick a "other unrelated" procedure.
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org

    In your scenario, I do generate DRG  952, which is a valid DRG. If, as you say, the SSS does not quality as the PDX, this seems to be the correct DRG, and your only option.   SSS as PDX generates  242, but may not be defensible.

    Paul Evans, RHIA, CCDS

    you can call me, if you wish

    415.412.9421

  • jwright@chmed.orgjwright@chmed.org
    Paul,  I called you and left a voice mail.  Did you mean DRG 982? I cant find a DRG 952.  What encoder do you use? Amber
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org

    Amber:  Sorry, but I was using APR-DRGs !  My mistake. (sorry for the confusion, just realized my error)

      If I use the Flu as the PDX, then I do not generate an MS-DRG for insertion of PM and leads.  I generate MS-DRG 194 using Quantim Encoder. If I use the SSS, then I generate MS-DRG  242.  This does seem odd, but the MS-DRG system does not generate a surgical MS-DRG in your scenario.


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