Second Level DRG Reviews

JMontg01

I am looking for advise on second level DRG reviews process.  Is anyone sending concurrently reviewed charts for a CDS second level review to maximize the DRG, SOI, and ROM?  If so, what is your process and how do you determine what is sent for review?

teresa.siler@advocatehealth.com

We send all cases w/o cc/mcc.  We also send cases that just don't seem right to make sure something was not missed.  
Our process is to send an email to the group requesting the review and then keep track on a spread sheet whether or not additional opportunities were found.  Whoever picked it up would reply to the group so we didn't duplicate.  Sometimes we did duplicate.
We found the process to be helpful in teaching new CDS and affirming for the seasoned ones when nothing else was found.
Of note, when a new manager came in she felt that the process was a crutch for low performers, however, that was not our experience.

dvitalone1

I am the Lead CDI and I have the staff send me cases with no MCC/CC, symptoms as PDX, unrelated DRGs, and TIA as PDX to me for a second level review after 2 reviews. As a system we have a process where certain DRGs are put into a work-que prebill (from a coder) and a CDA reviews for possible changes. The DRGs that fall into the work- que are ones that we have high denials of ie sepsis and ones with symptoms as PDX to name a couple. Also all mortality cases are reviewed prior to billing

kristine.meyer@dignityhealth.org

We have recently started having staff send requests to group when they have an account with no cc/MCC.  So far, we have not found any cases that had missed opportunities but as I said we just started this process.  We are going to compare this to DRG and QA audit results.