Highest MS-DRG Weight versus Highest SOI/ROM when 2 DX Equally Meet Definition for PDx

Taking an informal poll on which Principal Diagnosis (PDx) to sequence first in the following scenario.  There are two conditions that equally meet the definition of PDx.  One has a higher MS-DRG/CMI.  The other has a higher SOI/ROM.  Which would you sequence first and why? 

We have traditionally always used the highest MS-DRG PDx but with recent quality conversations, specifically the mortality index, we are curious as to what other organizations are following.

Thank you!


  • Sequence according to the clinical truth in the best application of coding guidelines.  Some times you will get the higher DRG, other times you will get the higher SOI/ROM.  

    Having said that, all else being equal, the selection could come to a facilities individual mission and goals and mandates. 
  • Precisely, Allen.
  • we always want to be true to the circumstances of the admission. your CDI mission should reflect the goals of your facility. remember every patient desires an accurate medical record regardless of the financial outcome direct or indirect. 

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