Selection of PDX
Our coders will select the Principal diagnosis based on how "invasive" the testing is. For example: A patient comes in with vertigo and hematemesis. For the vertigo- brain CT, IV meds, and ENT consult were ordered. Pt. diagnosed with a peri-lymphatic fistula. For the hematemesis - GI consult, IV meds, serial H/H, and an EGD (mild gastritis found) were ordered. MD stated there was no source found for the bleeding. The coder selected the hematemesis based on the fact that an EGD was done. ("More invasive") The CDS selected the per-lymphatic fistula because it was a higher DRG and felt both conditions were what occasioned the admission to the hospital. In this kind of case the procedure does not drive the DRG.
I am wondering if your coders use this thought process to select the Principal Diagnosis?