Stenosis of Larynx and Decannulation of Trach Procedure- Selecting PDX

Trach Dependent patient was found to have a grade 2 subglottic stenosis and large suprastomal granuloma which was preventing the desire to decannulate the trach.  Repair of the subglottic stenosis needed to be done first prior to performing the end goal of decannulation of the trach which was all completed during the same visit.  Granulomas are almost always complications of something else IE: tubes, stomas, sutures, etc.  Tracheal and subglottic stenosis are one of the serious complications of PCT and absence of stenosis is required for decannulation.  Typically these patients are expected to be hospitalized for over a week due to fixing the stenosis and allowing healing time for the decannulation to be completed.  Currently, the account has been coded to DRG 110 Ear, Nose, Mouth, and Throat Procedure (ages 0-17) with "Stenosis of the Larynx" as the PDX. My concern is that this DRG does not seem to represent the complexity of care given.  It is assigned a GMLOS 1.6 and r.w. 0.0908 (Tricare).  It seems that the stenosis of the larynx would be a complication or malfunction of the tracheostomy which would lead to DRG 163 (GMLOS 8.10, r.w. 4.3623). How do others address this documentation?  Do you submit queries to providers asking if the stenosis from granulation tissue was due to the tracheostomy?  Is that necessary?  Would large suprastomal granuloma be considered a complication on it's own?  Thank you for any guidance.

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