MDC 05 sequencing (type 2 MI)
We are starting to see denials for type 2 MI as principal diagnosis. The tabular list does say to code the underlying condition, but even when we put that as the principle, the 3m encoder groups to the MI DRG (as it always has when there is an MI and another diagnosis from that MDC).
Does anyone else see this? Are you manually forcing the Type 2 to be a secondary and bypassing the sequencing logic, or do you have resources to appeal on the grounds of it having to go first per coding guidelines?
Comments
We use 3m and if you go down the path and code them together it never sequences NSTEMI first. If you code them separately, then you will have to make sure they are correct
Type 2 MI should rarely be PDX. The only time I have seen it is when no one can find ANY diagnosis to designate as PDX.
It's rare but it's usually in a scenario where they might start saying Type 2 MI- Troponin 99th-percentile and CP (making it easy), suspected cause due to Sepsis, unidentified source of infection. THEN they "rule out Sepsis, no infection" found. So what is the principle now?
It doesn't happen that often but that is the odd kind of thing I have seen happen.
Are saying because the encoder causes the DRG to drive to MI you are moving the MI to the PDX position? if so that is probably what is the issue. If so, you'd leave it in the secondary position and it will still DRIVE to MI diagnosis, assuming your PDX is in the Circulatory DRG.
If your PDX is NON-circulatory your type 2 MI will be in the secondary position and NOT be PDX or DRG driver. It will act as MCC or ( severity MCC).
MDC has the most oddities in my opinion :).