incidental pregnency?

katysuegood@gmail.com

I was looking through some data recently and noticed 2 lap choles that ended up with DRG 781 (other antepartum dx with medical complications). the pts were 16-20 weeks pregnant. The reimbursement is MUCH lower than a Lap Chole DRG. I asked our coding manager about it and she said that the pregnancy is always coded as the primary dx unless it is stated as "incidental". I have a feeling Dr's would be hesitant to state the pregnancy was "incidental" concidering it absolutely affects care. There was significant risk to the fetus related to the surgery and they required monitoring and such.
However, the reason for their hospitalizion is clearly the Cholecystitis requiring a lap chole. the reimbursement is abysmal and i think it should end up in the Lap Chole DRG.
Has anyone else come accross this issue? how are your physicians documenting when the patient is pregnant but that is not the primary concern?

Also, We do not review OB charts but I am trying to help the OB's improve their documentation. Anyone have any tips for improved documentation? Common CC/Mcc's?

THANKS!!

fishdl@shands.ufl.edu

Unless the physician documents something like - "the reason for admission/treatment (in this case cholecystitis requiring lap cholecystectomy) poses no risk to this pregnancy and should not be considered a complication of this pregnancy" - coding guidelines dictate that it be coded to an pregnancy related DRG. I agree that it doesn't make sense, but ... :-)

catladyrn

Oddly, the only grouping in MDC 14 that is a couplet is C-section; all the others are singlets and won't be impacted by a CC/MCC.

We do not routinely review OB patients. I've occasionally been assigned a patient with a medical condition whom I discover is pregnant. When the pregnancy really doesn't seem to be a meaningful part of the admission, I've asked for incidental pregnancy. The OB DRGs really don't adequately reflect the SOI or the resources used on a med/surg admission, so I have no problem asking when it seems legitimate. On the flip side, I've also had to argue with coders who forget the coding rule that pregnancy trumps everything else when the physician doesn't document incidental pregnancy.

Renee


Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center

lspryszak

This is one of those situations where the coding is determined by the "chapter specific guidelines" in the "Official Guidelines for Coding and Reporting". They don't always seem to make clinical sense or appear logical, but there you go - many of the coding rules often don't appear to be sensible, from a clinical perspective.

I feel that if the record accurately reports the diagnoses and treatments then I've done my job. Accurate coding is the job of the coder. My job is to just make sure everything is documented to the highest degree of specificity.

Whenever I started reviewing on a unit (like OB) that was "foreign" to me, I would review the Official Coding Guidelines to see if there was something "unique" about that population that I needed to know from a coding standpoint. Similar to this situation is HIV.

That's the neat thing about this job: there's always something new to learn.

ssalinas

There are 2 DRGs for vaginal deliveries:
774 Vaginal Delivery with complicating diagnosis
775 Vaginal Delivery without complicating diagnosis.

The complicating diagnosis may be the principal or a secondary.

catladyrn

Apparently the list of "complicating diagnoses" is not the same as the CC/MCC list.

Often I wonder what they were thinking when they were developing the DRGs...pregnancies and female gyn dx/procedures are so poorly weighted compared to, well, other situations.

Renee


Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center