Re: APR DRG (SOI/ROM)

mahmed1

Hi! Does any body know list of specific SOI/ROM secondary diagnosis which increases SOI/ROM one to two or two to three etc. same like MS-DRG we have list of CC/ MCC.

Thanks,



Sincerely,

Mohammad Ahmed, M.D, CCS, CCDS,
Certified Clinical Documentation Specialist
Bronx Lebanon Hospital Center
Health Information Management
1650 Grand Concourse
Bronx, NY 10457
Phone: 718-518-5322
Cell : 347-307 5403
Fax: 718-518-5634
Email: mahmed1@bronxleb.org

Unknown

My understanding is that the SOI/ROM takes into consideration the patient's age, disposition as well as diagnoses. To my knowledge, there is not 'list' and the very strangest things can change the SOI/ROM. That is why it is so important to make sure all diagnoses are documented as you never know which one (s) will impact the SOI/ROM.

mahmed1

you are right, but what I was thinking if we could have a list of most common diagnosis which could change SOI/ROM that will help us when CDS staff reviewing chart they will know where and what to hit.

Thanks,

Mohammad

Sincerely,

Mohammad Ahmed, M.D, CCS, CCDS,
Certified Clinical Documentation Specialist
Bronx Lebanon Hospital Center
Health Information Management
1650 Grand Concourse
Bronx, NY 10457
Phone: 718-518-5322
Cell : 347-307 5403
Fax: 718-518-5634
Email: mahmed1@bronxleb.org

Melindascharf

It is my understanding that any diagnosis that is a cc/mcc will impact SOI/ROM. But if you already have another cc/mcc it may or may not impact the SOI/ROM. The only way I have figured out how to determine if it is going to impact is to put all the diagnosis through the encoder. (which has the APR drg) This can be very time consuming so we don't do it very much. I am not sure if there is an easier way??

Melinda Scharf RN BSN CCDS
St Joseph Hospital, Orange

mdominesey

There are certain diagnoses that will always move a chart into the highest SOI/ROM. I do not have APR/DRG in my current facility, but someone correct me if I am wrong, Acute Respiratory Failure was always a huge driver of SOI/ROM, taking 2/3 to like 4/4. I am sure that people can respond with diagnoses that are similar in how they drive SOI/ROM.

MND

Mark N. Dominesey, RN, BSN, MBA, CCDS
Sr. Clinical Documentation Improvement Specialist
Sibley Memorial Hospital
Mdominesey@sibley.org
W: 202.660.6782

mahmed1

I agree with you, but my point is same if you could have list of Diagnosis which impact SOI/ROM.

Sincerely,

Mohammad Ahmed, M.D, CCS, CCDS,
Certified Clinical Documentation Specialist
Bronx Lebanon Hospital Center
Health Information Management
1650 Grand Concourse
Bronx, NY 10457
Phone: 718-518-5322
Cell : 347-307 5403
Fax: 718-518-5634
Email: mahmed1@bronxleb.org

evanspx@sutterhealth.org

We all agree access to the entire list would be fantastic - but, I do
not believe such a list exists - or least, is not available to the
public.

The APR-DRG system is copyrighted by 3M - "they' have the entire list,
but they do not release this list to the public. You must 'buy' the 3M
product, and even then, they do not have a compiled list of all of the
conditions affecting ROM/SOI. By law, this private firm is not
required to make this list available to the public - conversely,
because CMS has mandated the MS-DRG system must be transparent, a full
listing of CC/MCC codes must be provided to all free of charge.


Paul Evans, RHIA, CCS, CCS-P
Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739

paxneros

Would it be safe to say that many/most/all of the diagnoses which qualify as CCs/MCCs would certainly be part of any SOI/ROM "list" which may be out there?

We are not an APR/DRG state so we have not concerned ourselves with such - we focus on documentation. Much of our efforts do result in the capture of MCCs/CCs. We were told by our CDI program Consultant/Educators that this would reflect in our SOI/ROM overall.

NBrunson, RHIA, CCDS

mdominesey

Paul,

MD is an APR/DRG state; they report via APR/DRG and are reimbursed by that method. Maybe there is some method where the system is transparent, but I do not know. My last hospital had the grouper w/ APR/DRG and I used it extensively. In my head, I am thinking I attended a presentation, read a presentation, or found somewhere an algorithm for the APR/DRG system. I believe it was high level and only had some examples, certainly not an entire list. Even if I could find a presentation in my own archives, by 3M's non-disclosure agreement, I would be prevented from discussing it.

Each hospital will have to make the determination whether licensing the grouper is worth the investment. My recommendation for my own hospital as I am developing/fleshing out my CDI program is to license it because of what it offers.

HTH,

MND

Mark N. Dominesey, RN, BSN, MBA, CCDS
Sr. Clinical Documentation Improvement Specialist
Sibley Memorial Hospital

evanspx@sutterhealth.org

Speaking anecdotally, only, there appear to me to be many conditions
that are CC/MCC conditions that also positively change the ROM/SOI.

Acute Respiratory Failure will positively affect the ROM/SOI. If
you have the option, some coding software allows you to code in both
systems - this is the only sure way to see the impact as you audit or
code.

Paul

Paul Evans, RHIA, CCS, CCS-P
Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739

mdominesey

Yes, I remember all CC's and MCC's affecting severity, but it is surprising how some affect it so much more than others. I remember (but could be wrong) a case where someone was admitted with Anemia, had Pneumonia (an MCC) but only like an overall SOI/ROM of 1/2! Each secondary dx definitely affects the SOI/ROM and many secondaries affect SOI/ROM without being a CC or MCC.

Mark N. Dominesey, RN, BSN, MBA, CCDS
Sr. Clinical Documentation Improvement Specialist
Sibley Memorial Hospital

evanspx@sutterhealth.org

We have a license to use the APR-DRG grouper, but the system still does
not provide us with a list. So, we don't know the impact unless or
until we code or query for condition "X".

If the full list is available anywhere, it would be wonderful to have.
I have asked many sources for said list many years and have never been
granted access.

There are algorithms and a FEW examples that demonstrate the impact of
specific conditions upon the ROM/SOI, but I have never found 'the'
complete list.

The last time I fully read the Final Rule regarding this topic, I
recall an explanation for the lack of transparency with a statement
speaking to a federal standard for grouping still being based upon the
MS-DRG system rather than the APR-DRG system.

Thanks, Paul

Paul Evans, RHIA, CCS, CCS-P
Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739

mdominesey

The 3M encoder will display both MS-DRG as well as APR/DRG (as long as you have it licensed) on the same screen. You can click "display secondary grouper data" to get the SOI/ROM reported and leave it on as a selection for the entire time you have the program opened. No need to switch to another screen. It will also let you group to other systems as well, but generally you have to switch to another grouper to use when you first start coding the case if you need something other than MS-DRG with APR/DRG also reported.

I was also the Applications Specialist for HIM at my last job, so I was able to manipulate the applications as an administrator.

MND