Pneumonia and pacemaker insertion - Procedure does not impact the DRG?

lwolff123lwolff123
in Clinical & Coding
Hi,

This is my first time posting a question. I hope I didn't make it too long, but I wanted to show my steps.
Can someone explain to me why a total system pacemaker inserted into a patient with a principal diagnosis of pneumonia does not impact as a surgery procedure DRG? Is there a coding rule that I have missed?
The coders here are telling me this is because it should have been done as an OP procedure, but this doesn't make sense to me as the patient was having SSS/asystole in the hospital. 

We have coded pneumonia, unspecified organism as PDx in the 3M encoder. Secondary dx : SSS because a few days later the patient had SSS/asystole and needed a dual chamber pacer with leads. I coded 0JH606Z for pacer, right atrium lead 02H63JZ, and right ventricle lead 02HK3JZ. The DRG I get is 193 Simple pneumonia with MCC (d/t to other secondary diagnoses)

PDx was Simple PNA- and the encoder codes the pacer as a non-extensive procedure- unrelated procedure.  The DRG comes out to be DRG 194 Simple pneumonia with a MCC w/o a procedure.This means the pacer is not a procedure which impacts? This does not seem correct.

I looked in the 3M References in the CDI Module under Unrelated MS-DRGs associated with ALL MDCs and under the Surgical MS-DRGS (981-989) It shows that Insertion of pacemaker is in the list for surgeries that impact all MDCs.

I looked in the ICD-10-CM/PCS MS-DRG v36.) Definitions Manual under the Appendix F Unrelated OR Procedures (MS-DRGs 981-989) and I did not see insertion of pacer in the Non-extensive Procedure Unrelated to PDx List- DRGs 987- 989.

The Extensive OP Procedure Unrelated to PDx states “ALL other OR procedures not listed in DRGs 987-989”, so to me it should be DRG 982.  

Can someone please explain where I have gone wrong?

Thank you, 

Leigh



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