APR DRG Review
Are there tips in how to review a case for APR DRG instead of MS DRG? We have the Solventum tool and realize it shows us the SOI/ROM and unlike MS DRG there is no listing of "CC and MCC" but rather look for acuity, organ system involvement, response to treatment, etc.
I am trying to provide guidance to the CDI team who will be reviewing some cases for MS DRG and others for APR DRG so want to minimize the confusion while also not just telling them to keep adding dx until they get to the highest level SOI/ROM as this will be more time consuming.
Any and all tips or guidance are much appreciated.
Thank you,
Alicia Mitchell
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Hello Alicia,
The APR-DRG was developed as a quite sophisticated algorithm, and because of that, it is dependent on multiple inputs in order to determine the APR-DRG. Conditions and procedures will impact the DRG just as it does with MS-DRG, however, the combination of the input may produce a differing result so there is no way to "memorize" the conditions that are impacting and how the DRG will end up.
The closest we can get to understanding the severity conditions is to look to other severity tools such as Elixhauser and include Hierarchical Condition Categories but like I said it is not an exact match. There are also some other proprietary tools that may closely reflect severity and risk conditions.
Hope that helps.
Deanne Wilk