Part 4: Most Common DRG’s with Recommendations 2018

#4 DRG with the most recommendations

DRG 190—Chronic obstructive pulmonary disease w/MCC

The majority of the recommendations from DRG 190 (Chronic obstructive pulmonary disease w/MCC) was to DRG 189 (Pulmonary edema and respiratory failure) with re-sequencing of respiratory failure as the PDX or adding as a new code and sequenced as PDX.

• Review the medical record for documentation of acute respiratory failure. If it is in the record but not clearly documented a query should be sent. A lot of the recommendations were from the lack of clinical indicators, but the documentation of the diagnosis was in the record. Remember coders cannot ignore physician documentation and if it is not clear a query should be sent for clarification

• When two conditions are present on admission, they are not always equal choices for PDX. The focus of the treatment must be considered. A patient admitted with COPD and acute respiratory failure may or may not be equally treated. If the patient has severe clinical indicators for failure and they require ICU admission and BiPAP for the respiratory failure and only IV steroids/drugs for the COPD respiratory failure may be the more appropriate selection of PDX. These are case by case determinations and require the review of the entire medical record to properly select the PDX.

The second most common recommendation was to DRG 193 (Simple pneumonia & pleurisy with MCC) with change in PDX by re-sequencing pneumonia as the PDX or adding as a new PDX.

• Remember the sequencing of COPD and pneumonia changed in 10/2017 and the PDX is based on the circumstances of the admission. Early in 2018, we were finding that some coders were still following the old ICD-10-CM instructional notes instead of the new notes for FY2018.
• In some cases, the diagnosis of pneumonia was not reported or clarified at the time of coding. It is always best when a diagnosis is included in the discharge summary but the lack of this does not rule the condition out. Query may be necessary in some cases depending on the physician documentation.

The third most recommended change as to DRG 194 (Simple pneumonia & pleurisy with CC) with change in PDX by re-sequencing pneumonia as the PDX or adding as a new PDX (see above as the reasoning is the same this DRG is just without MCC).

There were a few records with a DRG change based on the pneumonia having a specified organism for the cause documented or aspiration pneumonia.

Be on the lookout for Part 5 (and final) of this series.

Authored by Kim Boy, RHIT, CDIP, CCS, CCS-P

References
AHA Coding Clinic 1Q2019, Pages 34-37
AHA Coding Clinic 4Q2017, Page 96
AHA Coding Clinic 1Q2017, Page 24
AHA Coding Clinic 3Q2016, Page 15

The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.