Title DRG BasicsSession T-6-1000.ppt

* * * * * Although AHA publishes the coding clinics quarterly – MHS only updates the coding clinics twice a year. * Developed in 1974 by the Department of Health Education and Welfare The UHDDS is defined as “a minimum, common core of data on individual acute care, short-term hospital discharges in Medicare and Medicaid programs. Sought to improve the uniformity and comparability of hospital discharge data set” (Schraffenberger 2005). Used in inpatient setting which includes acute care, short and long term care, psychiatric hospitals, home health agencies and nursing homes. * CMS requires the reporting of any procedure that affects payment, whether or not it meets the definition of a significant procedure. Other procedures may be reported at the hospital’s discretion. (Faye Brown) * Attending physician is responsible for designating the principal diagnosis (and any other diagnoses). It’s usually listed first in the Discharge Summary or diagnostic statement but it’s not always the case The coder should review the entire medical record to determine which condition should be reported as the principal diagnosis What is the Principal Diagnosis – Acute Appendicitis Track x – xxx day – 0000-0000 * * Do not report any diagnoses that relate to an earlier episode of care but have no bearing on current stay. Cannot refer to a previous admission to report diagnoses in the current admission For reporting purposes the definition is interpreted as additional conditions that affect patient care by requiring clinical evaluation, therapeutic treatment, diagnostic procedures, extended length of hospital stay or increased nursing care and/or monitoring. * * * Note: Hospitals usually use the 3M Coding encoder but some facilities use QuadraMed * Review Nursing Notes, Lab (do not code from for Inpatient) Radiology (only for more specificity, ex: fractures) – always confer with attending. More inpatient coding tips in later slides * * * * * Other factors affecting DRG reimb