Q: We had a question regarding documentation in a record of SIRS due to acute peritonitis without sepsis. Our critical care physician on that case called it severe sepsis as well. What would you do in a situation like that?
Although MS-DRGs have stolen the spotlight since CMS implemented them in 2007, hospitals are increasingly using All Patient Refined DRGs (APR-DRG) to compile the most accurate assessment of patient severity of illness (SOI) and risk of mortality (ROM). Cheryl M. Manchenton, RN, BSN, and Tamara A. Hicks, RN, BSN, MHA, CCS, CCDS, ACM, describe why APR-DRGs are the most widely-used SOI and ROM-adjusted DRGs and how organizations can use them to their advantage.
Q: If the physician writes septic shock instead of sepsis, do I need to query for sepsis? Is this an integral part of the diagnosis and sepsis would be the principal diagnosis, with septic shock a secondary diagnosis, making it an MCC?
Physicians use a lot of shortcuts and abbreviations. Some of them may even make it onto the official abbreviation list at their hospital. Some don’t. And even if they did, some physicians will use the wrong term. Robert S. Gold, MD, discusses an example that was featured in the January Medicare Quarterly Provider Compliance Newsletter regarding proper identification and ICD-9-CM coding of a bronchoscopy with biopsy (TBB) vs. a bronchoscopic lung biopsy (TBLB).
Q: A patient undergoes placement of a MediPort ® to receive chemotherapy for lung cancer. What principal diagnosis should we report? Should we report V58.81 (fitting and adjustment of vascular catheter) or 162.9 (malignant neoplasm of bronchus and lung unspecified)?
QUESTION: A patient is admitted with pneumonia and atrial fibrillation and both are present on admission. The patient receives antibiotics for the pneumonia and a pacemaker during the stay, but undergoes no other procedures. Does the procedure automatically make ICD-9-CM code 427.31 for the atrial fibrillation the principal diagnosis?
Consider the following: A beneficiary is admitted to a hospital pursuant to a physician order and receives medically necessary care spanning at least two midnights. CMS will consider this appropriate for payment under Medicare Part A, according to the FY 2014 IPPS proposed rule released April 26. Actuaries estimate that this proposal for what constitutes appropriate inpatient care would increase IPPS expenditures by $220 million due to an expected net increase in inpatient encounters. CMS proposes a 2% reduction to offset projected spending increases.
Robert S. Gold, MD, gives coding guidance on primary cardiomyopathy, SIRS, sepsis, acute respiratory distress syndrome, and conditions during the perinatal period.
ICD-10 implementation will arrive very soon, and many facilities are putting the final touches on their preparations. In the rush to complete coding education, documentation improvement, and system updates, HIM managers may not have looked at looming MS-DRG shifts.
