Health Information Management

A snapshot of the effect of MS-DRGs on cardiac coding

Briefings on Coding Compliance Strategies, May 1, 2008

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Capture patient’s severity of illness for CHF and CABG, regardless of payment effect

Medicare predicted that after Medicare Severity DRGs (MS-DRG) were implemented, facilities would have one or more complications and comorbidities (CC) in more than 40% of their cases. This is down from an expected CC capture rate of 78% prior to October 2007.

“We’ve found, with the analysis of current data, that this [prediction] is fairly accurate,” said Audrey G. Howard, RHIA, senior consultant at 3M Health Information Systems in Salt Lake City.

More stringent specificity requirements to achieve a CC or major CC (MCC), as well as the fact that Medicare removed some common secondary diagnoses from the CC list, account for this decrease.

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