Topic: Understand how MCC capture affects reimbursement
HIM Connection, August 12, 2008
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It is important that a physician document all relevant major complications/comorbidities (MCC) to ensure accurate reimbursement. Consider the following scenario:
A 72-year-old male patient is admitted for a revision of a hip replacement. On admission, the physician also documents a Stage II decubitus ulcer on his sacram and provides an appropriate protocol for wound care.
If the physician documents “decubitus ulcer Stage II,” in his or her orders in the medical record, a coder can assign this condition, which results in an MCC/CC (code 707.03). The assignment of this additional code (707.03) would yield MS-DRG 466, Revision of hip or knee replacement with MCC, which has a relative weight of 3.5408.
If the physician does not document the MCC, this case falls into MS-DRG 468, Revision of hip or knee replacement without CC/MCC, which as a relative weight of 2.4545.
Editor’s note: This article was adapted from HCPro's The MS-DRG Training Handbook. For more information or to purchase a copy, visit www.hcmarketplace.com/prod-6201.html.
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