Health Information Management

Q&A: Impact of SOI/ROM on DRG assignment

CDI Strategies, July 23, 2009

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Q: When coded, will the five ICD-9 diagnosis codes which turn off if the patient expires for use in DRG reimbursement still affect severity of illness (SOI)/risk of mortality (ROM) levels? Or, since the patient expired, would the codes be eliminated as an influence on SOI/ROM levels? We use 3M APR-DRGs for our SOI/ROM levels and have not been able to determine if a hospital acquired condition (HAC) or the five ICD-9 diagnosis codes which turn off at expiration have an impact.
 
A: The APR-DRG system does not use death in the assignment of a DRG or SOI/ROM. Regarding those particular five codes (42741, 4275, 78551, 78559, 7991) in APR-DRG V26.1, 74241 and 4275 are listed under the complication of care codes, for which special logic applies. This means that if you are grouping for admission APR and discharge APR, if either code is not present on admission then it will not be used for admission or discharge APRs. If you are grouping for discharge APRs only, these two codes also would not be used. We are however, re-evaluating these two codes on the complication of care list for V27.0. 

Editor’s Note: Janice Bonazelli, senior clinical analyst with 3M Health Information Services, answered this question. Contact her at jabonazelli@mmm.com.

To register for the 90-minute audio conference Friday, September 18 Severity of Illness and Risk of Mortality: Sharpen Your CDI Focus with New Measures of Success,visit The HCPro Healthcare Marketplace or call the customer service department at 866/439-1592 and mention Source Code EZINEAD.

 



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