Health Information Management

Q&A: Benchmarks for DRGs

CDI Strategies, June 24, 2010

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Q: Do you know of any recommended benchmarks or targets we should be hitting?  For example, chest pain DRG (no higher than___%). 

A: When setting your benchmarks for something like chest pain, look back at the past 12 months of data and set your initial target at reducing your baseline in increments. 

For example, if you have 200 patients discharged with a primary diagnosis of chest pain (DRG 313) over six months, I would implement a process to reduce the number by 50% over the next couple of months. Plan to incorporate a combination approach that includes:
  • educating the physicians
  • prioritizing all chest pain reviews within 24 hours of admission by the CDI specialist and a physician advisor
  • developing a compliant chest pain query template
  • validating final DRG assignment if it codes to DRG 313
Documentation clarification needs to be both a front-end and back-end process.  
 
As an additional aside, in my former facility our target rate for DRG 313 was “0%”.   Any cases grouping to DRG 313 at final coding were referred to case management for follow-up as this identified a utilization review opportunity.
 
Editor’s Note: This question was answered by Lynne Spryszak, RN, CCDS, CPC-A, CDI education director, at HCPro Inc., in Marblehead, MA. Contact her at lspryszak@cdiassociation.com.



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