Health Information Management

Q&A: Assigning the correct DRG when a caregiver refuses a vaccination

HIM-HIPAA Insider, November 9, 2010

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Q: I heard that code V64.05 (vaccination not carried out because of caregiver refusal) has been removed from MS-DRG 794 (neonate with other significant problems) and instead moved to MS-DRG 795 (normal newborn). Could you provide more information about this?

A: Coders current report code V64.05 when a physician documents that a caregiver or parent has refused immunization for a child. Coding Clinic, 1st quarter 2007, reiterates that the code should be assigned when immunization is not administered because of parental refusal.
 
Prior to October 1, reporting this code as a principal or secondary diagnosis yielded MS-DRG 794 for an otherwise normal newborn. However, in the fiscal year 2011 IPPS final rule, CMS states that the presence of code V64.05 does not indicate a significant problem with the newborn and should not be assigned to MS-DRG 794. Therefore, it has moved the code to the secondary diagnosis list for MS-DRG 795.
 
Editor’s note: Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I,CEMC, CCDS, director of HIM and coding for HCPro, Inc answered this question, which originally appeared in the November issue of Briefings on Coding Compliance Strategies.



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