Health Information Management

Focus on DRGs with one MCC

HIM Connection, January 10, 2012

Want to receive articles like this one in your inbox? Subscribe to HIM Connection!

Coders must pay close attention to records that include only one MCC, says Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, an independent HIM consultant in Madison, WI. The October 2011 Medicare Quarterly Provider Compliance Newsletter addresses several denials related to the invalidation and removal of MCCs.

For example, one scenario involves the removal of ICD-9-CM code 518.4 (acute edema of lung, unspecified), which is an MCC. As a result, the MS-DRG changes from 235 (coronary bypass without cardiac cath with MCC) to MS-DRG 236 (coronary bypass without cardiac cath without MCC). Another example involves the removal of ICD-9-CM code 518.5 (pulmonary insufficiency following trauma and surgery), which is also an MCC. This- also changes the MS-DRG from 235 to 236. A third example involves the removal of ICD-9-CM code 434.91 (cerebral artery occlusion, unspecified; with cerebral infarction), which is an MCC. As a result, the MS-DRG changes from 100 (seizures with MCC) to MS-DRG 101 (seizures without MCC).

Hospitals should generate reports of their top 25 MS-DRGs by frequency and then reduce the list to those with only one MCC, says Krauss. Ensure that documentation supports assignment of that MCC, he says.

Editor’s note: This tip has been adapted from an article which originally appeared in the January issue of Briefings on Coding Compliance Strategies.



Want to receive articles like this one in your inbox? Subscribe to HIM Connection!

Most Popular

Related Articles