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Tip: Understand new CC categories under MS-DRGs

CDI Strategies, October 1, 2007

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If you've been diligent in your coding and stressing documentation improvement, you shouldn't have too much more work on your plate, says Robert S. Gold, MD, founder of DCBA, Inc.-an Atlanta consulting firm that provides physician-to-physician programs in clinical documentation improvement. "If coders are doing their job and the documentation program that the hospital has is doing its job, almost all of the questions will already be answered, and the coding will be an accurate reflection of what's wrong with the patient," he says.

But even for facilities that have followed all the rules thus far, getting the word out to physicians and coders is the most important part of ensuring a smooth transition to the new system. An important step toward preparing your staff is to understand the changes yourself. The most obvious difference between the old and new systems is that instead of grouping cases into medical and surgical DRGs with or without complications or cormbidities (CCs), the MS-DRGs separate cases into one of three main categories. The categories now distinguish between no CC, a CC, and a major CC (MCC). An MCC refers to a condition that requires double the additional resources of a normal CC. Cases in which an MCC is present will fall into the highest-tiered DRG, and thus yield the highest reimbursement.

To view a DRG crosswalk from the old system to the new system, visit the CMS Web site at http://www.cms.hhs.gov/AcuteInpatientPPS/FFD/ then search for "crosswalk from CMS-DRGs to MS-DRGs."

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