Revenue Cycle

Brush up on sequencing as RAC complex reviews get under way

Recovery Auditor Report, February 18, 2010

As RACs begin to roll out complex reviews and request medical record documentation, compliant coding will continue to take center stage. And although correct coding is vital, sequencing codes is equally as important because it affects MS-DRG assignment and payment.

Sequencing is something with which coders continually struggle, says Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CCDS, director of HIM and coding at HCPro, Inc., in Marblehead, MA. That's because the circumstances of some admissions are somewhat debatable, leaving a big question mark in terms of which diagnosis is principal, McCall says.   
In addition, there are a whole slew of rules to follow. A cursory look at the ICD-9-CM Guidelines for Coding and Reporting reveals a plethora of sequencing requirements, some of which only apply to certain code sets.  

It's a lot of information to digest and remember, says McCall. And although encoders can assist with sequencing, coders have the final say in determining which diagnosis is principal. If the patient underwent multiple procedures, coders must also determine which one is principal. The principal diagnosis, principal procedure, and any relevant CCs or MCCs map to a particular MS-DRG (i.e., payment to the hospital). 

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