Case Management

Mentor moment: Communicate with coders to assign proper discharge codes

Case Management Weekly, December 22, 2010

Proper assignment of discharge codes can make a big difference in a hospital’s reimbursement. Unfortunately those who know most about discharge plans—case managers—are not always responsible for assigning these codes.

Assigning the correct MS-DRG requires reporting the patient’s age, gender, discharge status, principal diagnosis, secondary diagnosis and procedures performed. The discharge status has equal weight with diagnosis and procedures, and not everyone appreciates that, according to a Curaspan Connections article entitled “Closing the Gap Between Case Managers and Coders” written by Jackie Birmingham, RN, BSN, MS, vice president of regulatory monitoring and clinical leadership at Curaspan Health Group.

Coders are ultimately responsible for assigning discharge codes. They typically rely on what the physician initially ordered for postacute care. However, the case manager who facilitates the transition of care may have additional information that is valuable to the coders—including where the patient ultimately went, what level of care the patient  received, and when the services began, Birmingham wrote. Failing to communicate that information can lead to an inaccurate claim, which can result in financial or legal penalties.

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