Health Information Management

Q&A: Hospital Acquired Conditions and SOI/ROM levels

CDI Strategies, June 11, 2009

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Q: Will a Hospital Acquired Condition (HAC), when coded, still affect severity of illness (SOI)/risk of mortality (ROM) levels? Or, by nature of the fact that the condition was hospital acquired, is it eliminated in the move to a higher level of SOI/ROM?
 
A:MS-DRGs and APR-DRGs are grouped independently. Therefore, one grouper does not rely on what is happening in the other to determine the results. However, if the user is coding for admission DRGs as well, it is possible that a code that satisfies a HAC condition (not POA) is not used for the final MS-DRG and not used for the admission APR DRGs.
 
For example, take a look at 707.24 (pressure ulcer—Stage IV). In the MS-DRGs system, if 707.24 does not have a POA indicator of Y or W, then it will be demoted to a non-CC. In APR-DRGs, if it does not have a POA of Y, then it will not be used at all for the admission APR-DRG, but will be used for the discharge APR-DRG with a default SOI =3.
 
(Janice Bonazelli, senior clinical analyst with 3M HIS, answered this question. Contact her at jbonazzelli@mmm.com)



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