Health Information Management

Tip: Cirrhosis and alcoholic hepatitis

CDI Strategies, October 28, 2010

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MS-DRG 432 (cirrhosis and alcoholic hepatitis with MCC) is one of many MS-DRGs slated for RAC validation audits by HealthDataInsights and Connolly Healthcare, two of the four RACs nationwide. 

RACs may target this particular MS-DRG for a variety of reasons, says James S. Kennedy, MD, CCS, managing director at FTI Healthcare in Atlanta. Insufficient documentation and sequencing of hepatic encephalopathy will be primary focus areas, Kennedy says.
CDI specialists and coders should think like RAC auditors by asking the following questions about MS-DRG 432:
  • Is the principal diagnosis correct?
  • Does the documentation support the assignment of an MCC?
  • Is the principal diagnosis sequenced correctly?
As a quick rule of thumb, says Kennedy, coders should sequence alcoholic cirrhosis of the liver as the principal diagnosis when the clinical scenario satisfies one of the following three criteria:
1.      The patient is admitted with esophageal varices (i.e., dilated blood vessels within the esophagus due to portal hypertension). The ICD-9-CM index classifies bleeding esophageal varices in cirrhosis of the liver to 571.5 (cirrhosis of the liver without mention of alcohol) followed by manifestation code 456.20 (esophageal varices in diseases classified elsewhere). Note, however, that 456.20 has an instructional note to code first the underlying disease as cirrhosis of the liver (571.0–571.9). This means that 571.2 (alcoholic cirrhosis of the liver) would be coded first, when documented, instead of 571.5.
2.      The patient is admitted primarily for a symptom due to his or her cirrhosis, such as ascites, edema, jaundice, or abnormal liver enzymes that is directly linked to the cirrhosis. 
3.      The purpose of the admission is to diagnose the patient’s cirrhosis or specifically treat the cirrhosis itself.
 Editor's Note: This article was first published in the HCPro newsletter Briefings on Coding Compliance Strategies and was chosen as the ACDIS July article of the month.  


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