Health Information Management

News: Carefully examine syncope and collapse denials

CDI Strategies, December 8, 2011

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Hospitals reported syncope and collapse (MS-DRG 312) as the top MS-DRG with respect to financial impact due to denials for lack of medical necessity and incorrect coding, according to previously released RACTrac data from the American Hospital Association.

Medical necessity denials for MS-DRG 312 are likely the more frequent culprit, but incorrect coding and sequencing also poses a challenge, says Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, an independent HIM consultant in Madison, WI and a member of the ACDIS advisory board.
For example, when a physician determines after study that the patient's syncope is related to pneumonia, coders should report pneumonia as the principal diagnosis. Coders should not separately report syncope because it is a symptom that can be associated with pneumonia, according to ICD-9-CM Official Guidelines for Coding and Reporting. This yields MS-DRG 195 (simple pneumonia and pleurisy without CC/MCC) with a relative weight of 0.7096 for FY 2011.
Some coders incorrectly report syncope as the principal diagnosis with pneumonia as a secondary condition, yielding MS-DRG 312, which has a relative weight for FY 2011 of 0.7172. 
Review coding guidelines for MS-DRG 312 and how they pertain to signs and symptoms, assignment of principal diagnosis, and sequencing, says Krauss.
Editor’s Note: This article was originally published in the October issue of Briefings on Coding Compliance Strategies.

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