Health Information Management

Queries can help reflect accurate SOI, ROM

HIM-HIPAA Insider, February 23, 2015

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Coding tells a patient's story, based on the narrative the physician provides in his or her documentation. Accurately painting a picture of the patient's severity of illness (SOI) and risk of mortality (ROM) is essential for good patient care, and it is becoming increasingly important for quality measures and payment.

MS-DRGs group similar clinical conditions (diagnoses) and the procedures furnished by the hospital during the stay. The patient's principal diagnosis and up to 24 secondary diagnoses that may include comorbidities or complications will determine the MS-DRG assignment.
The MS-DRG system includes three levels of severity:
  • With MCC, which reflects the highest level of severity
  • With CC, which is the second highest level of severity
  • Without CC/MCC, which does not significantly affect SOI and resource use
 For example, a patient is admitted with acute renal failure secondary to dehydration and treated appropriately with IV fluids. The rehydration corrected the acute renal failure, and the patient did not require dialysis. Coders would sequence ICD-9-CM code 584.9 (acute kidney failure, unspecified) as the principal diagnosis with code 276.51 (dehydration) as a secondary diagnosis.
This case groups to MS-DRG 675 (other kidney and urinary tract procedures without CC/MCC). This MS-DRG has a relative weight of 1.3558, a geometric mean length of stay (GMLOS) of 1.8 days and an arithmetic mean length of stay (AMLOS) of 6.5 days.
Continue reading "Queries can help reflect accurate SOI, ROM" on the HCPro website. Subscribers to Briefings on Coding Compliance Strategies have free access to this article in the February issue.

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