Health Information Management

Tip of the Week: Make RAC-targeted DRGs a focus in your facility

APCs Insider, August 17, 2007

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Although most hospitals are aware of the recovery audit contractor (RAC) demonstration project, some are just now gearing up to experience the RAC projects firsthand.

Although changes to debridement and sepsis DRGs result in the most significant financial impact and have been prime targets, the RAC software is also examining a handful of other DRGs that are improperly coded with some degree of frequency. Consider taking a look at the following example:

DRG 188 coded as DRG 189: Ischemic colitis with gastrointestinal (GI) bleed, with either 557.9 or 578.x as the only complication/comorbidity (CC).

For coders, this means that you can't assign the GI bleed code as a secondary diagnosis, because it's included as a nonessential modifier in the narrative description of colitis.

When the only CC you report is a GI bleed, the original payment for DRG 188 is overturned. This could mean the difference of a relative weight change from 1.0931 to 0.5916, which carries a significant financial impact.

(This article appeared in the August 2007 Briefings on Coding Compliance Strategies).



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