IR-DRG and You Reaches a Rock? of Course Not
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Your connection to medical coding and documentation compliance "Does running water stop when it IR-DRG and You reaches a rock? Of course not. It In today’s fast-paced world where comfort breeds for-Service payment model and has been utilized turns either left or complacency, it is essential that we take the within Abu Dhabi since 2011. initiative to engage in continuous learning as a right, and IR-DRGs have estimated length of stay and relative means to sharpen our saw. This will ensure more continues its weight based on the presentation of patient’s success in our chosen field. So how do we go about way. Likewise, a disease condition and plan of care. Variations may in enriching our knowledge? The media, books, positive person is happen depending on the progress of the patient, events such as AAPC meetings, for instance, are confident that no some of the ways to learn, Rachel Coon, AAPC President and Sandra Chamberlin, the IR-DRG speaker for the AAPC March challenge will to grow, to socialize and Local Event. stand in the way of meet other professionals, achieving his or and to be proactive her goal" outside of work. His Highness AAPC meetings intend to Sheikh Mohammed provide an avenue for bin Rashid al learning in-depth Maktoum information on critical topics, led by experts in the field and imparted by selected knowledgeable AAPC Event presenters. The IR-DRG for Reminder instance was tackled Next Event during the March 21st AAPC meeting, presented Saturday June 20th by a specialist in the DRG arising complications, and comorbidities that 10:30am coding field Ms. Sandra Chamberlin. Ms. Sandra warrants additional care. Since IR-DRGs might be Managing Procedure Chamberlin is a holder of various certifications such affected by the patient’s secondary diagnoses, Denials as RHIA, CCS, CPC and a Certified trainer for ICD- complete and concise documentation by the 10; she is also the Executive and Chief Clinical physician is of utmost importance to reflect an Speaker: Coding Officer for Gulf-HRA and an expert in (to accurate DRG assignment and with it an optimal Dr. Mohammad Balochi mention a few) Coding & Supervision, Clinical reimbursement for the facility. Payment is calculated Documentation Improvement, and Coding by multiplying the base weight (the AED amount Training. With her long experience in the coding that stays consistent) by the individual IR-DRG Inside this issue: arena, there is no other expert who can explain to relative weight, this results in the expected us better the importance of IR-DRG. reimbursement to the facility. IR-DRG serves a two ICD-9 CODING way purpose of measuring the quality of physician AREA: So, what is IR-DRG? IR-DRG which stands for 2 –4 services and as reimbursement tool for facilities thus Cardiovascular International Refined - Disease Related Groups, is a System it is important that as HIM professionals we system that classifies patients into different understand how IR-DRGs can impact our work. REFRESHING CPT: categories based on their condition/diagnosis, Cardiovascular 5-7 treatment modalities, age and sex. IR-DRGs are One’s knowledge and understanding of the System primarily driven by the principal diagnosis but can importance and implication of IR-DRGs cannot be Meet the AAPC be affected by a patient’s secondary diagnosis. IR- understated. With this, I quote the influential Albert 8 Officers DRGs encompass all the procedures, services, Einstein, “Wisdom is not a product of schooling but Answer Me This 9 products and devices utilized during the single of the lifelong attempt to acquire it.” Regularly inpatient encounter. The IR-DRGs replaced the Fee- improve your skills. Continuously seek knowledge. Gulf –HRA 10 Accelerate your career. Volume 3. Page 1 GULF-HRA | 2015 ICD-9 CODING AREA Circulatory System by: Eric Tayag Chapter 7 of ICD-9-CM pertains to diseases of the Circulatory System with codes ranging from 390 to 459. Listed below are the commonly applied guidelines that must be known by every coder. HYPERTENSION NOTE: Late effect has no time frame, it can occur any time after the resolution of the infarction state. Do not use either.0 (malignant) or .1 (benign) unless medical record History of TIA/CVA with NO RESIDUAL DEFICITS documentation supports such a identified is coded to V12.54. designation. Hypertension and Heart Disease: A direct relationship of hypertension ACUTE MYOCARDIAL and heart condition must be documented by the INFARCTION physician (i.e. “due to” or implied hypertensive) If no An AMI documented as non-trans causal relationship stated, hypertension and heart mural /sub endocardial/ NSTEMI condition should be coded separately. with a provided site is still coded as a NSTEMI. Hypertension and Chronic Kidney Disease: A direct causal relationship is presumed. A secondary code If NSTEMI evolves to STEMI, assign the STEMI code. from 585 code category can be used to identify the CKD stage along with the 403 code category. If STEMI converts to NSTEMI due to thrombolytic therapy, it is still coded as STEMI. Hypertensive Heart and Chronic Kidney Disease: Category code 404 can be used when both hypertensive kidney disease and hypertensive heart CODING TIPS! disease are stated in the diagnosis. Additional codes Medical coding is a dynamic process. from code categories 428 and 585 can be used to What you’ve known in the past may identify heart failure (if patient has) and CKD stage. not be suitable in the current trend. In order to become a proficient coder, Code 796.2 is used for elevated blood pressure if no YOU NEED TO CONTINUALLY READ, prior diagnosis of hypertension. COMPREHEND and most importantly, BE UPDATED! Basic knowledge on concepts of anatomy and CEREBROVASCULAR ACCIDENT physiology is a MUST! This will help you to learn the disease process, the necessity of The terms stroke, cerebral interventions and be guided with the details of infarction and CVA are all indexed the operative report itself. to 434.91. To be able to assign the most appropriate code: Postoperative cerebrovascular Specific chapter guidelines must be read accident: A cause and effect prior to assigning a code. relationship between the Always check the Tabular section after intervention done and occurrence checking the index section. There are some of CVA must be specifically instructional notes listed in this section documented by the physician. A secondary code that can direct you to a more appropriate should also be used to identify the type of code. haemorrhage or infarct. Read code descriptions to avoid unbundling. Late Effects of Cerebrovascular disease (Category Check the Coder Desk Reference for a 438): Specific residual must be documented as due more elaborated procedural code. If the to the previous attack of CVA. Codes from category details of the OP report do not match on 438 may be assigned with an active infarction code what is stated in the CDR, your assigned provided that the patient has a current CVA and code might be inappropriate. deficits from an old CVA. Be mindful of medical necessity of the procedure done. Volume 3. Page 2 GULF-HRA | 2015 ICD-9 CODING AREA Circulatory System SITUATIONAL CODING was concluded that the report have showed multi-vessel coronary artery disease. Physician discharged the patient CODING SCENARIO: week after the admission with the following diagnosis: A 76 year old male patient was discharged following a Acute Anteroseptal wall myocardial Infarction Non ST-elevation myocardial infarction. 2 weeks later, he Multi-vessel coronary disease developed severe dyspnea and chest Code the diagnosis in this scenario. pain and decided to go to ER for check-up. Patient noticed to have bi- Answer: Assign code 410.11 as principal diagnosis and lobar crackles upon auscultation with 414.01 as secondary. significant increased in his vital signs. Rationale: As previously stated in the previous example, After due workups, he was diagnosed with cause of occasioning the patient for admission is due to questionable congestive heart failure and subsequently myocardial infarction. As per Coding Clinic, Third admitted. Cardiology consultation was made on his 2nd Quarter 2009 Page 10; Assign MI code as the principal stay in the hospital and confirmed the diagnosis of diagnosis since the MI is still being treated, 414.01 can Severe CHF along with episode of chest pain due to his be added as a secondary diagnosis. Myocardial previous NSTEMI. Pharmaco-management was initiated infarction is a more life threatening event in comparison and patient gradually improved. No new infarction to CAD making it more applicable to be placed as the noted during admission. Patient discharged on 4th day principal diagnosis. Although there’s a facility to facility with the following diagnosis: transfer in this scenario, subsequent episode of care is Severe CHF still not applicable since acute treatment is still being initiated in patient’s condition. Chest pain due to previous MI, no new infarction ICD 10 CODING: I21.09, I25.10 Code the diagnosis in this scenario. Answer: Assign code 428.0 as principal diagnosis and 410.72 as secondary. ICD-10 HINT!! Rationale: As per Coding Clinic Third quarter 1997 Page: In contrary to 8-week period in ICD-9, ICD 10 only 10;assign 428.0 as principal diagnosis and subsequent considers MI as active in a span of 4weeks. As per Section E of the ICD-10-CM Draft Code Set (2012), MI code as secondary. As per HAAD Coding Manual “For encounters occurring while the myocardial (2011), is defined as the condition, after study, which infarction is equal to, or less than, four weeks old, occasioned the admission to the hospital. In this including transfers to another acute setting or a post- instance, the CHF is the main reason for admitting the acute setting, and the patient requires continued care patient.