Download Prepare for RAC in ICD-10

9/16/2014
Prepare for RAC in ICD‐10
Leigh Poland, RHIA, CCS
AHIMA‐Approved ICD‐10‐CM/PCS Trainer
Agenda
• RAC Preparation Audit Findings
– MS‐DRG (s) with Highest Error Rate & Trends
• Debridement Procedures (MS‐DRG 463‐465;573‐575;576‐578; 622‐624; & 901‐903)
• Coagulation Disorders (MS‐DRG 813)
• Other Kidney & Urinary Tract Procedures (MS‐DRG 673‐675)
• Respiratory Diagnosis with Vent Support (MS‐DRG 207‐208)
• Percutaneous Non‐Drug Eluting Stent with MCC or 4+ Vessels/ Stents (MS‐
DRG 248)
RAC Preparation Audits Debridement (MS‐DRG 463‐465, 573‐574, 576‐577, 622‐623, & 902)
Excisional Debridement (Ref: ICD‐9‐CM Procedure Tabular)
86.22, Excisional debridement of wound, infection, or burn
Removal by excision of :
Devitalized tissue
Necrosis
Slough
Excludes debridement of: Abdominal wall (wound) (54.3)
Bone (77.60‐77.69)
Muscle (83.45)
Nonexcisional debridement (86.28)
Open Fracture Site (79.60‐79.69)
TIP: Assign only if the debridement involves skin & subcutaneous tissues: any deeper structures(e.g., muscle, bone) are coded elsewhere
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RAC Preparation Audits Debridement (MS‐DRG 463‐465, 573‐574, 576‐577, 622‐623, & 902)
Debridement (Ref: ICD‐10‐PCS Coding Index)
Excisional see Excision
Non‐excisional see Extraction
Irrigation
Skin, Irrigating Substance 3E10
ICD‐10‐PCS Official Guidelines for Coding and Reporting 2014
Medical and Surgical Section Guidelines (section 0) B3. Root Operation Overlapping body layers B3.5 If the root operations Excision, Repair or Inspection are performed on overlapping layers of the musculoskeletal system, the body part specifying the deepest layer is coded. Example: Excisional debridement that includes skin and subcutaneous tissue and muscle is coded to the muscle body part. Excision Skin and Breast Extraction Skin and Breast 2
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Excision Subcutaneous Tissue and Fascia Extraction Subcutaneous Tissue and Fascia Irrigation
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RAC Preparation Audits Debridement (MS‐DRG 463‐465, 573‐574, 576‐577, 622‐623, & 902)
– Debridement Error # 1: Sharp Debridement
• When you see the terminology of sharp debridement alone you can not automatically assign a code 86.22, excisional debridement of wound, infection, or burn. – The note must document a definite cutting away of tissue and not the minor removal of loose fragments with scissors or scraping away tissue with a sharp instrument. – 86.28, Nonexcisional Debridement of Wound, Infection or Burn if only the terminology of sharp debridement is used. » You would then follow up with query to clarify. • Remember to properly code debridement procedures you need at least three basic elements: – Excisional Debridement Terminology
– Instrument Used
– Tissue Depth
•
•
REF: AHA Coding Clinic‐ Excisional Debridement 1st Quarter 2008 Page: 3‐ 4
REF: AHA Coding Clinic‐ Nonsurgical Mechanical Debridement 2nd Quarter 2004 Page 5
RAC Preparation Audits Debridement (MS‐DRG 463‐465, 573‐574, 576‐577, 622‐623, & 902)
Facility Operative Note
HANDWRITTEN OPERATIVE NOTE: Debrided skin of right diabetic heel ulcer. Sharply debrided
underlying skin to bleeding surface.
ICD-9-CM CODE ASSIGNMENT: 86.28, Nonexcisional debridement of wound, infection or burn
ICD-10-PCS CODE ASSIGNMENT: OHDMXZZ, Extraction of right foot skin, external approach
NOTE: This would be a perfect opportunity to follow up with query or prompter to ask about more details
concerning the debridement.
Extraction Skin and Breast Extraction
Skin, Right Foot
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RAC Preparation Audits Debridement (MS‐DRG 463‐465, 573‐574, 576‐577, 622‐623, & 902)
Sample #1
Debridement Procedures- How Could These Impact DRG Assignments?
T81.4XXA, Infection following a
procedure, initial encounter
Principal
Diagnosis
T81.4XXA, Infection following a procedure,
initial encounter
L03.113, Cellulitis of right upper
limb
L03.113, Cellulitis of right upper limb
CC/MCC
Principal
Procedure
0JBD0ZZ, Excision of right upper
arm subcutaneous tissue and
fascia, open approach
0HDBXZZ, Extraction of right upper arm skin,
external approach
DRG 857, Postoperative or PostTraumatic Infections w O.R.
Procedure w CC
DRG 863, Postoperative & Post-Traumatic
Infections w/o MCC
DRG
DRG RW
2.0412
0.9845
DRG National
Average
Payment
$12,180.21
$6,315.71
RAC Preparation Audits Debridement (MS‐DRG 463‐465, 573‐574, 576‐577, 622‐623, & 902)
RAC Preparation Audits Debridement (MS‐DRG 463‐465, 573‐574, 576‐577, 622‐623, & 902)
– Debridement Error # 2: Tissue Depth
• Assign a code for the deepest layer of debridement when multiple layers of the same site are debrided. • When coding debridement of sites other than skin & there is not an index entry for the particular site, the coder should look for other terms such as excision or destruction of lesion of that site
• REF: AHA Coding Clinic‐ Extensive Wound Debridement 1st Quarter 1999 Page: 8 to 9
• REF: AHA Coding Clinic‐ Excisional Debridement 1st Quarter 2008 Page: 4
• REF: AHA Coding Clinic – Excisional Debridement 2nd Quarter 2005 Page 3 to 4
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RAC Preparation Audits Debridement Tissue Depth
Facility Operative Note Example #2
DIAGNOSIS: Gangrene of the right foot with foot infection
PROCEDURE PERFORMED: Debridement of necrotic skin, subcutaneous tissue, and muscle from right foot.
PROCEDURE: After induction of general endotracheal anesthesia, an incision was made in the right foot.
Dissection was carried through the tissues until there was found to be no bleeding and an extremely foul smell.
The wound was excisionally debrided with scissors and scalpel of the necrotic tissue and pieces of
muscle from the right foot. After debridement of this necrotic tissue & muscle, the wound was irrigated with the
pulse irrigator. A sterile dressing was applied. The patient tolerated the procedure well. All needle, lap, and
sponge counts were correct.
ICD-9-CM CODE ASSIGNMENT: 86.45, Other myectomy
ICD-10-PCS Code ASSIGNMENT: 0KBV0ZZ, Excision of right foot muscle, open approach
ICD-9-CM PROCEDURE TABULAR TIP: Do not assign a skin/soft tissue debridement procedure code (e.g. 86.22) in
addition to the muscle debridement (83.45) code; all more superficial debridement is included when multilayer debridement
is performed at the same site.
RAC Preparation Audits Debridement Tissue Depth
Sample #2
Debridement Procedures- How Could These Impact DRG Assignments?
Principal
Diagnosis
L03.116, Cellulitis of Left Lower
Limb
CC/MCC
I96, Gangrene
I96, Gangrene
0KBT0ZZ, Excision of Left Lower
Leg Muscle, Open Approach
0JBP0ZZ, Excision of left lower leg
subcutaneous tissue and fascia, open approach
DRG 580, Other Skin,
Subcutaneous Tissue & Breast
Procedures with CC
DRG 571, Skin Debridement with CC
DRG
DRG RW
1.5398
1.4906
DRG National
Average
Payment
$9,397.52
$9,124.47
Principal
Procedure
L03.116, Cellulitis of Left Lower Limb
Excision Muscle Body Part‐ Muscle
Lower Leg, Left
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RAC Preparation Audits Coagulation Disorders (MS‐DRG 813)
–
Four Common Coding Errors
•
•
•
•
REF: (AHA Coding Clinic‐ Coumadin Maintenance Therapy 3rd Quarter 1990 Page:14)
REF: (AHA Coding Clinic‐ Coumadin Therapy 3rd Qtr 1992 Page: 15)
REF: (AHA Coding Clinic‐Coagulation Defects 4th Quarter 1993 Page 29)
REF: (AHA Coding Clinic‐ Hemoptysis & GI Bleeding due to Anticoagulation 2nd Qtr 2006 Page: 17)
• REF: (AHA Coding Clinic‐ Epistaxis Secondary to Coumadin Therapy 3rd Qtr 2004 Page: 7)
• Number 1: Misuse of code 286.9, Other & Unspecified coagulation defects.
– Code not used for patient with abnormal labs on Coumadin. Coagulation Defects ( ICD‐9‐CM Tabular)
286.9, Other & Unspecified coagulation defects
Defective Coagulation NOS
Delay, coagulation
EXCLUDES abnormal coagulation profile (790.92)
– October 1, 1993 new code 790.92, Abnormal Coagulation Profile has been created to identify abnormal laboratory findings of prolonged bleeding time without the presence of hemorrhage or a coagulation disorders. » Prolonged PT times are an expected result of Coumadin therapy and a code from the 286 series would not be used. RAC Preparation Audits Coagulation Disorders (MS‐DRG 813)
Sample #1
Prolonged PT Times Secondary to Coumadin
Principal
Diagnosis
CC/MCC
790.92, Abnormal Coagulation
Profile
286.9, Other and unspecified coagulation defects
No CC or MCC Conditions Noted
No CC or MCC Conditions Noted
N/A
N/A
DRG 813, Coagulation Disorders
MSDRG
DRG 948, Signs & Symptoms
without MCC
MSDRG
RW
0.6897
1.6433
MSDRG
National
Average
Payment
$4,679.62
$9,971.93
Principal
Procedure
RAC Preparation Audits Coagulation Disorders (MS‐DRG 813)
Sample #1
Prolonged PT Times Secondary to Coumadin
Principal
Diagnosis
CC/MCC
R79.1, Abnormal Coagulation
Profile
D68.9, Coagulation Defect, Unspecified
No CC or MCC Conditions Noted
No CC or MCC Conditions Noted
N/A
N/A
DRG 813, Coagulation Disorders
MSDRG
DRG 948, Signs & Symptoms
without MCC
MSDRG
RW
0.6897
1.6433
MSDRG
National
Average
Payment
$4,679.62
$9,971.93
Principal
Procedure
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RAC Preparation Audits Coagulation Disorders (MS‐DRG 813)
RAC Preparation Audits Coagulation Disorders (MS‐DRG 813)
• Number 2: If a patient is admitted with a hemorrhage (epistaxis, hematemesis, melena, etc) due to Coumadin the hemorrhage is sequenced as PDX followed by E‐code E934.2, Adverse effect of Anticoagulants. Facility Discharge Summary Example
IMPRESSION: 79 Year old male with chronic atrial fibrillation on Coumadin
therapy. Patient was brought into the hospital for hematuria & rectal bleed
secondary to Coumadin. Coumadin was discontinued on admit. Patient received
two units of plasma.
ICD-9-CM CODE ASSIGNMENT: 569.3, Hemorrhage of rectum & anus; 599.70,
Hematuria; E934.2, Adverse effect of anticoagulants; 427.31, Atrial fibrillation; and
99.07, Transfusion of plasma
ICD-10-CM CODE ASSIGNMENT: K62.5, Hemorrhage of rectum & anus; R31.9,
Hematuria, unspecified; T45.515A, Adverse effect of anticoagulants, initial
encounter; I48.2, Atrial fibrillation; and table 302 for Transfusion
RAC Preparation Audits Coagulation Disorders (MS‐DRG 813)
Sample #2
Rectal Hemorrhage Secondary to Coumadin
Principal
Diagnosis
569.3, Hemorrhage of rectum &
anus
286.9, Other and unspecified coagulation
defects
No CC or MCC Conditions Noted
CC/MCC
No CC or MCC Conditions
Noted
99.07, Transfusion of Plasma
99.07, Transfusion of Plasma
Principal
Procedure
DRG 379, GI Hemorrhage
without CC/MCC
DRG 813, Coagulation Disorders
DRG
DRG RW
0.6937
1.6433
DRG
National
Average
Payment
$4,701.82
$9,971.93
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RAC Preparation Audits Coagulation Disorders (MS‐DRG 813)
Sample #2
Rectal Hemorrhage Secondary to Coumadin
Principal
Diagnosis
K62.5, Hemorrhage of anus &
rectum
No CC or MCC Conditions Noted
CC/MCC
No CC or MCC Conditions
Noted
D68.9, Coagulation defect, unspecified
Principal
Procedure
Table 302- Administration of
Transfusion
Table 302- Administration of Transfusion
DRG 379, GI Hemorrhage
without CC/MCC
DRG 813, Coagulation Disorders
DRG
DRG RW
0.6937
1.6433
DRG
National
Average
Payment
$4,701.82
$9,971.93
RAC Preparation Audits Coagulation Disorders (MS‐DRG 813)
–
Number 3: The predominant adverse effect of Coumadin is bleeding ranging from mild (ecchymosis, hematoma, epistaxis) to major or life‐threatening. Another common scenario seen during the audits is a patient admitted with hematoma secondary to Coumadin toxicity. Example: Patient is admitted with chest wall hematoma secondary to Coumadin. The physician states the hematoma was down into the muscle fibers. The coder chose 782.7, spontaneous ecchymosis as PDX. This is incorrect. The correct coding pathway in your ICD‐9‐CM 2014 Coding Index is : Hematoma Muscle (traumatic)‐see Contusion, by site
Nontraumatic 729.92
The ICD‐9‐CM 2014 Tabular reminds you to use an additional E code for an adverse drug effect if caused by Coumadin or other anticoagulants with code 729.92, nontraumatic hematoma of soft tissue. RAC Preparation Audits Coagulation Disorders (MS‐DRG 813)
–
Number 3: The predominant adverse effect of Coumadin is bleeding ranging from mild (ecchymosis, hematoma, epistaxis) to major or life‐threatening. Another common scenario seen during the audits is a patient admitted with hematoma secondary to Coumadin toxicity. Hematoma ‐ Nontraumatic
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RAC Preparation Audits Coagulation Disorders (MS‐DRG 813)
Sample #3
Hematoma Secondary to Coumadin Toxicity
Principal
Diagnosis
782.7, Spontaneous Ecchymosis
729.92, Nontraumatic Hematoma of Soft Tissue
CC/MCC
No CC or MCC Conditions Noted
No CC or MCC Conditions Noted
Principal
Procedure
N/A
N/A
DRG 813, Coagulation Disorders
DRG 556, Signs & Symptoms of Musculoskeletal
System & Connective Tissue without MCC
MSDRG
RW
1.6433
0.7066
MSDRG
National
Average
Payment
$9,971.93
$4,773.42
MSDRG
RAC Preparation Audits Coagulation Disorders (MS‐DRG 813)
Sample #3
Hematoma Secondary to Coumadin Toxicity
Principal
Diagnosis
R23.3, Spontaneous Ecchymosis
M79.81, Nontraumatic Hematoma of Soft Tissue
CC/MCC
No CC or MCC Conditions Noted
No CC or MCC Conditions Noted
Principal
Procedure
N/A
N/A
DRG 813, Coagulation Disorders
DRG 556, Signs & Symptoms of Musculoskeletal
System & Connective Tissue without MCC
MSDRG
RW
1.6433
0.7066
MSDRG
National
Average
Payment
$9,971.93
$4,773.42
MSDRG
Facility RAC Preparation Audits Coagulation Disorders (MS‐DRG 813)
–
Number 4: The same code assignment of 782.7, Spontaneous Ecchymosis was being used incorrectly for patient admitted with ecchymosis secondary to Coumadin Toxicity. Facility Discharge Summary Example
81 year old female admitted from the ER secondary to bruising as a result of
Coumadin Toxicity. Coumadin has been held. She is doing well. She got 2 units of PRBC.
Description:
PLAN:
She is to go home with her regular medications without the Coumadin and the aspirin.
Follow-up with me in the office on Monday.
IMPRESSION:
Coumadin toxicity with ecchymosis. Anemia.
CORRECT ICD-9-CM CODE ASSIGNMENT:
459.89, Other Specified Disorders of Circulatory
System; E9342, Anticoagulant Causing Adverse effects in Therapeutic use; 285.9, Unspecified
Anemia; and 99.04, Transfusion of packed cells.
CORRECT ICD-9-CM CODE ASSIGNMENT: R58, Hemorrhage, NEC ; E9342, Adverse effects of
Anticoagulants, initial encounter; D64.9, Unspecified Anemia; and Table 302- for
Administration of Transfusion
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RAC Preparation Audits Other Kidney & Urinary Tract Procedures (MS‐DRG 673‐675)
– VAD Insertion
• Perm‐A‐Cath is not a VAD. REF: (AHA Coding Clinic‐Correction‐VAD Perm‐
A‐Cath Coding Clinic 2nd Qtr 1996 Pg: 15).
• Simple Venous Catheter are inserted into a peripheral vein such as subclavian, jugular or femoral veins. Normally performed under local anesthesia by trained personnel (radiology, nursing, physician assistant or NP). – Used for Vascular Access, but on a much shorter term than VADs. – They are inserted into vein by puncture of the skin & taped in place. – Examples: Hickman, Broviac, Triple lumen, & Double lumen. REF: (AHA Coding Clinic‐VAD vs. Central Venous Catheter 1st Qtr 1996 Page: 3 to 4 & AHA Coding Clinic‐VAD & Venous Catheterization 3rd
Qtr 1991 Page: 13 to 14). RAC Preparation Audits Other Kidney & Urinary Tract Procedures (MS‐DRG 673‐675)
Facility Operative Note
Post Operative Diagnosis: Non-Hodgkin Lymphoma
Procedure: Insertion of a left subclavian vein, 8-French power port under fluoroscopy.
Description of Procedure: Under General anesthesia and after routine prep and drape of the left chest and under
fluoroscopic guidance, Percutaneous access to the subclavian vein is obtained. The guide wire is passed easily under
and we met a little bit of resistance. We pulled back the guide wire and turned it around a little bit and then it passed
easily into the SVC. After this was done, a subcutaneous pocket is created for placement of the reservoir. We then
passed the dilator over the guide wire, then we mounted the Peel-Away sheath over the dilator and passed it again and
left the Peel-Away sheath in, pulled out the dilator and the guide wire with my thumb on the opening so that we would
not get any air leakage or bleeding & then we passed the catheter, which was heparanized. We then under fluoroscopic
examination, placed it into the SVC. Please note that it measured about 15cm at the puncture site in the pectoralis
muscle. Then it was cut to length. The reservoir and the lock are applied. The reservoir is aspirated. Good blood flow
obtained. Heparin full-strength 3mL were infused and at this point the pocket is closed with subcutaneous 3-0 Vicryl and
a subcuticular interrupted 5-0 Monocryl and then Dermabond on top.
CORRECT CODE ASSIGNMENT: 86.07, Insertion of totally implantable vascular access device
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RAC Preparation Audits Other Kidney & Urinary Tract Procedures (MS‐DRG 673‐675)
Facility Operative Note
Indication for Procedure: Renal Failure
Procedure: Ultrasound guided dialysis catheter placement
Description of Procedure: The left neck was prepped and draped in usual
sterile fashion and lidocaine administered for local anesthesia. A micropuncture set
was used to gain access to the left internal jugular vein. The left internal
jugular vein was found to be patent and compressible by ultrasound. After placing a
0.035 J guide wire, vascular dilators were placed for dilation of the venotomy tract.
A # 14.5 French temporary hemodialysis catheter was then placed. The tip of the
catheter end within the superior vena cava-right atrial junction. The catheter
was sutured in position using 2-0 silk. The catheter was irrigated with sterile saline.
A sterile bandage was applied.
CORRECT CODE ASSIGNMENT: 38.95, Venous catheterization for renal dialysis
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RAC Preparation Audits Respiratory Diagnosis with Vent Support (MS‐DRG 207‐208)
– Trend # 1
• Invasive Ventilation Hours need to be reviewed & calculated carefully.
– Review ER triage sheet, ER physician assessment, physician orders, respiratory therapy notes, nursing assessment notes, progress notes, etc to verify intubation time & extubation times. • RAC Preparation Account Audit Notes to Facility
– Disagree with PPX of 96 + hours vent. Patient was intubated in ER 7/13 @ 21: 35 & family made decision to terminate ventilation 7/16 @ 09:50. Patient expired 7/16@ 17:50. This is less than 96 + Hours. This changes your MS‐DRG from 207 (RW 5.2556) to MS‐DRG 208 (RW 2.2871)
Ventilation
Respiratory Failure
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RAC Preparation Audits Respiratory Diagnosis with Vent Support (MS‐DRG 207‐208)
– Trend #2
• Sequencing of Respiratory Failure
– Our 2014 ICD‐9‐CM Coding Guidelines for Chapter 17: Injury & Poisoning
instruct us when coding poisoning or reaction to the improper use of medication (e.g., wrong dose, wrong substance, wrong route of administration) the poisoning is sequenced first, followed by a code for the manifestation. » REF: AHA Coding Clinic‐Acute Respiratory Failure due to Poisoning 3rd
Qtr 2007 Page: 7‐8
RAC Preparation Audits Respiratory Diagnosis with Vent Support (MS‐DRG 207‐208)
RAC Preparation Audits Respiratory Diagnosis with Vent Support (MS‐DRG 207‐208)
– Trend #2
• Sequencing of Respiratory Failure
Facility Coding Example
Description: Patient admitted in acute respiratory failure & was intubated and placed on the
vent in the ER. Physician final diagnostic statement states “39 year old female admitted in
respiratory failure. After long discussion with her family members it was identified that she
had been taking a significant number of medications including tramadol 18 tablets a day;
Xanax, which was not prescribed for her; as well as phendimetrazine. It was felt that
the patient had accidentially overdosed on these medications. Ventilation 12 hours.
CORRECT ICD-9 CODE ASSIGNMENT:
969.4, Poisoning by benzodiazepine based tranquelizer;
965.8, Poisoning by other specified analgesics and antipyretics; 977.0, Poisoning by dietetics;
518.81, Acute Respiratory Failure and 96.71, Ventilation less than 96 hrs
Notes: Incorrect sequencing of respiratory failure as PDX results in a MS-DRG change from MSDRG 208, Respiratory System Diagnosis with Ventilator Support less than 96 hours (RW 2.2871)
to the correct MS-DRG of 917, Poisoning & Toxic Effects of Drugs with MCC (RW 1.4093).
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RAC Preparation Audits Respiratory Diagnosis with Vent Support (MS‐DRG 207‐208)
– Trend #2
Facility Coding Example
Description: Patient admitted in acute respiratory failure & was intubated and placed on the
vent in the ER. Physician final diagnostic statement states “39 year old female admitted in
respiratory failure. After long discussion with her family members it was identified that she
had been taking a significant number of medications including tramadol 18 tablets a day;
Xanax, which was not prescribed for her; as well as phendimetrazine. It was felt that
the patient had accidentially overdosed on these medications. Ventilation 12 hours.
CORRECT ICD-10-CM CODE ASSIGNMENT: T40.4X1A, Poisoning by other synthetic narcotics,
accidental (unintentional), initial encounter; T42.4X1A, Poisoning by benzodiazepines,
accidental (unintentional), initial encounter and antipyretics; T50.5X1A, Poisoning by appetite
depressants, accidental (unintentional), initial encounter; J96.00, Acute respiratory failure,
unspecified whether with hypoxia or hypercapnia and 5A1935Z, Respiratory Ventilation,
Less than 24 Consecutive Hours
Notes: Incorrect sequencing of respiratory failure as PDX results in a MS-DRG change from MSDRG 208, Respiratory System Diagnosis with Ventilator Support less than 96 hours (RW 2.2871)
to the correct MS-DRG of 917, Poisoning & Toxic Effects of Drugs with MCC (RW 1.4093).
RAC Preparation Audits Respiratory Diagnosis with Vent Support (MS‐DRG 207‐208)
– Trend #2
• Sequencing of Respiratory Failure
– 2014 ICD‐9‐CM Coding Guidelines for Chapter 1: Infectious & Parasitic Diseases (b) Septicemia, SIRS, Sepsis, Severe Sepsis, & Septic Shock
» If Sepsis or severe sepsis is POA & meets the definition of principal diagnosis, the system infection code (e.g., 038.xx, 112.5,etc.) should be assigned as the principal diagnosis, followed by code 995.91, Sepsis or 995.92, Severe sepsis, as required by the sequencing rules in the ICD‐9‐
CM Tabular List.
• RAC Preparation Account Audit Notes to Facility
– Disagree with PDX of acute respiratory failure. Patient was admitted with acute respiratory failure & acute renal failure secondary to septicemia. The sepsis stems from his cellulitis of the lower leg & pneumonia. Coding clinic guidelines state sequence 038.XX first followed by acute organ dysfunction, infections, and severe sepsis code. This changes your MS‐DRG from 208 (RW 2.2871) to 871 (RW 1.4093).
RAC Preparation Audits • Respiratory Diagnosis with Vent Support (MS‐DRG 207‐208)
– Trend #2
• Sequencing of Respiratory Failure
– 2014 ICD‐9‐CM Coding Guidelines for Chapter 1: Infectious & Parasitic Diseases (b) Septicemia, SIRS, Sepsis, Severe Sepsis, & Septic Shock
» If the septicemia is determined to be due to a postprocedural infection the complication code such as 998.59, Other postoperative infection should be coded first followed by the appropriate sepsis code. – If the diagnosis of sepsis is used interchangeably with the diagnosis of urosepsis, UTI, &/or bacteremia a query needs to be placed to verify the conflicting documentation. 15
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ICD‐10‐CM Guidelines • Respiratory Diagnosis with Vent Support (MS‐DRG 207‐208)
RAC Preparation Audits • Percutaneous Non‐Drug Eluting Stent with MCC or 4+ Vessels/Stent (MS‐DRG 248)
– If a patient is admitted with an acute MI and found to have newly diagnosed CAD or a HX of CAD the acute MI is always sequenced as your primary diagnosis.
• The improper sequencing of CAD as primary with a MCC of MI used as your secondary diagnosis
–
MS‐DRG 248, Percutaneous Cardiovascular Procedure with Non Drug Eluting Stent with MCC or 4 + Vessels/Stents (RW 2.9479).
• If sequenced correctly with the MI diagnosis used as your primary
– MS‐DRG 249, Percutaneous Cardiovascular Procedure with Non Drug‐Eluting Stent without MCC (RW 1.8245)
• REF: (AHA Coding Clinic‐Acute MI 4th Quarter 2005 Page: 69 to 72)
RAC Preparation Audits • Percutaneous Non‐Drug Eluting Stent with MCC or 4+ Vessels/Stent (MS‐DRG 248)
– Determining if a stent is non‐drug eluting or drug eluting can be difficult to determine when the physician only states the brand of stent used. • Common stents identified as drug eluting: Endeavor, Promus, Cypher, & Xience. • Common stents identified as non‐drug eluting: Vision, Medtronic Driver, Liberte, & Veriflex. – MS‐DRG 248‐Percutaneous Cardiovascular Procedure with Non‐Drug Eluting Stent with MCC or 4+ Vessels/Stents (RW 2.9479)
– MS‐DRG 246‐Percutaneous Cardiovascular Procedure with Drug‐Eluting Stent with MCC or 4+ Vessels/Stents (RW 3.183)
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Coronary Artery Disease
Myocardial Infarction
Myocardial Infarction
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Coronary Angioplasty
Coronary Angioplasty
Coronary Angioplasty
Dilation
18