Let’s Play APR DRG! - ACDIS · CHF NYHA Class 4D • Unable to carry on physical activity without discomfort – Debility – Skin breakdown due to pressure – DVT or PE 2017

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Let’s Play APR‐DRG!

Candace Blankenship, BSN, RN, CCDSMember of Maryland ACDIS

Deborah Neville, RHIADirector, Revenue Cycle, Coding and Compliance, Elsevier

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• At the completion of this educational activity, learners will be able to improve their CDI practice through:

– Identification and capture of secondary diagnoses that influence quality scores for the primary surveillance DRGs of CHF, COPD, pneumonia, CVA, and AMI

– Identification and capture of secondary diagnoses that influence quality scoring for the surgical patient population

– Development of APR‐DRG profile tools for their practice’s most frequent DRGs that will focus their chart review and supply data for provider education and EMR management

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How many of you have received formal training in APR‐DRG?

2017 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved. These materials may not be copied without written permission.

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So Why Do We Think We Can Help Other CDI Specialists With APR‐DRG Scoring?

• Elsevier has a long history of providing education to the healthcare workforce.

• Maryland ACDIS members have a unique practice.

• Maryland uses only APR‐DRG for both reimbursement and quality scoring. And Maryland scores for ALL PAYERS, not just Medicare patients.

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Let’s PlayAPR-DRG!Let’s PlayAPR-DRG!

SOI

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ROM4

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• In MS‐DRG, you get one chance to impact the relative weight and LOS for the assigned DRG

MS‐DRGMS‐DRG

CC/MCCCC/MCC


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• In APR‐DRG, you get 69,000 chances to change the relative weight, LOS, and quality scores for the assigned DRG

APR‐DRGAPR‐DRG

25Secondary Diagnoses

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An APR‐DRG chart review takes longer than

a MS‐DRG chart review.

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ED Record72‐year‐old female presents to ED complaining of symptoms of dysuria, fever, and AMS. Admitted for AMS and treatment of UTI.

History & Physical

Labs: UC: E. coli

PMH:Hypothyroid

Home Rx: Synthroid

Assessment Plan:UTI. Culture + for E. coli. Continue antibiotics. Consult ID. Negative for hematuria.AMS. Likely due to UTI.Looks dry. Continue gentle IV hydration.Hypothyroid. Continue Synthroid.

Discharge SummaryAMS has resolved. Continue on oral abx.Follow‐up outpatient with PCP.

Case Study

QUERY


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APR‐DRG Analysis

APR 463 Kidney UTI

Weight 0.5524

ALOS 3.33

SOI 2 Moderate

ROM 2 Minor

Principal Diagnosis

N390 Urinary tract infection, site not specified

Secondary Diagnosis SOI ROM

B9620 Unspecified E. coli cause of disease

G9341 Metabolic encephalopathy

1 Minor

3 Major

1 Minor

3 Major

E039 Hypothyroidism, unspecified 1 Minor 1 Minor

MS‐DRG

MS‐DRG 689 Kidney/UTI with MCC

Weight 1.0649

ALOS 4.9

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ED Record72‐year‐old female presents to ED complaining of symptoms of dysuria, fever, and AMS. Admitted for AMS and treatment of UTI.

History & Physical

Labs: UC: E. coli

PMH:Hypothyroid

Home Rx: Synthroid

Assessment Plan:UTI. Culture + for E. coli. Continue antibiotics. Consult ID. Negative for hematuria.AMS. Likely due to UTI.Looks dry. Continue gentle IV hydration.Hypothyroid. Continue Synthroid.

Discharge SummaryAMS has resolved. Continue on oral abx.Follow‐up outpatient with PCP.

Case Study

QUERY

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APR‐DRG Analysis

APR 463 Kidney UTI

Weight 0.7673

ALOS 4.61

SOI 3 Major

ROM 3 Major

Principal Diagnosis

N390 Urinary tract infection, site not specified


B9620 Unspecified E. coli cause of disease

G9341 Metabolic encephalopathy

E870 Hypernatremia

E860 Dehydration

1 Minor

3 Major

2 Mod

2 Mod

1 Minor

3 Major

3 Major

1 Minor

E039 Hypothyroidism, unspecified 1 Minor 1 Minor

MS‐DRG

MS‐DRG 689 Kidney/UTI with MCC

Weight 1.0649

ALOS 4.9


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• Dehydration increases SOI for patients > 70

• Dehydration w/electrolyte abnormality increases ROM

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APR‐DRG provides an accurate description of the complicated patient.

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What Motivates Me?

Acute on Chronic Systolic CHF Relative Wgt ALOS

MS‐DRG 293 Heart Failure & Shock w/o CC/MCC

0.6618 3.0

APR‐DRG 194 Heart Failure 0.5044 2.79


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Build an APR‐DRG profile for your most frequently occurring primary DRGs.

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Congestive Heart Failure

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QUERY YOURSELFThe patient has a current documented diagnosis of CHF. Based on your many years of clinical experience caring for patients with CHF, could you further describe the patient for the coder?


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Heart Failure Classification

Class Patient Symptoms

INo limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath).

IISlight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea(shortness of breath).

III Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea.

IVUnable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.

Class Objective Assessment

A No objective evidence of cardiovascular disease. No symptoms and no limitation in ordinary physical activity.

BObjective evidence of minimal cardiovascular disease. Mild symptoms and slight limitation during ordinary activity. Comfortable at rest.

CObjective evidence of moderately severe cardiovascular disease. Marked limitation in activity due to symptoms, even during less than ordinary activity. Comfortable only at rest.

D Objective evidence of severe cardiovascular disease. Severe limitations. Experiences symptoms even while at rest.

American Heart Association http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure

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CHF NYHA Class 4D

• Unable to carry on any physical activity without discomfort

• Symptoms of heart failure at rest

• If any physical activity is undertaken, discomfort increases

• Objective evidence of severe cardiovascular disease

• Severe limitations

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CHF NYHA Class 4D

• Unable to carry on physical activity without discomfort

– Debility

– Skin breakdown due to pressure

– DVT or PE


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APR‐DRG Analysis

DRG 194 Heart Failure

Weight 0.5044

ALOS 2.79

SOI 1 Minor

ROM 1 Minor

MS‐DRG Analysis

DRG 293 Heart Failure & Shock (without CC/MCC)

Weight 0.6618

ALOS 3.0

Principal Diagnosis

I5023 Acute on chronic systolic (congestive) heart failure


R5381 Other malaise 1 Minor* 1 Minor

CHF NYSE Class 4D

* Denotes that this secondary diagnosis will have a direct impact on the primary DRG scoring.

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Not every secondary diagnosis will impact your primary APR‐DRG.

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CHF NYHA Class 4D

• Symptoms of heart failure at rest Edema

Ascites/anasarca

NSVT

Weight loss/cardiac cachexia

Unstable angina

Ischemic cardiomyopathy

Home O2 use


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APR‐DRG Analysis


Weight 0.6477

ALOS 3.64

SOI 2 Moderate

ROM 2 Moderate

MS‐DRG Analysis

DRG 293 Heart Failure & Shock (with CC)

Weight 0.9574

ALOS 4.3

Principal Diagnosis



I472 Ventricular tachycardia 3 Major* 3 Major*

I255 Ischemic cardiomyopathy 2 Mod* 1 Minor

I200 Unstable angina 1 Minor 1 Minor*

R5381 Other malaise 1 Minor 1 Minor

R600 Localized edemaR634 Abnormal weight loss

1 Minor1 Minor

1 Minor1 Minor

CHF NYHA Class 4D

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PrimaryDRG

CC or MCC

Secondary diagnoses that directly impact the primary DRG

Secondary diagnoses that do not directly impact the primary DRG

In the APR‐DRG grouper, secondary diagnoses are arranged in a hierarchy

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CHF NYHA Class 4D

• If any physical activity is undertaken, discomfort increases

• Objective evidence of severe cardiovascular disease: Pulmonary HTN

Valvular heart disease

Chronic passive congestion of liver

CKD

Cardiorenal syndrome

Demand ischemia

Electrolyte abnormalities

Metabolic alkalosis with respiratory acidosis


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APR‐DRG Analysis


Weight 0.9660

ALOS 5.28

SOI 3 Major

ROM 3 Major

MS‐DRG Analysis

DRG 293 Heart Failure & Shock (with CC)

Weight 0.9574

ALOS 4.3

Principal Diagnosis




E874Mixed disorder of acid‐base 3 Major* 3 Major*

I272 Other secondary pulm HTN 2 Mod * 2 Mod *

E878 Other d/o of electrolyte bal 2 Mod* 2 Mod*

K761 Chronic passive liver cong 1 Minor 2 Mod*

N183 CKD, stage 3 (moderate) 1 Minor 2 Mod*

E871 Hypo‐osmo and hyponatrem 2 Mod* 1 Minor

E8342 Hypomagnesemia 2 Mod* 1 Minor


I248 Other forms of acute ischheart dz

1 Minor 2 Mod*


R600 Localized edema 1 Minor 1 Minor

R634 Abnormal weight lossI081 Rheum d/o of both mitral/tri

1 Minor2 Mod

1 Minor1 Minor

CHF NYHA Class 4D

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Cardiogenic Shock

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APR‐DRG Analysis


Weight 1.8244

ALOS 8.76

SOI 4 Extreme

ROM 4 Extreme

MS‐DRG Analysis

DRG 293 Heart Failure & Shock (with MCC)

Weight 1.4796

ALOS 5.8

Principal Diagnosis



R570 Cardiogenic shock 4 Extreme 4 Extreme


E874 Mixed disorder of acid‐base 3 Major* 3 Major*

I272 Other secondary pulm HTN 2 Mod * 2 Mod *

E878 Other d/o of electrolyte bal 2 Mod* 2 Mod*

K761 Chronic passive liver cong 1 Minor 2 Mod*

N183 CKD, stage 3 (moderate) 1 Minor 2 Mod*

E871 Hypo‐osmo and hyponatrem 2 Mod* 1 Minor



I248 Other forms of acute ischheart dz

1 Minor 2 Mod*



CHF NYHA Class 4D


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Some secondary diagnoses are considered integral to the primary APR‐DRG by the provider and are often not documented as separate conditions.

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Alarm fatigue in both the providers and nursing staff prevents accurate documentation of arrhythmias and electrical conduction defects.

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APR‐DRG Analysis


Weight 0.9660

ALOS 5.28

SOI 3 Major

ROM 3 Major

MS‐DRG Analysis

DRG 293 Heart Failure & Shock (with MCC)

Weight 1.4796

ALOS 5.8

Principal Diagnosis



R570 Cardiogenic shock 4 Extreme 4 Extreme

I255 Ischemic cardiomyopathy 2 Mod 1 Minor

N183 CKD, stage 3 (moderate) 1 Minor 2 Mod

I248 Other forms of acute ischemic heart disease

1 Minor 2 Mod



I12.9 Hypertensive with CKD stage 1–4 or unspecified CKD

1 Minor 1 Minor

CHF NYHA Stage 4D


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Unable to carry out physical activity without discomfort:Debility clinical indicators:

• Provider documentation of condition of debility• PT/OT consult: Order indication, PT/OT assessment• Nursing staff documentation of Braden score

Skin breakdownclinical indicators:

• Provider documentation of skin interruption (weeping, ulcer, etc.)• Nursing skin assessment/Braden score • Wound nurse consult: Order indication, assessment

DVT or PEclinical indicators:

• Initial provider exam documenting unilateral extremity swelling• Vascular studies: Order indication and final report CT chest or VQ

scan: Order indication and final report

CHF APR‐DRG Profile

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Symptoms of heart failure at rest: (1 of 2)Edema • Provider documentation of edema in exam portion of H&P

• Ascites/anasarca• Provider documentation of anasarca in exam portion of H&P• Ascites noted as an incidental finding in CT chest or CXR report• Indicator for IR paracentesis order

NSVT/arrhythmias: • Provider documentation of arrhythmia event• Nursing documentation of arrhythmia event• AICD/PPM interrogation recording 12‐lead EKG• Cath lab event log

Unintentional wgt loss/cardiac cachexia:

• Provider documentation in the exam section or problem list of the H&P

• Admission nursing assessment, nutritional section• Nursing documentation for % meal intake• Nutritionist consult: Order indication and assessment• Diet order (calorie count, increase protein, supplements)• Admission serum albumin or prealbumin• BMI (admission and dry wgt)• PT/OT assessment of muscle strength

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Symptoms of heart failure at rest: (2 of 2)Unstable angina: • Provider documentation of condition of unstable angina

• Provider documentation of chest pain at rest• Indicator on anti‐anginals (ranexa, isosorbide, etc.)

Ischemic cardiomyopathy:

• Provider documentation of ischemic cardiomyopathy, cardiomyopathy, cardiomegaly, or LVH with hx of CAD

• CXR report documenting cardiomegaly• EKG report indicating LVH• Cath lab report indicating CAD, cardiomyopathy• Echo report documenting cardiomyopathy or LVH

Home O2 use: • Provider documenting home O2 use, chronic respiratory failure• Admission nursing assessment indicating DME of home O2• Nursing documentation of patient’s need for supplemental O2

use to maintain O2 saturations


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Objective evidence of severe cardiovascular disease: (1 of 3)Pulmonary HTN: • Provider documentation of pulmonary HTN, PH, PHTN

• Provider documentation of OSA/CPAP use (etiology of condition)• Provider documentation of right heart failure• CXR report documenting enlarged pulmonary arteries, enlarged

right atrium• 12‐lead EKG documents right axis deviation, right atrial

enlargement, RBBB• Echo documents tricuspid regurgitation, right ventricular

hypertrophy, elevated pulmonary pressure• Right heart cath documents pulmonary hypertension, elevated

pulmonary pressures

Valvular heart disease:

• Provider documentation of valvular heart disease in H&P, progress notes

• Provider documents murmur in exam section of H&P• Echo documents valvular regurgitation or stenosis

Chronic passive liver congestion:

• Provider documentation of chronic passive congestion of liver• Elevation of AST/ALT with no documented underlying liver disease

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Objective evidence of severe cardiovascular disease: (2 of 3)CKD: • Provider documentation of CKD (stage defined for coder)

• Nephrology consult indication and assessment• Laboratory results document a consistent GFR of less than 60

Cardiorenal syndrome:

• Provider documentation of cardiorenal syndrome or CHF with CKD

• Nephrology consult indication and assessment• Clinical results indicating EF < 50% and GFR < 60

Demand ischemia: • Provider documentation of demand ischemia, elevation of troponin, troponemia

• Laboratory results document abnormal troponin levels

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Objective evidence of severe cardiovascular disease: (3 of 3)Electrolyte abnormality:

• Provider documentation of hypo/hypernatremia, hypo/hyperkalemia, hypomagnesia, hypo/hyperphosphatemia, hypochloremia

• Provider documents indication for electrolyte replacement• Provider orders electrolyte replacement (no codeable indicator)• Laboratory report documents electrolyte abnormality

Metabolic alkalosisMetabolic acidosisRespiratory alkalosis Respiratory acidosis

• Provider documentation of metabolic alkalosis, metabolic acidosis, respiratory alkalosis, respiratory acidosis, mixed acid‐base disorder, alkalemia, lactic acidosis

• ABG or VBG documents abnormal pH or HCO3• Laboratory report documents abnormal serum CO2, abnormal

chloride, abnormal lactic acid


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COPD

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End‐Stage COPD

• Chronic cough

• Difficulty finishing a meal due to shortness of breath

• Sudden, acute exacerbations, or worsening of the condition

• Hypoxia

• Oxygen dependence

• SOB with moderate activity

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APR‐DRG Analysis

DRG 140 COPD

Weight 0.8480

A LOS 4.69

SOI 3 Major

ROM 3 Major

MS‐DRG Analysis

DRG 191 COPD w/CC

Weight 0.9184

A LOS 4.0

Principal Diagnosis

J441 Chronic obstructive pulmonary disease with acute exac

Secondary Dx SOI ROM

J9611 Chronic respiratory failure 3 Major* 2 Mod*

R64 Cachexia 2 Mod* 3 Major*

Z9981 Dependence on supplemental oxygen

2 Mod* 2 Mod*

Z681 Body mass index 19 or less 1 Minor 1 Minor

J209 Acute bronchitis, unspecified 1 Minor 1 Minor

J440 Chronic obstructive pulmonarydisease with LRI

X X

End‐Stage COPD


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APR‐DRG Analysis

DRG 140 COPD

Weight 0.8480

ALOS 4.69

SOI 3 Major

ROM 3 Major

MS‐DRG Analysis

DRG 191 COPD w/CC

Weight 0.9184

ALOS 4.0

Principal Diagnosis



J9611 Chronic respiratory failure 3 Major* 2 Mod


E870 Hyperosmo and hypernatremia 2 Mod* 3 Major*

I471 Supraventricular tachycardia 2 Mod* 1 Minor

E1165 Type 2 DM with hyperglycemia 2 Mod* 2 Mod

I4510 Unspecified RBBB 1 Minor 2 Major

M810 Osteoporosis 1 Minor 1 Minor

Z7952 Long term steroid use 1 Minor 1 Minor

E785 Hyperlipidemia 1 Minor 1 Minor

R64 Cachexia 2 Mod* 3 Major

F17213 Nicotine depend, w/d 1 Minor 1 Minor


2 Mod 2 Mod




X X

End‐Stage COPD

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The status of a secondary diagnosis that directlyinfluences the primary APR‐DRG is fluid. It can be elevated or demoted based on the complexity of the patient.

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APR‐DRG Analysis

DRG 140 COPD

Weight 0.8480

ALOS 4.69

SOI 3 Major

ROM 4 Extreme

MS‐DRG Analysis

DRG 191 COPD w/MCC

Weight 1.1481

ALOS 4.8

Principal Diagnosis



J9622 Acute and chronic resp failure 4 Extreme 4 Extreme


I471 Supraventricular tachycardia 2 Mod* 1 Minor

E1165 Type 2 DM with hyperglycemia 2 Mod* 2 Mod

I4510 Unspecified RBBB 2 Mod 1 Minor

M810 Osteoporosis 1 Minor 1 Minor

Z7952 Long term steroid use 1 Minor 1 Minor


R64 Cachexia 2 Mod* 3 Major*

F17213 Nicotine depend, w/d 1 Minor 1 Minor


2 Mod* 2 Mod*




X X

End‐Stage COPD


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Pneumonia

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• Coding Clinic, Third Quarter 2016

• Not a chronic illness

• Not a predictable disease based on comorbidities

• Simple versus complex

• Anticipated elimination of the simple sepsis dx

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APR‐DRG Analysis

DRG 140 COPD

Weight 0.8480

ALOS 4.69

SOI 3 Major

ROM 3 Major

MS‐DRG Analysis

DRG 190 COPD W/MCC

Weight 1.1481

ALOS 4.8

Principal Diagnosis

J440 COPD with acute lower respiratory infection


J159 Unspecified bacterial pneumonia 3 Major* 3 Major*

E870 Hyperosmolality and hypernatremia

2 Mod* 3 Major*

E860 Dehydration 2 Mod* 1 Minor

J441 COPD with acute exacerbationR0902 HypoxemiaY95 Nosocomial condition

X1 Minor1 Minor

X1 Minor1 Minor

Pneumonia With COPD Exacerbation


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APR‐DRG Analysis

DRG 139 Other Pneumonia

Weight 0.6031

ALOS 3.61

SOI 2 Moderate

ROM 2 Moderate

MS‐DRG Analysis

DRG 194 Simple Pneumonia w/CC

Weight 0.9469

ALOS 4.3

Principal Diagnosis

J159 Unspecified bacterial pneumonia


E870 Hyperosmolality and hypernatremia

2 Mod* 3 Major*

E860 Dehydration 2 Mod 1 Minor

R0902 Hypoxemia 1 Minor 1 Minor

Y95 Nosocomial condition 1 Minor 1 Minor

Pneumonia

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CVA

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APR‐DRG Analysis

DRG 045 CVA w/Infarct

Weight 0.8929

ALOS 3.57

SOI 2 Moderate

ROM 1 Minor

MS‐DRG Analysis

DRG 065 CVA w/CC

Weight 1.0431

ALOS 4.0

Principal Diagnosis

I63232 Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries


G8191 Hemiplegia, unsp affect rt 2 Mod* 1 Minor*

R1311 Dysphagia, oral phase 2 Mod 1 Minor

R1312 Dysphagia, oropharyngealphase

2 Mod 1 Minor

I160 Hypertensive urgency 1 Minor 1 Minor


R471 Dysarthria 1 Minor 1 Minor

R29810 Facial weakness 1 Minor 1 Minor

R29710 NIHSS score 10 1 Minor 1 Minor

CVA


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NIHSS scoring does not improve your SOI or ROM scoring.

Glasgow Coma Scale has a significant impact on SOI and ROM scoring when documented in its 3 parts.

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APR‐DRG Analysis

DRG 045 CVA W Infarct

Weight 1.2875

ALOS 5.69

SOI 3 Moderate

ROM 2 Moderate

MS‐DRG Analysis

DRG 065 CVA w/CC

Weight 1.0431

ALOS 4.0

Principal Diagnosis




I119 Hypertensive heart disease w/o heart failure

1 Minor 2 Mod*

I471 Supraventricular Tach 2 Mod* 1 Minor

I4510 Unspecified right bundlebranch block

1 Minor 2 Mod*

R1312 Dysphagia, oral phase 2 Mod* 1 Minor

R1312 Dysphagia, oropharyngeal phase 2 Mod* 1 Minor

I071 Rheumatic tricuspid insuff 2 Mod* 1 Minor

F17213 Nicotine dependence,cigarettes with withdrawal

1 Minor 1 Minor






CVA

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Secondary diagnoses that describe conditions outsideof the primary APR‐DRG’s body system will have a greater impact on SOI and ROM scores.


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AMI

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APR‐DRG Analysis

DRG AMI

Weight 1.1927

ALOS 5.18

SOI 3 Moderate

ROM 3 Moderate

MS‐DRG Analysis

DRG AMI w/CC

Weight 0.9968

ALOS 3.4

Principal Diagnosis

I2119 ST elevation (STEMI) myocardial infarction involvingother coronary artery of inferior wall





E1165 T2 DM with hyperglycemia 2 Mod* 2 Mod*

I119 Hypertensive heart diseasew/o HF

1 Minor 2 Mod*

E785 Hyperlipidemia, unspec 1 Minor 1 Minor

E876 Hyperkalemia 1 Minor 1 Minor

AMI

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APR‐DRG and the Surgical Patient


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APR‐DRG Analysis

DRG Appendectomy

Weight 0.8215

ALOS 1.48

SOI 1 Minor

ROM 1 Minor

MS‐DRG Analysis

DRG Appendectomy

Weight 1.0198

ALOS 2.0

Principal Diagnosis

K3580 Unspecified acute appendicitis


E669 Obesity, unspecified 1 Minor 1 Minor

Z6835 Body mass index (BMI) 35 1 Minor 1 Minor

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APR‐DRG Analysis

DRG Major Joint w/o MCC

Weight 1.6732

ALOS 3.43

SOI 2 Moderate

ROM 1 Minor

MS‐DRG Analysis


Weight 2.0671

ALOS 2.9

Principal Diagnosis

M1612 Unilateral primary OA, left hip


E669 Obesity, unspecified 2 Mod* 1 Minor*


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• The secondary diagnosis of obesity has an impact on risk adjustment scoring for the abdominal surgical patient

• The secondary diagnosis of obesity has an impact on the SOI/ROM for the surgical hip patient


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A robust EMR is your best hope for accurate documentation for the surgical patient population.

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APR‐DRG Analysis

DRG Appendectomy

Weight 1.0925

ALOS 3.61

SOI 2 Minor

ROM 1 Minor

MS‐DRG Analysis

DRG Appendectomy

Weight 1.0198

ALOS 2.0

Principal Diagnosis

K3580 Unspecified acute appendicitis


E8351 Hypocalcemia 2 Mod* 1 Minor*

E669 Obesity, unspecified 1 Minor 1 Minor


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With the exception of hypokalemia, electrolyte imbalances will impact the SOI/ROM of the general surgical patient.


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APR‐DRG Analysis


Weight 1.6732

ALOS 3.43

SOI 2 Moderate

ROM 1 Minor

MS‐DRG Analysis


Weight 2.0671

ALOS 2.9

Principal Diagnosis





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APR‐DRG Analysis


Weight 2.2895

ALOS 4.71

SOI 3 Major

ROM 2 Moderate

MS‐DRG Analysis


Weight 2.0671

ALOS 2.9

Principal Diagnosis





I081 Rheumatic d/o of mitr/tric 2 Mod* 1 Minor

I119 HTN heart dz w/o HF 1 Minor 2 Mod*

I447 Left bundle‐branch blk 1 Minor 2 Mod*

E8351 Hypocalcemia 2 Mod* 1 Minor

I2510 Atherosclerotic heart dz 1 Minor 1 Minor

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Create internal coding guidelines that define the coding validity of preadmission provider notes.


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APR‐DRG Analysis


Weight 0.8929

ALOS 3.57

SOI 2 Moderate

ROM 1 Minor

MS‐DRG Analysis

DRG 065 CVA w/CC

Weight 1.0431

ALOS 4.0

Principal Diagnosis




R1311 Dysphagia, oral phase 2 Mod 1 Minor

R1312 Dysphagia, oropharyngealphase

2 Mod 1 Minor






CVA

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APR‐DRG Analysis


Weight 1.2875

ALOS 5.69

SOI 3 Moderate

ROM 2 Moderate

MS‐DRG Analysis

DRG 065 CVA w/CC

Weight 1.0431

ALOS 4.0

Principal Diagnosis




I119 Hypertensive heart disease w/o heart failure

1 Minor 2 Mod*

I471 Supraventricular Tach 2 Mod* 1 Minor

I4510 Unspecified right bundlebranch block

1 Minor 2 Mod*

R1312 Dysphagia, oral phase 2 Mod* 1 Minor

R1312 Dysphagia, oropharyngeal phase 2 Mod* 1 Minor


F17213 Nicotine dependence,cigarettes with withdrawal

1 Minor 1 Minor






CVA

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APR‐DRG Analysis


Weight 1.6732

ALOS 3.43

SOI 2 Moderate

ROM 1 Minor

MS‐DRG Analysis


Weight 2.0671

ALOS 2.9

Principal Diagnosis






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APR‐DRG Analysis

DRG Appendectomy

Weight 1.6732

ALOS 3.43

SOI 2 Minor

ROM 1 Minor

MS‐DRG Analysis

DRG Appendectomy

Weight 1.0198

ALOS 2.0

Principal Diagnosis

M1612 Unilateral primary OA left hip


E8351 Hypocalcemia 2 Mod* 1 Minor

E669 Obesity, unsp 2 Mod 1 Minor


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APR‐DRG Analysis

DRG Appendectomy

Weight 1.6732

ALOS 3.43

SOI 2 Minor

ROM 1 Minor

MS‐DRG Analysis

DRG Appendectomy

Weight 1.0198

ALOS 2.0

Principal Diagnosis



F3340 MDD, recurrent, remission 2 Mod* 1 Minor

E8351 Hypocalcemia 2 Mod 1 Minor



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APR‐DRG Analysis

DRG Appendectomy

Weight 1.6732

ALOS 3.43

SOI 2 Minor

ROM 2 Minor

MS‐DRG Analysis

DRG Appendectomy

Weight 1.0198

ALOS 2.0

Principal Diagnosis



E1140 T2 DM with neuropathy 2 Mod 2 Mod*

F3340 MDD, recurrent, remission 2 Mod 1 Minor

E8351 Hypocalcemia 2 Mod 1 Minor




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It is harder to move the SOI/ROM scores on a same‐day surgical patient then it is to move the SOI/ROM scores on a medical admission.

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Handouts

• As you entered the presentation, a Maryland ACDIS member gave you an APR‐DRG tip card and a hard copy of the CHF APR‐DRG profile. We hope that these tools will help strengthen your CDI practice.

• More copies are available at the Elsevier booth in the exhibit hall.

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Thank you. Questions?

[email protected]

In order to receive your continuing education certificate(s) for this program, you must complete the online evaluation. The link can be found in the continuing education section at the front of the program guide.


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Documents

Let’s Play APR DRG! - ACDIS · CHF NYHA Class 4D • Unable to carry on physical activity without discomfort – Debility – Skin breakdown due to pressure – DVT or PE 2017