The Diagnosis Related Group (DRG):
A patient classification system, which provides a means of relating the type of patients a hospital treats to the costs incurred by the hospital.
There are currently three major versions of the DRG in use: Basic DRGs, All Patient DRGs, and All Patient Refined DRGs.
The basic DRGs are used by CMS for hospital payment for Medicare beneficiaries.
The All Patient DRGs (AP-DRGs) are an expansion of the basic DRGs to be more representative of non-Medicare populations such as pediatric patients.
The All Patient Refined DRGs (APR-DRG) incorporate SOI into the AP-DRGs.
DRGs will be affected by Principle Diagnosis, MCC (Major complications or comorbidities), CC (Complications or comorbidities), Age, Gender, Principle Procedure etc.
In brief Principal Diagnosis represents the main cause of admission of a patient to the hospital for treatment.
Complication: Complication is a condition that arises during the hospital stay that prolongs the length of stay of a patient.
Co-morbidity: Pre-existing condition that affects the treatment received and/or prolongs the length of stay.
A patient classification system, which provides a means of relating the type of patients a hospital treats to the costs incurred by the hospital.
There are currently three major versions of the DRG in use: Basic DRGs, All Patient DRGs, and All Patient Refined DRGs.
The basic DRGs are used by CMS for hospital payment for Medicare beneficiaries.
The All Patient DRGs (AP-DRGs) are an expansion of the basic DRGs to be more representative of non-Medicare populations such as pediatric patients.
The All Patient Refined DRGs (APR-DRG) incorporate SOI into the AP-DRGs.
DRGs will be affected by Principle Diagnosis, MCC (Major complications or comorbidities), CC (Complications or comorbidities), Age, Gender, Principle Procedure etc.
Principle Diagnosis: Also called as PDx, the condition established after study to be chiefly responsible for occasioning the ADMISSION of the patient to the HOSPITAL for care.
In brief Principal Diagnosis represents the main cause of admission of a patient to the hospital for treatment.
Complication: Complication is a condition that arises during the hospital stay that prolongs the length of stay of a patient.
Co-morbidity: Pre-existing condition that affects the treatment received and/or prolongs the length of stay.
MCC: Also called as Major complications or comorbidities. Ex: Acute
CVA / Stroke / Cerebral Infarct or Hemorrhage, Acute
MI, Pulmonary Embolism, Decubitus Ulcer, Diabetic Ketoacidosis, Encephalopathy – Metabolic, Toxic, ESRD, GI Disorder w/ Hemorrhage, Malnutrition, Pneumonia, Respiratory Failure, Sepsis, Severe Sepsis, Septic Schock etc. (Please follow CMS guidelines for annual update of MCC list)
CC: Also called as Complications or comorbidities. Ex: ABLA (Acute blood loss anemia), Acidosis, Ascites, Cachexia, Cardiomyopathy (non-ischemic), Cellulitis, Crohn’s Disease, Diverticulitis, Esophagitis, Hemiplegia, Hypernatremia / Hyponatremia, Ileus, Pyelonephritis, UTI etc. (Please follow CMS guidelines for annual update of MCC list)
Useful info. Keep posting more information related to inpatient coding.
ReplyDeleteThanks for your support. I will update as much information as I can related to IP-DRG medical coding.
Delete