MS DRG of the Week: MS-DRG 343: Appendectomy without Complicating Principal Diagnosis

Sep 22 2011 12:17 PM

Change the Principal diagnosis

· Alternate principal diagnoses that will lead to "Appendectomy with Complicated Principal Diagnosis" (DRG 340) include 540.0 Appendicitis with peritonitis, 540.1 Appendicitis with perforation, 153.5 Malignant neoplasm of appendix, and 209.11 Malignant carcinoid tumor of appendix

CC Conditions

· 789.59 Ascites → DRG 342

· 751.5 Congenital anomaly of intestine → DRG 342

· 568.82 Chronic peritoneal effusion (Serositis codes to this) → DRG 342

· 428.42 Chronic systolic and diastolic heart failure → DRG 342

· 401.0 Malignant hypertension → DRG 342

· 997.4 Digestive system complication → DRG 342

· 599.0 Urinary tract infection → DRG 342

· 560.1 Ileus → DRG 342

· 997.1 Cardiac complication → DRG 342

· V85.0 BMI <19, adult → DRG 342

MCC Conditions

· 567.29 Suppurative peritonitis → DRG 341

· 518.5 Pulmonary insufficiency following surgery → DRG 341

· 428.31 Acute diastolic heart failure → DRG 341

Add a procedure

· 54.51 Laparoscopic lysis of adhesions → DRG 337

· 17.39 Laparoscopic partial excision of large intestine → DRG 331

Discussion

· The ICD-9-CM Alphabetic index directs "Fluid - abdomen" and "Fluid - peritoneal cavity" to 789.59 Ascites, a frequently coded secondary diagnosis. If the attending physician documents abdominal or peritoneal fluid and that fluid meets coding criteria for significance, 789.59 can be coded without query for the term "ascites."

· The operative notes are rich sources of significant secondary diagnoses and possibly uncoded procedures. Documentation of peritonitis or perforation in the Op Note may permit selection of a more specific principal diagnosis including one of those complications.