MS DRG of the Week: MS DRG 812 Red Blood Cell Disorders without MCC

Change the Principal diagnosis

DRG 812 has been changed far more often by changing the principal diagnosis than by adding a secondary diagnosis. This is probably   because an MCC is required to change the Red Blood Cell Disorders DRG.

578.9     or other GI bleed PDx                           →  DRG 378

455.2     Hemorrhoids w/ complication                 →  DRG 394

996.77  Complication joint prosthesis                   →  DRG 560

250.xx   Diabetes                                                →  DRG 638

584.9    Acute renal failure                                   →  DRG 683

996.64  UTI complicating Foley cath                     →  DRG 700

996.76  Complication IUD insertion                     →  DRG 700

283.x    Autoimmune hemolytic anemia                →  DRG 809

288.8    Neutropenia                                           →  DRG 816

286.9    Acquired coagulation defect                     →  DRG 813

287.5    Thrombocytopenia / 287.31 ITP               →  DRG 813 

205.00  Acute myeloid leukemia                           →  DRG 836

273.3    Waldenstrom's macroglobulin                  →  DRG 841

998.59   Other postop infection                           →  DRG 863

780.60   Fever of unknown origin                         →  DRG 864

294.8     Dementia NOS                                      →  DRG 884

996.59   Mech complication of device                   →  DRG 920

 Other complication codes leading to DRG 920:  996.70 Complication of device / implant/graft, 998.11 Hemorrhage complicating a procedure, and 998.12 Postoperative hematoma.

Coding Clinic 4Q 1991 states “A continuing problem with sequencing has been whether the gastrointestinal condition or its associated hemorrhage should be listed as the principal diagnosis.  Although an attempt has been made to provide advice on this topic, a degree of subjectivity in making the assignment has remained.  Effective 10/1/91 this dilemma has been largely resolved by the addition of certain 5^th –digit codes that indicate whether or not hemorrhage is present.”  If you recommend a change from an anemia PDx to a GI bleed PDx, consider supporting your recommendation by citing circumstances of admission such as treatment or procedures focusing on GI diagnosis or treatment. Query if needed.

Remember that a new PDx might be one that can be changed by adding a CC condition.

MCC Conditions

Infectious conditions:  038.9 Septicemia; 486 Pneumonia; 599.60 Urinary obstruction

GI bleeds:  535.61 Duodenitis w/ hemorrhage; 569.85 Angiodysplasia intestine w/ hemorrhage

Other conditions:   262 Severe malnutrition; 428.3X Acute diastolic heart failure (or other acute CHF code); 518.4 Acute edema of lung; 707.23 Pressure ulcer Stage III.