MS DRG of the Week: MS-DRG 103: Headaches without MCC

Change the Principal diagnosis

·         Alternate principal diagnoses recommended by FairCode docs include ...

o   340         Multiple sclerosis                             →  DRG 60

o   722.4      Cervical disc disease                        →  DRG 552

CC Conditions

·         None;  this DRG can't be changed by the addition of a CC condition

MCC Condition

·         Only Acute Congestive Heart Failure (428.33 Acute diastolic heart failure or other)

Discussion

·       This DRG usually is what it is.  Patients admitted with headaches commonly are given a principal diagnosis of migraines or tension headaches.  Headaches from post-concussion syndrome and reaction to spinal puncture also lead to DRG 103. Serious MCC medical conditions rarely complicate these admissions.

·       Consider an alternative PDx to the one that gave you DRG 103.  For example, a principal diagnosis of Cerebral arteritis (437.4) leads to DRG 103.   Cerebral arteritis is a CC condition which could complicate a case with an alternative principal diagnosis. 

o      An ICD-9 instructional note under listing 710.0 Systemic lupus erythematosis directs that additional codes be added to identify manifestations.  Cerebral arteritis can certainly be a manifestation of lupus, and if so documented would provide a CC condition for a principal diagnosis of 710.0.  

o     The inclusion terms listed as manifestations under 710.0 do not include Cerebral arteritis - are we limited to the examples provided by ICD-9-CM?  Fortunately not. The ICD-9-CM Official Guidelines for Coding and Reporting Section I.A.4. states that "inclusion terms are not necessarily exhaustive.  Additional terms found only in the index may also be assigned to a code."