MS DRG of the Week: MS-DRG 149: Dysequilibrium

Change the Principal diagnosis

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

o   250.60   Diabetic gastroparesis                                                     →  DRG 73

o   276.52   Hypovolemia                                                                     →  DRG 641

o   280.9     Anemia                                                                               →  DRG 812

o   284.1     Pancytopenia                                                                    →  DRG 812

o   322.0      Parkinson's disease                                                         →  DRG 57

o   427.31   Atrial fibrillation                                                               →  DRG 308

o   435.1     Vertebral artery syndrome                                             →  DRG 69

o   437.0     Cerebral ischemia                                                             →  DRG 70

o   438.85  Vertigo as late effect of cerebrovascular disease        →  DRG 56

o   599.0     Urinary tract infection                                                      →  DRG 690

o   780.2     Syncope                                                                              →  DRG 312

o   781.2     Abnormality of gait                                                           →  DRG 92

o   997.00   Nervous system complication                                         →  DRG 91

CC  and MCC Conditions

·         None;  this DRG is not affected by co-morbidities

·         Remember, CC and MCC conditions may complicate DRGs corresponding to some of the alternative principal diagnoses listed above.

Discussion

·       Patients may experience dysequilibrium as a result of many underlying conditions, including the examples above.  Look for documented diagnoses that explain the patient's dysequilibrium and can provide a principal diagnosis that is more specific than the general symptom of dysequilibrium.

·       Late effects codes are usually reported as secondary diagnoses, per the ICD-9-CM Official Guidelines for Coding and Reporting.  Late effects of cerebrovascular disease are exceptions.  Coding Clinic Second Quarter 2009 advises assigning code 438.89 Other late effects of cerebrovascular disease for a seizure disorder due to old stroke.  ICD-9-CM provides specific codes under Category 438 for other late effects of old stroke, including aphasia, dysarthria, dysphagia, ataxia, and vertigo as in this case.  Listing 438.9 Other late effects of cerebrovascular disease may be an option for late effects of cerebrovascular disease not specifically listed under Category 438.