MS DRG of the Week: MS-DRG 153: Otitis Media and Upper Respiratory Infection without MCC

Change the Principal diagnosis

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

o   493.21   COPD exacerbation                                                         →  DRG 191

o   516.8     Interstitial pneumonitis                                                  →  DRG 198

o   493.92   Acute asthma exacerbation                                           →  DRG 202

o   789.91   Diarrhea                                                                             →  DRG 392

o   276.51    Dehydration                                                                     →  DRG 641

o   682.0     Cellulitis of face                                                                →  DRG 603

o   600.01  Benign prostatic hypertrophy                                        →  DRG 726

o   038.9     Septicemia                                                                        →  DRG 872

CC Conditions

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

·         Remember that CC conditions may complicate DRGs assigned from alternative principal diagnoses above.

MCC Condition

·         038.9     Septicemia                                                                                   →  DRG 152

Discussion

·       Patients admitted with upper respiratory conditions may have viral syndromes that affect other body systems.  Depending on the circumstances of admission, the diseases of these other body systems may be better-supported as principal diagnoses than the URI PDx.

·       A couple of things to remember if you consider some of the alternative principal diagnoses above ...

o      A principal diagnosis of Orbital cellulitis (376.01) will lead to DRG 121 Acute Major Eye Infections, which has a relatively high case weight and can be complicated by both CC and MCC conditions.  Be sure to differentiate between facial and orbital cellulitis.

o      Coding Clinic 3Q 2006 advises that Obstructive chronic bronchitis with acute bronchitis (491.21) and Chronic obstructive asthma with (acute) exacerbation (493.22) should be coded together when both are present. 

§       The Excludes notes under these conditions indicate that the two conditions are classified under different categories, not that the two conditions cannot be coded together.  They can, as advised by Coding Clinic 3Q 2006.