MS DRG of the Week: MS-DRG 189: Pulmonary Edema and Respiratory Failure

Change the Principal diagnosis

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

o   348.31   Metabolic encephalopathy                                           →  DRG 70

o   507.0     Aspiration pneumonitis                                                 →  DRG 177

o   482.42   Pneumonia due to Staphylococcus (MRSA)               →  DRG 177

o   162.9     Cancer of lung                                                                 →  DRG 180

o   486          Pneumonia                                                                     →  DRG 196

o   516.8     Interstitial pneumonia                                                   →  DRG 603

o   428.0     Congestive heart failure                                                →  DRG 291

o   458.9     Hypotension                                                                    →  DRG 314

o   416.9     Cor pulmonale                                                                →  DRG 314

o   584.9     Acute renal failure                                                         →  DRG 682

o   038.9     Septicemia                                                                       →  DRG 871

CC and MCC Conditions

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

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

Add a Procedure

·         96.71     Continuous mechanical ventilation <96 hours                     →  DRG 208

Discussion

·       Coding Clinic First Quarter 2005 advises, "If a patient is admitted for both respiratory failure and another acute condition, either condition may be listed as principal. ...  Selection of the principal diagnosis will depend on the circumstances of admission. If two or more diagnoses equally meet criteria for principal diagnosis, either one can be selected."  Look carefully at the circumstances of admission to see two or more approximately co-equal conditions meet the criteria for principal diagnosis.

o      Coding Clinic First Quarter 2005 adds that respiratory failure is reported as a secondary diagnosis (not PDx) when the patient is admitted with sepsis, neoplasms, pregnancy, and poisoning.

·       Remember to check the nurses' notes or respiratory flow sheets for mechanical ventilation.  Count the hours.  Re-read the guidelines for counting the hours of mechanical ventilation - weaning counts!