MS DRG of the Week: MS-DRG 301: Peripheral Vascular Disease without CC/MCC

Oct 13 2011 3:42 PM

Change the Principal diagnosis

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

o 003.0 Salmonella infection → DRG 373

o 038.9 Septicemia → DRG 872

o 250.60 Diabetes with neurologic manifestations → DRG 74

o 250.82 Diabetes with other specified manifestation → DRG 638

o 348.31 Metabolic encephalopathy → DRG 70

o 415.19 Pulmonary embolus → DRG 175

o 434.91 CVA - occlusion with infarction → DRG 66

o 569.85 Angiodysplasia of intestine with hemorrhage → DRG 378

o 682.6 Cellulitis → DRG 602

o 707.07 Pressure ulcer of heel → DRG 592

o 707.19 Ulcer of lower limb → DRG 593

o 730.27 Osteomyelitis ankle/foot → DRG 540

o 733.6 Costochondritis → DRG 206

o 782.3 Edema of legs → DRG 948

o 996.1 Mechanical complication of vascular device → DRG 315

o 996.74 Other complication of vascular device → DRG 315

CC Conditions

Too numerous to list, CC conditions could include Acute blood loss anemia (285.1), Malnutrition unspecified (263.9), Hypercoaguable state (289.1), Chronic diastolic heart failure (428.23), Crohn's disease of the small intestine (555.0), Stage IV CKD (585.4), Peripheral vascular complication (997.2), Hematoma complicating a procedure (998.12), and BMI 40 and over (V85.4)

MCC Conditions

Consider Acute CHF such as 428.23 Acute on chronic systolic heart failure, 415.19 Pulmonary embolus, 348.31 Metabolic encephalopathy, 443.22 Dissection if iliac artery, 441.01 Dissection of thoracic aorta, 453.2 Embolism and thrombosis of the inferior vena cava, 486 Pneumonia, 562.9 Bacterial peritonitis, 707.23 Stage III Pressure Ulcer, and 780.72 Functional quadriplegia.

Add a Procedure

· 86.22 Excisional debridement → DRG 264

This common DRG is commonly complicated by co-morbidities from many different body systems. Careful review of charts with peripheral vascular disease principal diagnoses may be time well spent. Remember to look for complications and uncoded procedure.

Bullet list of CC and MCC conditions below need not be included.

CC Conditions

· 008.45 C diff colitis → DRG 300

· 202.80 Lymphoma → DRG 300

· 263.9 Malnutition, unspecified → DRG 300

· 285.1 Acute blood loss anemia → DRG 300

· 289.81 Hypercoaguable state → DRG 300

· 304.01 Opioid dependence, continuous use → DRG 300

· 334.3 Cerebellar ataxia → DRG 300

· 342.90 Hemiparesis → DRG 300

· 427.32 Atrial flutter → DRG 300

· 428.33 Chronic diastolic heart failure → DRG 300

· 444.21 Arterial embolism to upper extremity → DRG 300

· 555.0 Crohn's disease of the small intestine → DRG 300

· 584.9 Acute kidney failure → DRG 300

· 585.4 Stage 4 Chronic kidney disease → DRG 300

· 599.0 Urinary tract infection → DRG 300

· 682.6 Cellulitis of leg → DRG 300

· 733.13 Osteoporotic fracture → DRG 300

· 784.3 Expressive aphasia → DRG 300

· 807.00 Rib fracture → DRG 300

· 884.2 Traumatic open wound with tendon involvement → DRG 300

· 996.73 Stent occlusion → DRG 300

· 997.2 Peripheral vascular complication → DRG 300

· 998.12 Hematoma complicating a procedure → DRG 300

· V85.4 BMI 40 and over → DRG 300

MCC Condition

· 348.31 Metabolic encephalopathy → DRG 299

· 415.19 Pulmonary embolus → DRG 299

· 428.23 Acute on chronic systolic heart failure → DRG 299

· 441.01 Dissection of thoracic aorta → DRG 299

· 443.22 Dissection of iliac artery → DRG 299

· 453.2 Embolism and thrombosis of inferior vena cava → DRG 299

· 486 Pneumonia → DRG 29

· 562.9 Bacterial peritonitis → DRG 299

· 707.23 Stage II Pressure ulcer → DRG 299

· 780.72 Functional quadriplegia → DRG 299