MS DRG of the Week: MS-DRG 303: Atherosclerosis without MCC

Change the Principal diagnosis

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

o   404.91   Hypertensive heart and chronic kidney disease    →  DRG 291

o   410.71    Non-Q-wave myocardial infarction                         →  DRG 282

o   415.19   Pulmonary embolus                                                    →  DRG 176

o   421.0     Non-bacterial thrombotic endocarditis                   →  DRG 29

o   427.31   Atrial fibrillation                                                          →  DRG 309

o   428.0     Congestive heart failure                                             →  DRG 293

o   433.10   Occlusion / stenosis carotid artery w/o infarct      →  DRG 68

o   434.91   Cerebral artery occlusion with infarction                →  DRG 65

o   435.9     Unspecified transient cerebral ischemia (TIA)        →  DRG 69

o   440.29   Other atherosclerosis of lower extremity                →  DRG 300

o   537.83   Angiodysplasia of stomach                                         →  DRG 379

o   786.52   Painful respiration                                                       →  DRG 204

o   996.64   Infection/inflammation due to Foley  catheter      →  DRG 699

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 Conditions

·         261         Severe malnutrition                                                                 →  DRG 302

·         428.23   Acute on chronic systolic heart failure                                 →  DRG 302

Add a Procedure

·         Cardiac catheterization (37.22, 88.56, and 88.53)                            →  DRG 287

Discussion

·       The list of alternative principal diagnoses for this DRG is heavily weighted toward other cardiopulmonary conditions.  Read the medical record carefully to clarify the specific cardiac or pulmonary diagnosis responsible for the patient's presenting signs and symptoms.

·       Look for troponins and elevated cardiac enzymes - the patient may have had an MI!

·       Taking the time to make sure that all procedures are properly coded is more important for some DRGs than for others.  DRG 303 is one for which the extra time has often led to more accurate code assignment.