MS DRG of the Week: MS-DRG 305: Hypertension without MCC
Change the Principal diagnosis
· Alternate principal diagnoses recommended by FairCode docs include ...
o 215.9 Schwannoma → DRG 566
o 227.0 Pheochromocytoma → DRG 645
o 332.0 Parkinsonism → DRG 57
o 403.90 Hypertensive chronic kidney disease → DRG 684
o 404.91 Hypertensive heart and chronic kidney disease → DRG 291
o 427.31 Atrial fibrillation → DRG 309
o 428.0 Congestive heart failure → DRG 293
o 435.9 Unspecified transient cerebral ischemia (TIA) → DRG 69
o 445.5 Temporal arteritis → DRG 547
o 557.9 Unspecified vascular insufficiency of intestine → DRG 394
o 611.72 Breast mass → DRG 601
o 780.2 Syncope → DRG 312
o 781.2 Abnormality of gait → DRG 93
o 784.0 Headache → DRG 103
o 785.1 Palpitations → DRG 309
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
· 434.91 Cerebral artery occlusion with infarction → DRG 304
· 486 Pneumonia → DRG 304
· 518.4 Acute pulmonary edema → DRG 304
· 707.23 Pressure ulcer Stage III → DRG 304
Discussion
· ICD-9-CM assumes the relationship between hypertension and chronic kidney disease but not between hypertension and heart disease. An instructional note under Category 404 Hypertensive heart and kidney disease directs that an additional code be used to specify the type of heart failure (428.0 - 428.43) if known. The appropriate addition of an acute CHF code will add an MCC.
o Most commonly the missing piece in this puzzle will be hypertensive heart disease. Read the echocardiogram and cardiology consults for clinical indicators and query if needed.