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.

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