Many DRGs Undercoded During COVID

You may be wondering: what is the effect of COVID on our DRG pull lists? After all, there is no new DRG especially designated for COVID. So has it made a difference?

The answer is yes.

The DRGs that are primarily affected by the addition of COVID fall into 4 sets:

DRGs 177-179 (Resp Infections & Inflammation w MCC, w CC and without CC or MCC)

DRGs 791, 793 (Prematurity w major problems, Full term neonate with major problems)

DRGs 974 - 976 (HIV w major related condition w MCC, w CC and without CC or MCC)

DRGs 870-872 (Septicemia or Severe Sepsis w/without MV >96 Hours/with or without MCC)

We ran an analysis of our average dollar change per chart reviewed for these DRGs for the period of April – November 2019 and April – November 2020 (thus, controlling for seasonality). The differences were startling.
Those charts that tended to be over-coded (DRG 793) were even more over-coded in the COVID era. Of equal note was that those charts that were historically under-coded became even more valuable.

The message? Our clients need us more than ever!