Principal Procedure Selection and MS-DRG Flashcards
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Under ICD-10-PCS guidelines, which procedure is defined as the 'principal procedure' for DRG grouping purposes?
Answer: The procedure most related to the principal diagnosis and most resource-intensive
The principal procedure is the one most related to the principal diagnosis or the one performed for definitive treatment. When multiple procedures are performed, the one most closely related to the principal diagnosis and involving the most resources is typically selected.
A patient is admitted with acute appendicitis and undergoes a laparoscopic appendectomy. A second procedure (colonoscopy for incidental polyp removal) is also performed. Which procedure should be designated as principal?
Answer: Laparoscopic appendectomy, as it directly treats the principal diagnosis
The laparoscopic appendectomy directly treats acute appendicitis, the principal diagnosis. It should be designated as the principal procedure.
Which of the following changes to a case would MOST likely result in a shift from a medical MS-DRG to a surgical MS-DRG?
Answer: Documenting a therapeutic surgical procedure performed during the admission
When a therapeutic surgical procedure is performed and coded, the MS-DRG grouper typically assigns the case to a surgical DRG, which often carries a higher relative weight than the corresponding medical DRG.
In the MS-DRG system, what is the significance of a 'Major Diagnostic Category' (MDC)?
Answer: It groups cases by organ system or etiology and is the first-level classification before DRG assignment
Major Diagnostic Categories (MDCs) represent the first tier of DRG classification, grouping cases by primary organ system or disease etiology. The DRG grouper uses the MDC as the entry point before assigning a specific DRG.
A patient undergoes hip replacement surgery and develops a pulmonary embolism (PE) on post-operative day 2. Which DRG consideration is MOST important?
Answer: Whether PE documentation triggers a HAC payment adjustment for DVT/PE after orthopedic surgery
Post-operative PE after hip replacement is in the CMS-designated HAC category for DVT/PE after arthroplasty. If the PE is not documented as POA=Y, the HAC payment adjustment will apply, reducing reimbursement.
Which of the following ICD-10-PCS sections is used to code procedures on peripheral veins?
Answer: Section 0 - Medical and Surgical
The Medical and Surgical section (Section 0) of ICD-10-PCS covers all surgical procedures on anatomical body parts including peripheral veins.