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Principal Procedure Selection and MS-DRG Flashcards

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  1. A patient is admitted for coronary artery disease and undergoes cardiac catheterization. The catheterization reveals triple-vessel disease, and the patient proceeds to CABG during the same admission. Which procedure is the principal procedure?

    Answer: CABG, as it is the definitive therapeutic procedure for the principal diagnosis

    CABG is the definitive therapeutic procedure for coronary artery disease. The cardiac catheterization was a diagnostic procedure that preceded the treatment. Under UHDDS guidelines, the therapeutic procedure is the principal procedure.

  2. In ICD-10-PCS, which root operation is used to code the insertion of a cardiac pacemaker generator into the chest wall?

    Answer: Insertion

    Insertion is the ICD-10-PCS root operation for putting in a nonbiological device that monitors, assists, performs, or prevents a physiological function.

  3. A patient with chronic systolic heart failure undergoes implantation of a left ventricular assist device (LVAD) as destination therapy. How does this procedure affect DRG assignment?

    Answer: It assigns the case to a pre-MDC surgical DRG for LVAD implantation, bypassing standard MDC grouping

    LVAD implantation is a high-cost, resource-intensive procedure that is assigned to a pre-MDC DRG, reflecting the extraordinary resource utilization.

  4. A patient is admitted for total knee replacement (TKR) and is transferred to the ICU post-operatively for respiratory failure requiring mechanical ventilation for 96 or more hours and a tracheostomy. How does this change the DRG?

    Answer: The mechanical ventilation duration and tracheostomy may shift the case to a pre-MDC respiratory DRG

    Mechanical ventilation for 96 or more hours combined with a tracheostomy triggers a pre-MDC DRG assignment. This pre-MDC classification overrides the orthopedic MDC assignment.

  5. Under MS-DRG grouping logic, which factor determines whether a case is assigned to the 'with MCC' versus 'with CC' version of a DRG?

    Answer: Whether any secondary diagnosis coded on the claim carries an MCC designation for that specific MDC

    MS-DRG assignment to the 'with MCC' version requires that at least one secondary diagnosis coded on the claim carries an MCC designation within the context of that specific MDC.

  6. A patient is admitted for acute pancreatitis and subsequently requires a Whipple procedure for a newly discovered pancreatic mass. How should the principal diagnosis and principal procedure be assigned?

    Answer: Principal diagnosis: pancreatitis; principal procedure: Whipple procedure

    The principal diagnosis remains acute pancreatitis, the condition established after study to be chiefly responsible for the admission. The Whipple procedure is the principal procedure as the definitive therapeutic surgical procedure performed during the stay.