Principal Procedure Selection and MS-DRG Flashcards
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A patient undergoes coronary artery bypass grafting (CABG) and simultaneous mitral valve repair. Which procedure is designated as the principal procedure for MS-DRG assignment?
Answer: The procedure most closely related to the principal diagnosis or the most resource-intensive procedure
The principal procedure is the one most closely related to the principal diagnosis or, when tied, the most resource-intensive procedure performed.
Under ICD-10-PCS, which root operation would be coded when a surgeon removes a kidney stone via percutaneous nephrostolithotomy without removing any body part?
Answer: Extirpation
Extirpation is the root operation for taking or cutting out solid matter (such as a calculus) from a body part without removing the body part itself.
A patient admitted for pneumonia also undergoes diagnostic bronchoscopy with bronchoalveolar lavage. Which procedure is the principal procedure?
Answer: The procedure directly treating the principal diagnosis (none here, so bronchoscopy by default)
When no therapeutic procedure is performed, the diagnostic procedure most related to the principal diagnosis is designated the principal procedure.
Which MS-DRG grouping logic feature allows a single DRG to shift to a higher-weighted DRG when a qualifying OR procedure is present?
Answer: OR procedure designation
OR (operating room) procedure designation triggers MS-DRG logic to route a case to surgical DRGs, which typically carry higher relative weights than medical DRGs.
A CDS queries about the approach for a laparoscopic appendectomy converted to open. Which ICD-10-PCS approach character should be reported?
Answer: Open (0), reflecting the completed approach
ICD-10-PCS guidelines state that when a laparoscopic procedure is converted to open, the open approach (0) is coded because that is how the procedure was completed.
Which of the following best describes the 'non-OR procedure affecting MS-DRG assignment' designation?
Answer: Procedures not performed in an OR that nonetheless shift the MS-DRG when coded
Non-OR procedures affecting MS-DRG assignment are bedside or minor procedures not done in an OR that the grouper still uses to move a case to a different (often higher) DRG.
When two surgical procedures are performed and either could serve as the principal procedure, what does the UHDDS guideline recommend?
Answer: The facility may sequence them in any order, and the grouper selects the DRG with the highest weight
UHDDS guidelines allow facilities to sequence multiple qualifying procedures in any order; the MS-DRG grouper evaluates all coded procedures and assigns the DRG that results in the highest relative weight.