CDIP DRG Optimization and Case Mix Index

Question 1

What is the Case Mix Index (CMI) and why is it significant to a CDI program?

Accepted Answer

A numeric value reflecting the average relative weight of all MS-DRGs billed by a hospital, indicating resource use and complexity

Answer

A measure of patient satisfaction used to benchmark hospitals

Answer

The total number of diagnoses coded per discharge

Answer

A payer-specific metric used only for Medicaid reimbursement

Question 2

Under the MS-DRG system, which of the following MOST directly increases a DRG's relative weight and associated reimbursement?

Accepted Answer

Documenting and coding a complication or comorbidity (CC) or major complication or comorbidity (MCC)

Answer

Increasing the patient's length of stay beyond the geometric mean

Answer

Assigning a larger number of secondary diagnoses regardless of clinical specificity

Answer

Selecting a procedure code from a higher-cost DRG family

Question 3

A CDI specialist is reviewing a record where the principal diagnosis is listed as 'chest pain.' The physician also documented acute NSTEMI confirmed by troponin elevation. What CDI action is MOST appropriate?

Accepted Answer

Query the physician to clarify whether the NSTEMI should be the principal diagnosis

Answer

Leave the principal diagnosis as chest pain since it was the reason for admission

Answer

Code both diagnoses as co-principal diagnoses

Answer

Report the discrepancy to compliance and take no further action

Question 4

Which of the following secondary diagnoses would qualify as a Major Complication or Comorbidity (MCC) under the MS-DRG system?

Accepted Answer

Acute respiratory failure

Answer

Mild persistent asthma, well controlled

Answer

Essential hypertension

Answer

Vitamin D deficiency

Question 5

A hospital's CMI drops significantly over two quarters. After ruling out a change in patient population, which CDI-related factor is MOST likely contributing?

Accepted Answer

Underreporting of CC/MCC diagnoses due to documentation gaps

Answer

Increased ED visit volume

Answer

Higher readmission rates

Answer

Decreased length of stay

Question 6

In the MS-DRG grouping logic, what happens when NEITHER a CC nor an MCC is present for a condition that has a three-way DRG split?

Accepted Answer

The case groups to the base (lowest-weight) DRG without CC/MCC

Answer

The case is automatically denied by Medicare

Answer

The grouper assigns the MCC DRG by default

Answer

The principal diagnosis is changed to reflect the highest-acuity DRG