What is the difference between drgs and ms drgs

Fees are assessed by factoring the body system and groups affected, with the amount of hospital resources required to treat the condition.

The result is a fixed rate for patient services known as DRG. Payments are calculated using wage variations, geographic locations, and the percentage of Medicare patients that a hospital treats. The system has expanded the number of DRGs to about to facilitate a potential increase in diagnosable services, and provides better recognition of the severity of illness than the traditional CMS DRG system.

The two-tiered system that allowed hospitals the choice of a secondary diagnosis has now become a three-tiered system. Reviews and explains tricky coding sequencing and when procedures drive assignment and presents case studies and clinical Our experts review the changes around clinical documentation and coding for sepsis, coding guidelines and guidance, and Store About Us Career Center. Health Information Management. Forgot Password? Dutiful Documentation The need for physician education regarding clear, specific documentation of diagnoses and procedures cannot be overemphasized.

To arrive at the correct MS- or APR-DRG, several items must be included in the documentation, including the reason s for admission, all secondary diagnoses that affect care on the current encounter, the cause of those diagnoses, and procedure details.

Any facility without a clinical documentation improvement program needs to seriously explore the possibility of establishing one. If there is time to focus on only two areas of documentation improvement, choose cause and severity. What caused the inpatient admission?

What led to the problem? For example, was the patient admitted for breast milk jaundice or jaundice due to cephalohematoma? Other considerations include jaundice and positive direct antigen test due to blood incompatibility, hypotonia due to maternal analgesia, a drop in hemoglobin due to acute blood loss during delivery, additional pitocin and intramuscular injection of methergine to control blood loss secondary to uterine atony, elevated blood pressure, and proteinuria secondary to mild preeclampsia.

Does the patient have stage 3 chronic kidney disease, acute kidney injury as opposed to insufficiency , acute exacerbation of extrinsic asthma, or acute blood-loss anemia superimposed on chronic iron-deficiency anemia? To compensate for these changes, coder education is essential. They should study the basics of the neonatal and obstetric chapters in the Official Coding Guidelines and review the many Coding Clinic publications that provide both details and examples specific to the high-volume Medicaid patient population.

Make certain that the pressure to get claims out the door does not discourage the staff from coding completely and accurately or from waiting for pending documentation that can affect the final DRG.