News: Carefully examine syncope and collapse denials

Medical necessity denials for MS-DRG 312 are likely the more frequent culprit, but incorrect coding and sequencing also poses a challenge, says Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, an independent HIM consultant in Madison, WI and a member of the ACDIS advisory board.

 

For example, when a physician determines after study that the patient's syncope is related to pneumonia, coders should report pneumonia as the principal diagnosis. Coders should not separately report syncope because it is a symptom that can be associated with pneumonia, according to ICD-9-CM Official Guidelines for Coding and Reporting. This yields MS-DRG 195 (simple pneumonia and pleurisy without CC/MCC) with a relative weight of 0.7096 for FY 2011.

 

Some coders incorrectly report syncope as the principal diagnosis with pneumonia as a secondary condition, yielding MS-DRG 312, which has a relative weight for FY 2011 of 0.7172. 

 

Review coding guidelines for MS-DRG 312 and how they pertain to signs and symptoms, assignment of principal diagnosis, and sequencing, says Krauss.

 

Editor’s Note: This article was originally published in the October issue of Briefings on Coding Compliance Strategies.