Tips for ICD-10-related MS-DRG shifts
The MS-DRG shift driven by the switch to ICD-10 will impact diagnoses throughout ICD-10-CM. Gloryanne Bryant, RHIA, RHIT, CCS, CDIP, CCDS, an AHIMA-approved ICD-10-CM/PCS trainer with more than 30 years of experience in HIM, reviews additional diagnoses, as well as how the shift will affect procedure codes.
Not otherwise specified codes
Not otherwise specified (NOS) codes offer an opportunity to improve documentation, Bryant says. "We've been hearing since way before 2009 [that] specificity is so important and we've been trying to address that with our CDI programs and coding and documentation improvement to help with DRG capture."
Those improvements need to happen even faster with ICD-10, Bryant says. Start by running a report and identifying when you are reporting NOS codes. Look closely at cases when the ICD-9-CM NOS code is in the top five position of the MS-DRG.
"Analyze those cases. Maybe we could have queried the physician for specificity or maybe there was another code that better represents the condition," Bryant says.
Chronic obstructive pulmonary disease
Coding professionals also need to look at chronic obstructive pulmonary disease (COPD) cases, Bryant says.
In ICD-9-CM, COPD codes include:
- 491.21, acute exacerbation of COPD
- 491.22, COPD with acute bronchitis
- 493.22, COPD with acute exacerbation of asthma
In ICD-9-CM, all of these codes are listed as CCs. Cases will group to MS-DRG 191 (COPD with CC) when either condition is sequenced as the principal diagnosis followed by one of the other conditions listed above as a secondary diagnosis.
In ICD-10-CM, one code, J44.1 (COPD with acute exacerbation) includes chronic obstructive bronchitis, chronic obstructive asthma, and COPD in its description, Bryant says.
Cases will group to lower-weighted MS-DRG 192 (COPD without CC/MCC) in ICD-10-CM because these additional conditions will not be coded separately.
Editor’s note: This article was originally published in the September issue of Briefings on Coding Compliance Strategies.