The condition established after study to be chiefly responsible for admission of the patient to the hospital
The principal dignosis is .....
In 1982, TEFRA changed the Medicare inpatient payment system from a retrospective payment system to an Inpatient __________ Payment System.
MS-DRGs are an inpatient __________ __________ which groups patients who are medically related in diagnoses and treatment and who have similar lengths of stay.
Principal diagnosis, Secondary diagnosis,
Surgical procedure, Sex, Discharge disposition,
Birth weight of neonates
**** KNOW THESE ****
DRGs are assigned based on:
Major Diagnostic Category
Each _________ _________ __________ (MDC) includes principal diagnoses corresponding to a single organ system or etiology.
1st exception to assigning DRGs by principal diagnosis is - Pre-MDC DRGs are grouped by specific ________ procedures first, rather than principal diagnosis.
2nd exception to assigning DRGs by principal diagnosis is - The principal dignosis is not related to the __________ procedure.
Complication/Comorbidity and Major Complication/Comorbidity
Secondary diagnosis codes that impact MS-DRG assignment are called __________/__________ and __________ __________/__________.
1) Foreign object retained after surgery
2) Air embolism
4)Stage III and IV pressure ulcers
5) Falls and traumas
6) Manifestations of poor glycemic control
- Diabetic ketoacidosis
7) Catheter-associated UTI
8) Vascular catheter-associated infection
9) Surgical site infection following:
10) Deep Vein Thrombosis (DVT) / Pulmonary Embolism (PE)
- Total knee replacement
- Hip replacement
Secondary diagnoses and not Present On Admission (POA) - These do not count as CCs or MCCs because they could have been prevented. **GIVE EXAMPLES**
Skilled Nursing Facility, Home health, Rehabilitation facility
Reimbursement (of certain DRGs) to the transferring hospital is reduced when patients are transferred to:
S_________ __________ __________
Psychiatric, Rehabilitation, Children's, Long-term care, and designated cancer hospitals do not particpate in IPPS, but are reimbursed _____________
Where the patient goes when they leave. Expired, home, skilled nursing facility, other acute care facility.
Describe discharge disposition.
Clinical evaluation, Therapeutic treatment, Further evaluation by diagnostic studies, Extended length of hospital stay, Increased nursing care and/or other monitoring
**** FAYE BROWN PAGE 30 - KNOW THESE **** The definition of "other diagnosis" includes only those conditions that affect the episode of hospital care in terms of the following: