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Medicare Severity Diagnosis-Related Groups

The condition established after study to be chiefly responsible for admission of the patient to the hospital

The principal dignosis is .....

Medicare Severity Diagnosis-Related Groups

What does MS-DRG stand for?

Inpatient Prospective Payment System

What does IPPS stand for?

Prospective

In 1982, TEFRA changed the Medicare inpatient payment system from a retrospective payment system to an Inpatient __________ Payment System.

October 1st

MS-DRGs are update on ___ __every year.

CMS

__________ publishes MS-DRGs on 10/1 each year

classification 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:
P__________
S__________
S__________
S__________
D__________
B__________

Major Diagnostic Category

Each _________ _________ __________ (MDC) includes principal diagnoses corresponding to a single organ system or etiology.

Surgical

1st exception to assigning DRGs by principal diagnosis is - Pre-MDC DRGs are grouped by specific ________ procedures first, rather than principal diagnosis.

Surgical

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 __________ __________/__________.

Secondary

CC and MCC codes have got to be a __________ diagnosis.

1) Foreign object retained after surgery
2) Air embolism
3)Blood incompatibility
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:
- CABG
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**
A
B
C
C
C
D
D
F
F
P

2

How many digits are in a disposition code?

Skilled Nursing Facility, Home health, Rehabilitation facility

Reimbursement (of certain DRGs) to the transferring hospital is reduced when patients are transferred to:
S_________ __________ __________
H_________ _______
R_________ ________

Retrospectively

Psychiatric, Rehabilitation, Children's, Long-term care, and designated cancer hospitals do not particpate in IPPS, but are reimbursed _____________

Inpatient

__________ health records need an admit diagnosis.

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:
(DENTL)

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