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20 terms

MS-DRGs

Medicare Severity Diagnosis-Related Groups
STUDY
PLAY
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)