Case Presentations for ICD-10. 2 3M Health Information Systems © 3M 2014. All Rights Reserved. 3M Confidential – for customer's internal review only

Case Presentations for ICD-10

2

3M Health Information Systems

© 3M 2014. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M.

SOB cough pulmonary infiltrate

Patient admitted for SOB productive cough fever 101 .

O2 sat 60% Infiltrate LLL Chest Treated IV antibiotics no clearing

Await pulmonary consult

Noted to be visibly dyspneic using accessory muscles to breath. O2 sats were in the 80 – 90% range on 100% NRB. HR 120, BP 90/50.

Patient continued to desat; ABGs RA pH 7.20 pO2 55 pC02.

Bronchoscopy

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Case StudyBefore After

MS DRG 163 (w/ MCC) MS DRG 163 (w/ MCC)

Relative Wt: 5.0828 Relative Wt: 5.0828

PDx: Malig Neoplasm, Lung PDx: Lung CA

SDx: Pulmonary Embolism SDx: Same SDxsAdjustment DisorderHyperlipidemia ADD:Lumph Node Mets Acute Resp. Failure

Query for Acute Resp. Failure

Procedures: Lobectomy of Lung Procedures: SameMediastinoscopyLymph Node BiopsyCardiac U/SChest Tube PlacementArterial Line PlacementEndotrachial intubationMechanical Ventilation < 96 hrs

3M APR DRG: 120 3M APR DRG: 120SOI Level 3 SOI Level 4APR Weight 3.3459 APR Weight 6.5962ROM Level 3 ROM Level 4Exp. Mort Rate 5.70% Exp. Mort Rate 34.00%

Change: 28.30%

This report includes data produced by 3M’s

proprietary APR-DRG Software. All copyrights

in and to APR-DRG Classification System and

all APR-DRG Code Assignments are owned by

3M. All rights reserved

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Case Study dysuria fever AMS

Patient admitted with dysuria, fever, altered mental status.

“Urosepsis” documented in progress notes.

Lab reports showed serum creatinine and BUN levels of 4.5 & 50, respectively. Low urinary output

Physician ordered 1L of IV NS wide open with maintenance IV fluids of 150 cc/hr to follow.

Serial creatinine and BUN levels declined over the next 3 days to 1.2 & 24, respectively.

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This report includes data produced by 3M’s proprietary

APR-DRG Software. All copyrights in and to APR-DRG

Classification System and all APR-DRG Code

Assignments are owned by 3M. All rights reserved.

Before After

PDx: Urinary tract infection

SDx: AMLCoronary artery dzHypertensionHyperlipidemia

Procedures:

APR DRG:SOI Level:APR Weight:ROM Level:Exp. Mort Rate:

PDx: Sepsis

SDx: Add:Acute renal failure with acute tubular necrosis

Query for corresponding diagnosis

Procedures:

AMS dysuria and fever

4632

0.52332

0.3%

7204

2.81273

6.3%


MS-DRG: 690 (without MCC)Relative weight: 0.7693

MS-DRG: 871 (with MCC)Relative weight: 1.8527

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Case Study Neuro/Trauma

Patient admitted with traumatic subdural hemorrhage. H&P s “significant amount of midline shift over 1 cm…

largely symptomatic from her right sided subdural hematoma.”

SEPS drain was placed in ICU without successful drainage. CT of head “left-to-right midline shift of 11mm…there

may be early herniation as well.” Patient expired.

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Before After

PDx: Traumatic subdural hemorrhage, no LOC

SDx: Alzheimer’s dementiaUnspecified fallPalliative care


PDx: Same

SDx: Add:Herniation of brain

Sample Case Neuro

0551

0.63652

2.9%

0553

1.37173

7.5%


MS-DRG: 087 (without CC/MCC)CMI: 0.7345LOS: 2.2

MS-DRG: 085 (with MCC)CMI: 1.9733LOS: 4.9

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Case Study Pulmonary

Patient admitted through ED with obtundation labored breathing, and fever. Contusion of head . Diagnosed with pneumonia.

Temp 102.9, BP 97/57; O2 sat 84% on R/A. WBCs 20,000 with left shift. BUN/Creatinine = 49/2.1. ABGs: pH 7.33; pCO2 60; pO2 55. Changed to 100% NRB mask.

BP started to drop: 85/57, 97/46, 90/60. Placed on Levophed infusion @ 90cc/hr. BP cont’d to drop. Dopamine.added. Received IV Rocephin and IV Flagyl.

Patient became unresponsive to tactile and verbal stimuli. Cardiac arrest occurred.

Patient was subsequently intubated and expired.

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Before After

PDx: Pneumonia

SDx: Atrial fibrillation Left heart failureAtelectasisHypotensionCystic kidney diseaseEdemaRenal insufficiencyHistory of colon CA

Procedures: Mech vent & intub APR DRG:SOI Level:APR Weight:ROM Level:Exp. Mort Rate:

PDx: Sepsis

SDx: Add:Septic shockAcute renal failureAcute respiratory failureComaPneumonia

Query for corresponding diagnoses and for principal diagnosis

Procedures: Mech vent & intubation

Sample Case: Pulmonary Medicine

1393

1.00893

4.5%

7204

3.04994

29.8%


MS-DRG: 194 (with CC)Relative weight: 0.9771

MS-DRG: 871 (with MCC)Relative weight: 1.8527

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Impact of Responding to Query

Impact w/ Response to Query RW = 2.9797 GLOS = 8.98 SOI = 3 Major ROM = 2 Moderate

Impact w/o Response to Query RW = 2.9797 GLOS = 8.98 SOI = 2 Moderate ROM = 2 Moderate

Query:

“Patient had a magnesium level of 1.6 and received magnesium sulfate. Please provide a corresponding diagnosis for the treatment provided.”

** CDI seeks documentation of “ hypomagnesemia “

Cranial Procedure

Impact of DocumentationMS-DRG 330 2.4981

Bowel Procedurewith CC

PDx: Colon cancer

SDx:

Dehydration

Post-op ileus(codes to 997.4 + 560.1)

“Ulcer/Wound” noted by RN

PPx: Left hemicolectomy

MS-DRG 329 5.1396

Bowel Procedurewith MCC

PDx: Colon cancer

SDx:

Acute Renal Failure – ATN

Expected ileus(560.1)

Pressure Ulcer, site unspecific


APR DRG: 221SOI Level: 2APR Weight: 1.7681ROM Level: 1Peer Group 0.0%


Highest MS-DRG payment

MS-DRG 329 5.1396

Bowel Procedurewith MCC

PDx: Colon cancer

SDx:

Acute Renal Failure – ATN

Expected ileus(560.1)

Pressure Ulcer Stage IV on Sacrum



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― Acute renal “insufficiency” SOI 1; ROM 1― Acute kidney injury (AKI) SOI 3; ROM 3― Acute kidney failure SOI 3; ROM 3

Versus

― Acute kidney failure “ due to”

• Acute tubular necrosis SOI 4; ROM 4

• Cortical necrosis SOI 4; ROM 3

• Medullary (papillary) necrosis SOI 4; ROM 3

Acute Kidney Failure DocumentationImpact of Appropriate Documentation on SOI and ROM and Physician Scorecard

Documents

Case Presentations for ICD-10. 2 3M Health Information Systems © 3M 2014. All Rights Reserved. 3M Confidential – for customer's internal review only