Lecture Icd 10

Baruch College/Mount Sinai School of Medicine

Program in Health Care Administration and Policy

Medical Record Coding and DRGs

BUS9100 Lecture 10

Raymond R. Arons, Dr. P.H, M.P.H February 9, 2010

Lecture 10 2

Lecture 10-February 9, 2010

Revenues, Medical Record Coding and DRGs

Baruch College/Mount Sinai School of MedicineProgram In Health Care Administration and PolicyBUS 9100: The Social and Governmental Environment of the Business of Health Care

Raymond R. Arons, Dr. P.H, M.P.H

http://www.cms.hhs.gov/TheChartSeries/03_Health_Care_Facts_Figures.asp#TopOfPage

Section 10.0

The Hospital Revenue Cycle

Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

Lecture 10 3

3

Patient AdmittedTo Hospital

DemographicsInsurance, Other Data Captured

Diagnoses (Dx.), Procedures (Pr.), in Medical Record

Coders take the Dx. and Pr. Convert to ICD codes for billing

Patient Discharged

Bill is submittedto Insurance CompanyFor Payment $$$

INPATIENT REVENUE CYCLE

4

Revenue Cycle Obstacles to Payment

Bill is not complete and is bounced by Insurance Company– Insurance ID incorrect.– Other, missing elements such as secondary payer,

age sex, race, ethnicity, procedure dates etc.– Submission is not within the time limits.– Other factors such as denials etc,– Admitted within 30 days of discharge.– Never received claim.– Errors in medical record coding.


Lecture 10 4

Section 10.1

International Classification of Diseases Coding Methods

6

Coding Methods Currently in UseInternational Classification of Diseases - ICD-9-CM – Coding of Inpatient Discharges

International Classification of Diseases - ICD-10-CM– Mandated for 2013 but used as of 12/30/09

Diagnosis-related Groupings (DRGs) – Hospital reimbursement -Medicare– Hospital reimbursement -Non Medicare

Physician Current Procedure Terminology (CPT)– Physicians for procedures performed

Common Procedure Coding System (HCPCS)– Used by vendors of equipment and services


Lecture 10 5

7

International Classification of Diseases (ICD-9-CM)

History DefinitionsClassification of Diseases GroupingsDisease CodingProcedure GroupingProcedure CodingOther Areas such as V codes, E codes

8

ICD History Statistical classification of diseases date back to the eighteenth century with a primary focus upon the causes of death The Sixth Revision, in 1948 expanded to include non-fatal diseases. In 1950 the US Public Health Service and the Veterans Administration began independent tests of ICD-6 for hospital indexing purposes. In 1951 the Presbyterian Hospital in New York City adopted the ICD-6th Revision with some modifications for use in its record department (HCFA,1980)


Lecture 10 6

9

ICD History The Ninth revision in 1975 in Geneva included procedures in medicine and of impairments, and handicaps. ICD-9-CM became effective in January 1979 and is currently up to its latest revision to keep up with new technologies, procedures, and diseases.Over the past century, ICD was under the control of WHO, The Commission on Professional Hospital Activity and currently the Health Care Financing Administration (HCFA), and Centers for Medicare and Medicaid (CMS)ICD-10-CM was released in 1999 and will be required for physician and hospital use in 2013 and currently is optional as of December 2009

10

Definitions A classification of disease may be defined as a system of categories to which morbid entities are assigned according to established criteria.

A Statistical classification of diseases must encompass the entire range of morbid conditions within a manageable number of categories (ICD-10, WHO,1992)


Lecture 10 7

11

Examples of I9 Codes Infectious and Parasitic Diseases (000-139)

042 Human immunodeficiency virus (HIV) 090.0 Early congenital syphilis,symptomatic

Neoplasms (140-239)162.2 Malignant neoplasm of the main bronchus191.1 Malignant neoplasm of the fontal lobe

Endocrine,Nutritional and Metabolic Diseases and Immunity Disorders (240-319)

250.1 Diabetes mellitus with ketoacidosis278.01 Morbid obesity

continued...

12

Examples of I9 Codes Blood and Blood-Forming Organs (280-289)

282.6 Sickle-cell anemia285.9 Anemia, unspecified

Mental Disorders (290-319)295.4 Acute schizophrenic episode296.3 Major depressive disorders

Nervous System and Sense Organs (320-389)332.0 Parkinson’s disease with paralysis agitans362.0 Diabetic retinopathy

continued...


Lecture 10 8

13

Examples of I9 Codes Diseases of the Circulatory System (390-459)

410.1 Acute myocardial infarction of anterolateral wall414.0 Heart Failure

Diseases of the Respiratory System (460-519)492.0 Emphysema bleb493.9 Asthma, unspecified

Diseases of the Digestive System (520-579)540 Acute appendicitis with generalized peritonitis550 Inguinal hernia, with gangrene

continued...

14

Examples of I9 Codes Diseases of the Genitournary System (580-629)

592.0 Calculus of the kidney600 Hyperplasia of prostate

Complications of Pregnancy and Childbirth and the Puerperium (630-676)

633 Ectopic pregnancy634 Spontaneous abortion

Diseases of the Skin and Subcutaneous Tissue(680-709)

684 Impetigo 697.0 Lichen planus

continued...


Lecture 10 9

15

Examples of I9 Codes Congenital Anomalies (740-759)

734.61 Flat foot congenital749.00 Clef palate, unspecified

Certain Conditions Originating in the Perinatal Period (760-779)

760.0 Maternal hypertensive disorder762.4 Prolapsed cord

Symptoms, Signs and Ill-defined Conditions (780-799)780.6 Fever780.1 Hallucinations

continued...

16

Examples of I9 CodesDiseases of the Musculoskeletal System and Connective Tissue (710-739)

714.0 Rheumatoid arthritis722 Intervertebral disc disorder733.1 Pathologic fracture

Injury and Poisoning (800-999)800.1 Open fracture of clavicle952.01 C1/C4 level with complete lesion of spinal cord

continued...


Lecture 10 10

17

Examples of I9 Codes Supplementary Classification of Factors Influencing Health Status and Contact with Health Services (V01-V82)

V30.00 Single live born vaginal delivery in hospitalV60.3 Person living alone

Supplementary Classification of External Causes of Injury and Poisoning (E800-E999)

E813 Motor Vehicle traffic accident highway collisionE800 Railway accident involving collision with train

continued...

18

Examples of I9 Procedure Codes Operations of the Nervous System (01-05)

01.0 Cranial puncture01.2 Craniotomy and craniectomy03.01 Removal of foreign body from spinal canal

Operations on the Endocrine System (06-07)06.01 Aspiration of thyroid07.8 Thymectomy

Operations on the Eye (08-16)16.3 Evisceration of eyeball16.82 Repair of wound of orbit

continued...


Lecture 10 11

19

I9 Procedure Codes Operations of the Ear (18-20)

18.0 Incision of External Ear20.0 Myringotomy20.96 Implantation or replacement of cochlear

prosthetic deviceOperations on the Nose,Mouth and Pharynx (21-29)

21.0 Control of epistaxis21.7 Reduction of a Nasal Fracture

Operations on the Respiratory System (30-34)32.4 Lobectomy of lung33.5 Lung transplant

continued...

20

I9 Procedure Codes Operations on the Cardiovascular System (35-39)

35.2 Replacement of Heart Valve37.5 Heart Transplant38.5 Ligation and stripping of varicose veins

Operations on the Hemic and Lymphatic System (40-41)40.11 Biopsy of lymphatic structure41.01 Autologous bone marrow transplant

Operations on the Digestive System (42-54)42.42 Total esophagectomy47.0 Appendectomy

continued...


Lecture 10 12

21

I9 Procedure Codes Operations on the Urinary System (55-59)

55.5 Complete nephrectomy55.6 Kidney Transplant

Operations on Male Genital Organs (60-64)60.2 Transurethral prostatectomy64.5 Operation for sex transformation, NEC

Operations on Female Genital Organs (65-71)68.6 Radical abdominal hysterectomy69.92 Artificial insemination

continued...

22

I9 Procedure Codes Obstetrical Procedures (72-75)

74.0 Classical cesarean section72.31 High forceps operation with episiotomy

Operations on Musculoskeletal System (76-84)79.85 Open reduction of dislocation of hip81.51 Total hip replacement

Operations on the Integumentary System(85-86)85.23 Subtotal mastectomy85.94 Removal of implant of breast

continued...


Lecture 10 13

23

I9 Procedure Codes Miscellaneous Diagnostic and Therapeutic Procedures (87-99)

87.1 Other x-ray of face, head and neck88.4 Arteriography using contract materials88.93 Magnetic resonance imaging of spinal canal89.4 Cardiac stress tests and pacemaker checks 94.4 Psychotherapy and counseling99.92 Other acupuncture

continued...

24

Usage of I9 Coding SystemsAll discharges from hospitals, visits to physician offices, ambulatory care centers, and other sites of the delivery of care require and ICD-9-CM code that reflects the various diseases that were treated and procedures performed. All bills to third party agencies, Medicare, Medicaid, Blue Cross and other payors require diseases and procedures that were written in charts to be coded by staff prior to being submitted for payment. As of 2013 the ICD-10-CM will be required.


Lecture 10 14

25

A Sample of ECODES (Accidents)E8000 RR COLLISION NOS-EMPLOYE8001 RR COLL NOS-PASSENGERE8002 RR COLL NOS-PEDESTRIANE8003 RR COLL NOS-PED CYCLISTE8008 RR COLL NOS-PERSON NECE8009 RR COLL NOS-PERSON NOSE8010 RR COLL W OTH OBJ-EMPLOYE8011 RR COLL W OTH OBJ-PASNGRE8012 RR COLL W OTH OBJ-PEDESTE8013 RR COLL W OTH OBJ-CYCLE8018 RR COL W OTH OBJ-PER NECE8019 RR COL W OTH OBJ-PER NOS

26

A Sample of VCODESV3000 SINGLE LB IN-HOSP W/O CSV3001 SINGLE LB IN-HOSP W CSV301 SINGL LIVEBRN-BEFORE ADMV302 SINGLE LIVEBORN-NONHOSPV3100 TWIN-MATE LB-HOSP W/O CSV3101 TWIN-MATE LB-IN HOS W CSV311 TWIN, MATE LB-BEFORE ADMV312 TWIN, MATE LB-NONHOSPV3200 TWIN-MATE SB-HOSP W/O CSV3201 TWIN-MATE SB-HOSP W CSV321 TWIN, MATE SB-BEFORE ADMV322 TWIN, MATE SB-NONHOSP


Lecture 10 15

27

A Sample of Burn I9 Codes94510 1ST DEG BURN LEG NOS94511 1ST DEG BURN TOE94512 1ST DEG BURN FOOT94513 1ST DEG BURN ANKLE94514 1ST DEG BURN LOWER LEG94515 1ST DEG BURN KNEE94516 1ST DEG BURN THIGH94519 1ST DEG BURN LEG-MULT94520 2ND DEG BURN LEG NOS94521 2ND DEG BURN TOE94522 2ND DEG BURN FOOT94523 2ND DEG BURN ANKLE

28

Sample of Poisoning I9 Codes96502 POISONING-METHADONE96509 POISONING-OPIATES NEC9651 POISONING-SALICYLATES9654 POIS-AROM ANALGESICS NEC9655 POISONING-PYRAZOLE DERIV96561 POIS-PROPIONIC ACID DERV96569 POISON-ANTIRHEUMATIC NEC9657 POIS-NO-NARC ANALGES NEC9658 POIS-ANALGES/ANTIPYR NEC9659 POIS-ANALGES/ANTIPYR NOS9660 POISON-OXAZOLIDINE DERIV


Lecture 10 16

29

Example of I9 Cardiac Surgical Procedures3610 AORTOCORONARY BYPASS NOS3611 AORTOCOR BYPAS-1 COR ART3612 AORTOCOR BYPAS-2 COR ART3613 AORTOCOR BYPAS-3 COR ART3614 AORTCOR BYPAS-4+ COR ART3615 1 INT MAM-COR ART BYPASS3616 2 INT MAM-COR ART BYPASS3617 ABD-CORON ARTERY BYPASS3619 HRT REVAS BYPS ANAS NEC362 ARTERIAL IMPLANT REVASC3631 OPEN CHEST TRANS REVASC

30

Example I9 Neurosurgery Procedures0102 VENTRICL SHUNT TUBE PUNC0109 CRANIAL PUNCTURE NEC0111 CLOS CEREB MENINGES BX0112 OPEN CEREB MENINGES BX0113 CLOSED BRAIN BIOPSY0114 OPEN BRAIN BIOPSY0115 SKULL BIOPSY0118 OTHER BRAIN DX PROCEDURE0119 OTHER SKULL DX PROCEDURE0121 CRANIAL SINUS I & D0122 REMOV INTRACRAN STIMULAT0123 REOPEN CRANIOTOMY SITE


Lecture 10 17

31

Example I9 Orthopedic Procedures7971 CL REDUC DISLOC-SHOULDER7972 CL REDUC DISLOC-ELBOW7973 CL REDUC DISLOC-WRIST7974 CL REDUC DISLOC-HAND/FNG7975 CL REDUC DISLOC-HIP7976 CL REDUC DISLOC-KNEE7977 CL REDUC DISLOC-ANKLE7978 CL REDUC DISLOC-FOOT/TOE7979 CL REDUC DISLOCATION NEC7980 OPEN REDUC-DISLOCAT NOS7981 OPN REDUC DISLOC-SHOULDR7982 OPEN REDUC-ELBOW DISLOC

32

Example of I9 Obstetrical Procedures734 MEDICAL INDUCTION LABOR7351 MANUAL ROTAT FETAL HEAD7359 MANUAL ASSIST DELIV NEC736 EPISIOTOMY738 FETAL OPS-FACILITATE DEL7391 EXT VERSION-ASSIST DELIV7392 REPLACE PROLAPSED CORD7393 INCIS CX TO ASSIST DELIV7394 PUBIOTOMY TO ASSIST DEL7399 OPS ASSISTING DELIV NEC740 CLASSICAL C-SECTION741 LOW CERVICAL C-SECTION


Lecture 10 18

Section 9.2

Diagnostic-Related Groupings (DRGs) System

34

The Diagnosis-related Grouping System (DRGs)

IntroductionDesignHistoryGrouping SystemsMajor Diagnosis CategoriesExample DRGsDiagnosis-related grouping construct


Lecture 10 19

35

Introduction Medicare and Medicaid were adopted in 1965. Since their adoption and for the past 45 years the expenses for these federal funded programs have been uncontrollable.Many methods were attempted to reduce their annual growth. The most radical occurred in 1980 with the passage of public law PL-98-21 known as the Prospective Payment System (PPS). It mandated that hospitals rates were to be announces the prior year before they went into effect and rather than pay by a patients length of stay, payment would be by the diagnoses treated.

What Presidential Administration?

36

DRG DesignA system developed at Yale known as the diagnosis-related grouping system (DRG) was used as it currently is today, 29 years later. The patient variables to be used in the construction of the Diagnosis-related grouping system would consist of the information routinely collected by hospital in its current data collection and abstraction systems. These included diagnosis and procedure codes, death, age, and the existence of complications and comorbidities (CC). The system had as its goal the creation of a manageable number of DRGs to which payments would be assigned. Using the ICD-9-CM coding system was ruled out due to it having thousands of diagnoses and procedures.


Lecture 10 20

37

DRG History 1978 - HCFA funded an experiment with eighteen New Jersey hospitals having 383 DRGs as a prospective payment system. The ICD-8 coding system was used to construct the DRGs.1979 - The ICD-9-CM based DRGs were funded for development at Yale School of Organization and Management.1980 - Publication of the methodology used to construct the DRGs at Yale: Fetter R, Shin Y, Freeman RF, Averill R, Thomson JD.(1980) Case mix definitions by diagnosis-related groupings Medical Care, 18 (2, Supplement pp1-53).

continued...

38

DRG History 1982 - All New Jersey hospitals used the DRGs for all discharges including Medicare, Medicaid and all private payors using a DRG system with 430 categories. 1983 – In 1980 public law PL-98-21 was passed known as the Prospective Payment System (PPS). 2010 – The DRGs are into their 28th version and are used for all Medicare discharges and applied as a classification system for all discharge abstracts..

continued...


Lecture 10 21

39

DRG History

DRGs have been exported to France and a number of the European 8 nations. The DRG system is designed by a division of 3M which has been involved in its design since its inception. New York State uses a Non-Medicare Grouper for its younger patients. It has more categories such as:– The DRG 500 Series (Major Complications)– The DRG 600 Series (Neonates) – The DRG 700 Series (HIV) – The DRG 800 Series (TB)

40

Grouping Systems A grouper is a statistical program that takes the billing claims submitted to Medicare and places them into similar clinical and resource intense groupings. Each group is assigned a relative weight based on the mean charges submitted yearly. The results are reweighing the diagnosis-related groupings (DRGs) and the basis for rates of reimbursement for following year. In addition new DRGs are created based upon the use of new technologies that are considered standards of practice.

.

continued...


Lecture 10 22

41

Therefore in September of each year CMS will produce a list of new adopted Medicare DRGs with estimated payments for the upcoming fiscal yearThe DRGs are divided into surgical or medical treatments The principal diagnosis is “the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.”The principal procedure “performed for definitive treatment rather than diagnostic or exploratory purposes, or that was necessary to treat a complication. The principal procedure is usually related to the principal diagnosis.”

Grouping Systems

continued...

42

Complication or comorbidity (CC) are defined as:– A complication is a condition that arises during the

hospital stay that prolongs the length of stay one-day in approximately 75 percent of the cases.

– A comorbidity is a pre-existing conditions that because of its presence with a specific diagnosis causes an increase length of stay by at least one-day in approximately

Grouping Systems


Lecture 10 23

43

Definitions

Medicare DRGs

Non-Medicare DRGs

44

Major Diagnostic Categories (MDC)Diagnosis-related groupings have also been divided into categories that follow the body systems and function as a means to group DRGs. They are as follows:

MDC 1 Diseases and Disorders of the Nervous SystemMDC 2 Diseases and Disorders of the EyeMDC 3 Diseases and Disorders of the Ear, Nose &ThroatMDC 4 Diseases and Disorders of the Respiratory SystemMDC 5 Diseases and Disorders of the Circulatory SystemMDC 6 Diseases and Disorders of the Digestive System

continued...


Lecture 10 24

45

Major Diagnostic Categories (MDC)MDC 7 Diseases and Disorders of the Hepatobiliary System and PancreasMDC 8 Diseases and Disorders of Musculoskeletal System and Connective TissueMDC 9 Diseases and Disorders of the Skin Subcutaneous Tissue and BreastMDC 10 Endocrine, Nutritional and Metabolic Disease DisordersMDC 11 Diseases and Disorders of the Kidney and Urinary Tract

continued...

46

DRG Major Diagnostic Categories (MDC)MDC 12 Diseases and Disorders of the Male Reproductive SystemMDC 13 Diseases and Disorders of the Female Reproductive SystemMDC 14 Pregnancy, Childbirth and the PuerperiumMDC 15 Newborn and Other Neonates with Conditions Originating in the Perinatal PeriodMDC 16 Diseases and Disorders of the Blood and Blood Forming Organs and Immunological DisordersMDC 17 Myeloproliferative Diseases and Poorly Differentiated Neoplasms

continued...


Lecture 10 25

47

DRG Major Diagnostic Categories (MDC)MDC 18 Infectious and Parasitic DiseasesMDC 19 Mental Disease and Disorders and DisordersMDC 20 Alcohol/Drug Use and Alcohol/Drug Induces Organic Mental DisordersMDC 21 Injury Poisonings and Toxic Effects of DrugsMDC 22 Burns MDC 23 Factors Influencing Health Status and Other Contacts with Health ServicesMDC 24 Multiple Significant TraumaMDC 25 Human Immunodeficiency Virus Infectious

continued...

48

Example Neurosurgery DRGs (MDC1)DRG Description SIW1 CRANIOTOMY AGE >17 W CC 4.9024 2 CRANIOTOMY AGE >17 W/O CC 3.1039 6 CARPAL TUNNEL RELEASE 0.66307 PERIPH & CRANIAL NERVE 2.8127 9 SPINAL DISORDERS & INJURIES 1.5820 10 NERVOUS SYSTEM NEOPLASMS W CC 2.2098 11 NERVOUS SYSTEM NEOPLASMS W/O CC 1.2891 12 DEGENERATIVE NERVOUS SYSTEM DIS 1.5144 13 MULTIPLE SCLEROSIS 1.1198


Lecture 10 26

49

Example Cardiac Surgery DRGs (MDC5)DRG Description SIW103 HEART TRANSPLANT 34.0759 104 CARDIAC VALVE PROC W CATH 8.9205 105 CARDIAC VALVE PROC W/O CATH 5.9911 106 BYPASS W PTCA 7.1890 107 BYPASS W CATH W/O PTCA 6.3165 108 OTHER CARDIO PROC 4.5258 109 BYPASS W/O PTCA OR CATH 4.6174 110 MAJOR CARDIOVASCULAR W CC 4.2513111 MAJOR CARDIOVASCULAR W/O CC 2.8254

50

DRGs of Pregnancy, Childbirth (MDC14)DRG Description SIW364 D&C, CONIZATION NOT MALIGNANCY 0.6178 365 OTHER FEMALE REPRO. PROCED 1.4250 366 MALIGNANCY, FEMALE SYSTEM, W CC 1.9498 367 MALIGNANCY, FEMALE SYSTEM, W/O CC 0.9887368 INFECTIONS, FEMALE SYSTEM 0.7375 370 CESAREAN SECTION W CC 1.0677 371 CESAREAN SECTION W/O CC 0.8620 372 VAGINAL DELIVERY W COMP DX 0.7011 373 VAGINAL DELIVERY W/O COMP DX 0.5691


Lecture 10 27

51

Case Mix IndexThe case-mix index (CMI) is the sum of the total number (N) of unique DRGs multiplied by their DRG weights (SIWs) and then divided by the total (ΣN)number of cases.

Σ DRG1 X SIW1 + DRG2 X SIW2 + DRG3 ...DRGi X SIWi

Σ N1+ N2 +N3… +Ni

52

Example Case Mix Index Calculationfor Hospital A

DRG Discription Discharges (N) SIW N * Discharges1 CRANIOTOMY AGE >17 W CC 100 4.9024 490.242 CRANIOTOMY AGE >17 W/O CC 150 3.1039 465.5856 CARPAL TUNNEL RELEASE 60 0.663 39.789 SPINAL DISORDERS & INJURIES 200 1.582 316.4

10 NERVOUS SYSTEM NEOPLASMS W CC 150 2.2098 331.4711 NERVOUS SYSTEM NEOPLASMS W/O CC 220 1.2891 283.602

103 HEART TRANSPLANT 32 34.0759 1090.4288104 CARDIAC VALVE PROCEDURES W CATH 220 8.9205 1962.51105 CARDIAC VALVE PROCEDURES W/O CATH 235 5.9911 1407.9085106 CORONARY BYPASS W PTCA 125 7.189 898.625107 CORONARY BYPASS W CARDIAC CATH W/O PTCA 135 6.3165 852.7275209 MAJOR JOINT&LIMB REATTACH PROC 130 3.5778 465.114210 HIP & FEMUR PROC EX MAJOR JOINT AGE >17 W CC 155 3.4516 534.998211 HIP & FEMUR PROC EX MAJOR JOINT AGE >17 W/O CC 230 2.2291 512.693212 HIP & FEMUR PROCEDURES EX MAJOR JOINT AGE <18 110 2.0625 226.875213 AMPUTAT FOR MUSCULOSKELET SYSTEM 98 2.9877 292.7946216 BIOPSIES OF MUSCULOSKELETAL SYSTEM 75 2.6518 198.885218 LOW EXTREM & HUMER PROC W CC 200 2.4414 488.28370 CESAREAN SECTION W CC 250 1.068 267371 CESAREAN SECTION W/O CC 330 0.862 284.46372 VAGINAL DELIVERY W COMPLICATING DIAGNOSES 623 0.701 436.723373 VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES 730 0.057 41.537999 OTHER DRGs 15000 1.000 15000

TOTALS 19558 1.375 26888.6364


Lecture 10 28

53

Calculation of Hospital A - DRG RevenuesCMI=1.375Discharges=19,558Reimbursement= $10,000 per CMI pointPatient Revenues1.375* 19,558* $10,000=$268,992,500

54

Example Case Mix Index Calculationfor Hospital B

1 CRANIOTOMY AGE >17 W CC 167 4.9024 818.70082 CRANIOTOMY AGE >17 W/O CC 150 3.1039 465.5856 CARPAL TUNNEL RELEASE 60 0.663 39.789 SPINAL DISORDERS & INJURIES 159 1.582 251.538


103 HEART TRANSPLANT 0 34.0759 0104 CARDIAC VALVE PROCEDURES W CATH 150 8.9205 1338.075105 CARDIAC VALVE PROCEDURES W/O CATH 200 5.9911 1198.22106 CORONARY BYPASS W PTCA 128 7.189 920.192107 CORONARY BYPASS W CARDIAC CATH W/O PTCA 200 6.3165 1263.3209 MAJOR JOINT&LIMB REATTACH PROC 150 3.5778 536.67210 HIP & FEMUR PROC EX MAJOR JOINT AGE >17 W CC 232 3.4516 800.7712211 HIP & FEMUR PROC EX MAJOR JOINT AGE >17 W/O CC 300 2.2291 668.73212 HIP & FEMUR PROCEDURES EX MAJOR JOINT AGE <18 500 2.0625 1031.25213 AMPUTAT FOR MUSCULOSKELET SYSTEM 300 2.9877 896.31216 BIOPSIES OF MUSCULOSKELETAL SYSTEM 125 2.6518 331.475218 LOW EXTREM & HUMER PROC W CC 200 2.4414 488.28370 CESAREAN SECTION W CC 1000 1.068 1068371 CESAREAN SECTION W/O CC 500 0.862 431372 VAGINAL DELIVERY W COMPLICATING DIAGNOSES 2400 0.701 1682.4373 VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES 3600 0.057 204.84999 OTHER DRGs 20000 0.900 18000

TOTALS 30771 1.068 32849.462


Lecture 10 29

55

Calculation of Hospital B - DRG RevenuesCMI=1.068Discharges=30,771Reimbursement= $10,000 per CMI pointPatient Revenues1.068* 30,771* $10,000=$328,634,280

56

Example Case Mix Index Calculationfor Hospital C

1 CRANIOTOMY AGE >17 W CC 167 4.9024 818.70082 CRANIOTOMY AGE >17 W/O CC 150 3.1039 465.5856 CARPAL TUNNEL RELEASE 60 0.663 39.789 SPINAL DISORDERS & INJURIES 200 1.582 316.4


103 HEART TRANSPLANT 100 34.0759 3407.59104 CARDIAC VALVE PROCEDURES W CATH 333 8.9205 2970.5265105 CARDIAC VALVE PROCEDURES W/O CATH 436 5.9911 2612.1196106 CORONARY BYPASS W PTCA 128 7.189 920.192107 CORONARY BYPASS W CARDIAC CATH W/O PTCA 257 6.3165 1623.3405209 MAJOR JOINT&LIMB REATTACH PROC 180 3.5778 644.004210 HIP & FEMUR PROC EX MAJOR JOINT AGE >17 W CC 232 3.4516 800.7712211 HIP & FEMUR PROC EX MAJOR JOINT AGE >17 W/O CC 490 2.2291 1092.259212 HIP & FEMUR PROCEDURES EX MAJOR JOINT AGE <18 834 2.0625 1720.125213 AMPUTAT FOR MUSCULOSKELET SYSTEM 449 2.9877 1341.4773216 BIOPSIES OF MUSCULOSKELETAL SYSTEM 200 2.6518 530.36218 LOW EXTREM & HUMER PROC W CC 200 2.4414 488.28370 CESAREAN SECTION W CC 629 1.068 671.772371 CESAREAN SECTION W/O CC 555 0.862 478.41372 VAGINAL DELIVERY W COMPLICATING DIAGNOSES 2300 0.701 1612.3373 VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES 3300 0.057 187.77999 OTHER DRGs 25000 1.500 37500

TOTALS 36570 1.664 60856.8349


Lecture 10 30

57

Calculation of Hospital C - DRG Revenues

CMI=1.664Discharges=36,570Reimbursement= $10,000 per CMI pointPatient Revenues1.665* 36,570* $10,000=$608,892,250

58

Example DRG Construct (2)MDC 11 D&D of the Kidney and Urinary Tract

310

311

312

313

314

315

CC

CCOR

GT17

No

Yes

Yes

No

Yes

No

Transurethral

Other Kidney and Urinary Tract OR Proc.

UrethraNo

Yes


Documents

Lecture Icd 10