Validating drg 945

The Centers for Medicare and Medicaid Services (CMS) reminds providers that the medical record must contain sufficient documentation to demonstrate that the beneficiary’s signs and/or symptoms were severe enough to warrant the need for inpatient medical care.

To assist in lowering DRG claim errors, providers are reminded to accurately document the medical necessity of services, code correctly and ensure that care is provided in the appropriate setting.

The specificity of ICD-10-PCS causes multiple translations for extracranial procedures for head & neck endarterectomy and angioplasty of precerebral vessels, including specific root operations and approaches, causing the DRG shifts.

Coding will be based on the documentation provided in the record, so this shift is likely to be experienced.

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O14.00 Mild to moderate pre-eclampsia, unspecified trimester).

0DBA0ZZ, Excision of Jejunum, open approach) are now reclassified as anal and stomal procedures which are moving them further down the list of hierarchy for DRG assignment.Antepartum complications ICD-9 codes such as 642.43, "Mild or unspecified pre-eclampsia, antepartum" map to unspecified trimester codes in ICD-10.This is a "new" concept in ICD-10 diagnosis coding.Significant questions that arise during preparation include: ICD-10 procedure coding has multiple alternatives that are more specific than ICD-9, which could cause shifts to new MS-DRGs.Specifically, in reviewing the multiple ICD-10-PCS translations of ICD-9 procedure code 38.12.

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