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The following is a breakdown of the MS-DRG’s that were included in our first request. Of note, these are targets identified during the demonstration project:
|
RAC Complex DRG Review Record Requests 4/16/2010 |
MS-DRG Number |
SAC |
|
Major Chest Procedures with CC: MS-DRG 164 |
164 |
4 |
|
Other Respiratory System O.R. Procedures with MCC: MS-DRG 166 |
166 |
5 |
|
Other Respiratory System O.R. Procedures with CC: MS-DRG 167 |
167 |
2 |
|
Respiratory System Diagnosis with Ventilator Support < 96 Hours: MS-DRG 208 |
208 |
1 |
|
Inflammatory Bowel Disease with CC: MS-DRG 386 |
386 |
1 |
|
Other Digestive System Diagnoses with CC: MS-DRG 394 |
394 |
1 |
|
Wound Debridement and Skin Graft Except Hand, for Musculo-Connective Tissue Disorders with CC: MS-DRG 464 |
464 |
1 |
|
Fractures of Femur with MCC: MS-DRG 533 |
533 |
1 |
|
Skin Graft and/or Debridement for Skin Ulcer or Cellulitis without CC/MCC: MS-DRG 575 |
575 |
1 |
|
Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders with MCC: MS-DRG 622 |
622 |
1 |
|
Extensive O.R. Procedure Unrelated to Principal Diagnosis with CC: MS-DRG 982 |
982 |
10 |
|
Extensive O.R. Procedure Unrelated to Principal Diagnosis without CC/MCC: MS-DRG 983 |
983 |
5 |
|
Nonextensive O.R. Procedure Unrelated to Principal Diagnosis with CC – MS-DRG 988 |
988 |
1 |
|
Nonextensive O.R. Procedure Unrelated to Principal Diagnosis without CC/MCC – MS-DRG 989 |
989 |
1 |
|
TOTAL |
|
35 |
Our records arrived at Connolly Healthcare on Friday, May 28. I started to see updates as early as June 7. Our first determination letters started to arrive on June 17. I have been checking Connolly’s website daily to review the status of our records. Often times the “status date” would change on the individual cases. To my surprise, I found that updates were occurring on Saturdays and Sundays as well.
All of our records from this first request now have been reviewed, and we ended up with two cases having findings – and amazingly, one of them was a lower-weighted MS-DRG! At the beginning of the reviews, these records had been updated to show no recovery, but a few days later, that changed. This was a surprising discovery as I was tracking each case online and noting each outcome.
As mentioned, we also received our second record request. Our first request was dated April 16, and our second was dated June 15. The 45-day window for new requests certainly held true this time around. This second request however is for only four records, compared to the 35 in the first request. The due date for this second round is July 30.
The following is the breakdown of the MS-DRG’s for our second request:
|
RAC Complex DRG Review Record Requests 06/15/2010 |
MS-DRG Number |
SAC |
|
Percutaneous Cardiovascular Procedure with Non Drug-Eluting Stent with MCC or +4 vessels DRG 248 |
248 |
1 |
|
Inflammatory Bowel Disease with CC: MS-DRG 386 |
386 |
2 |
|
Cirrhosis and Alcoholic Hepatitis with MCC: MS- DRG 432 |
432 |
1 |
|
TOTAL |
|
4 |
This next month we will be busy processing our new request and determining our next steps for our two cases with findings from our initial request. I’m sure there will continue to be new learning opportunities as we move through our next phase in the RAC experience!
Anissa Fabrizio, RHIA, CCS is the Administrative Director of Health Information Management and Patient Access for St. Anthony Central Hospital in Denver, Colorado. Sponsored by Catholic Health Initiatives, St. Anthony Hospitals is part of Centura Health, Colorado’s largest family of hospitals and health care services and one of the state’s largest private employers, operating 12 hospitals, seven senior living communities and home care and hospice services. Anissa has had various roles within HIM for the past 18 years, and currently serves as the Treasurer for the Colorado Health Information Management Association.
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