Healthcare
MS-DRG and Present on Admission (POA)
Effective 10/1/07
MS-DRG 291 – Heart Failure & Shock w/MCC
MS-DRG 292 – Heart Failure & Shock w/CC
MS-DRG 293 – Heart Failure & Shock w/out MCC/CC
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Presented by
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- Effective October 1, 2007
- Medicare Severity-Diagnosis Related Groups (MS-DRG’s)
- 745 New Codes
- Diagnosis Categories
- Major Complication/Comorbidity (MCC)
- Complication/Comorbidity (CC)
- Non-CC
- Replaces the current 538 CMS-DRG’s
- May result in increases in payment to urban hospitals
- Generally treat more severely ill patients
- Prior to 10/1/07 the CC list included 3,326
- Effective 10/1/07, MCC & CC list increased the number of codes to 4,922
- Excluded Conditions When a Patient Dies
- Ventricular fibrillation – 427.41
- Cardiac Arrest – 427.5
- Cardiogenic Shock – 785.51
- Other Shock Without Mention of Trauma – 785.59
- Respiratory Arrest – 7991
- Documentation must be very specific to bill for a MS-DRG
- Acute Systolic Heart Failure – 428.21 (Major CC)
- Systolic Heart Failure – 428.20 (CC)
- Congestive Heart Failure – 428.0 (no longer a CC)
- Chargemaster needs to be reviewed and re-mapped to identify new MS-DRG’s
- DRG 127
- MS-DRG 291 – Heart Failure & Shock w/MCC
- MS-DRG 292 – Heart Failure & Shock w/CC
- MS-DRG 293 – Heart Failure & Shock w/out MCC/CC
- Hospital-Acquired Conditions
- Effective 10/1/08
- Medicare will not reimburse for a higher-paying DRG for CC’s that are hospital-acquired and preventable
- POA will be the determining factor
- Hospital-Acquired Injuries
- Pressure Ulcers
- Surgical Site Infections
- Catheter-Associated UTI’s
- Vascular Catheter Associated Infection
- Present on Admission (POA)
- Present at the time the order for inpatient admission occurs
- Includes conditions present during an outpatient encounter, including the ED
- Reporting Options
- Y – Yes
- N – No
- Developed during course of stay
- U – No information in the record
- W – Clinically undetermined
- 1 – Unreported/Not Used Exempt from POA Reporting
- Certain E Codes; V Codes; Maternity
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