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Case Presentations for ICD-10
2
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© 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
3
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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
4
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.
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.
5
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.
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%
APR DRG:SOI Level:APR Weight:ROM Level:Exp. Mort Rate:
MS-DRG: 690 (without MCC)Relative weight: 0.7693
MS-DRG: 871 (with MCC)Relative weight: 1.8527
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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.
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.
7
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.
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: Traumatic subdural hemorrhage, no LOC
SDx: Alzheimer’s dementiaUnspecified fallPalliative care
APR DRG:SOI Level:APR Weight:ROM Level:Exp. Mort Rate:
PDx: Same
SDx: Add:Herniation of brain
Sample Case Neuro
0551
0.63652
2.9%
0553
1.37173
7.5%
APR DRG:SOI Level:APR Weight:ROM Level:Exp. Mort Rate:
MS-DRG: 087 (without CC/MCC)CMI: 0.7345LOS: 2.2
MS-DRG: 085 (with MCC)CMI: 1.9733LOS: 4.9
8
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.
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.
9
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.
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: 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%
APR DRG:SOI Level:APR Weight:ROM Level:Exp. Mort Rate:
MS-DRG: 194 (with CC)Relative weight: 0.9771
MS-DRG: 871 (with MCC)Relative weight: 1.8527
10
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© 3M 2014. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M.
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
PPx: Left hemicolectomy
APR DRG: 221SOI Level: 2APR Weight: 1.7681ROM Level: 1Peer Group 0.0%
APR DRG: 221SOI Level: 3APR Weight: 2.9531ROM Level: 3Peer Group 2.5%
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
PPx: Left hemicolectomy
APR DRG: 221SOI Level: 4APR Weight: 6.3732ROM Level: 4Peer Group 24.2%
11
12
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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