Question

Variation Log by Type of Error	% of errors
Inaccurate sequencing or specificity principal diagnosis, affect MS-DRG	17%
Inaccurate sequencing or specificity principal diagnosis, non affect MS-DRG	16%
Omission CC, affect MS-DRG	33%
Omission CC, non affect MS-DRG	2%
Inaccurate principal procedure, affect MS-DRG	3%
Omission procedure, affect MS-DRG	4%
More specific coding of diagnosis or procedure, non affect MS-DRG	12%
Inaccurate coding	5%
Missed diagnosis or procedure code	8%

Variation Log by Coder
Coder	Error Rate	Standard
Coder 1	3%	5%
Coder 2	9%	5%
Coder 3	8%	5%
Coder 4	2%	5%
Coder 5	4%	5%
Coder 6	16%	5%
Coder 7	12%	5%
Coder 8	3%	5%

Step One: You are the inpatient coding manager at XYZ University Hospital. Your director has asked you to develop a draft Corporate Compliance plan with an ongoing review and monitoring schedule for the next year based on the results from the outside review. Review the reports provided and determine a list of recommendations ( at least two recommendations based on Variation Log by Coder and two recommendations based on Variation Log by Type of Error)

Answer 1

On the basis of above Variation Log by type of Error and variation log by Codder, It is observed that 33% errors types are “Inaccurate sequencing or specify principal diagnosis. Out of this 33%, 17 % affect MS-DRG & 16% not affect MS-DRG.

It is also observed that 12% error types are more specific coding of diagnosis or procedure non affect MS-DRG.

As we know that Sequencing is the list of codes in order based on severity of illness (SOI) and resources utilized. Inappropriate sequencing shows that these codes are not analyzed appropriately by coders and not assigned appropriately.

Sequencing drives selection of the principal diagnosis and 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.

Once a principal diagnosis is assigned at the highest level of severity, a secondary diagnosis should be chosen. It should be classified as complications/comorbidities (CCs) or major CCs (MCCs), the presence or absence of a CC or an MCC code as a secondary diagnosis changes the DRG.

Recommendations:

1. I would like to recommend the coders that they must choose and assign codes in the correct order for appropriate sequencing of codes and with detail specification of principal diagnosis conditions.
2. I would like to recommend the coders that they Final MS-DRG assignments should be done based on principal diagnosis and secondary diagnoses, the principal procedure and secondary procedures. Coder should ensure an accurate MS-DRG assignment is made with appropriate specification of This key decision directly impacts reimbursement, compliance, and readmission rates via core measures.