Review the following cases. Select and code the principal diagnosis and all significant secondary diagnoses, as well as the principal procedure and secondary procedures as applicable. Use the computer (encoder and grouper) for this assignment. You may use your coding book to locate the codes if you don’t feel comfortable enough with the encoder yet. Once you obtain your correct codes, you can input them directly into the Summary screen to calculate the DRG. ** There is no correlation between the number of spaces provided and the number of codes!! Use the following admission/discharge dates for all: 1/10/xx—1/15/xx.
All will have a Discharge Status of Home. Be sure the payer is St. Vincent Hospital and all are classified as Inpatients. In addition, designate whether or not the diagnoses were present on admission (Y for “yes” or N for “no”). Incomplete or incorrect information will result in a 1 point deduction for each. 1. Patient was a 66 year old male admitted for excision of malignant melanoma, base of the skull. The day after admission a wide excision of scalp with split thickness skin graft and bilateral radical cervical lymph node dissection was performed. Principal Dx Code: 172. 4 POA: Y Secondary Dx Code(s) & POAs:
Principal Proc. Code:86. 69 Secondary Proc. Code(s):01. 6 & 40. 42 DRG:00578 Weight: 0. 99250 Payment:6,049. 53 MLOS1: 2. 4000 2. Patient was an 85 year old male with a long history of benign prostatic hypertrophy. He was admitted and scheduled for a transurethral resection of the prostate. However, the night before surgery, he fell out of the hospital bed and fractured his right hip (right femoral neck). This required an unexpected trip to the operating room for open reduction and internal fixation of the fracture.
While in the operating room, the TURP was carried out. The final diagnoses were benign prostatic hypertrophy and fracture of right hip. Principal Dx Code: 600. 0 POA: Y Secondary Dx Code(s) & POAs: 820. 8 &N E884. 4N Principal Proc. Code: 60. 29 Secondary Proc. Code(s):79. 39 DRG: 00714 Weight:0. 63640 Payment: 3,879. 01 MLOS1: 1. 6000 3. 78-year-old male patient admitted following mugging with fracture of left hip (left femoral neck) and internal abdominal bleeding. A splenectomy was performed immediately for a ruptured spleen and an open reduction with internal fixation of the fractured hip was performed after the patient’s condition stabilized. Principal Dx Code: 289. 59 POA: Y Secondary Dx Code(s) & POAs:820. 8 Y E968. 8 Y.
Principal Proc. Code:41. 5 Secondary Proc. Code(s): 79. 39 DRG: 00799 Weight:5. 10870 Payment: 31,138. 75 MLOS1: 13. 7000 4. 70-year-old male patient admitted with third degree burns over 30% of his body involving trunk. Patient was smoking in bed. Burns were excisionally debrided and split thickness skin grafts applied to burns of the trunk. Principal Dx Code: 942. 30 POA: Y Secondary Dx Code(s) & POAs: E898. 0 Y Principal Proc. Code:86. 22 Secondary Proc. Code(s): 86. 69 DRG:00929 Weight: 2. 00860 Payment: 12,242. 90 MLOS1: 7. 4000 5. Patient was a 66 year old female with adult onset diabetes and acute abdominal colic.
Work-up revealed gallstones and a cholecystectomy and common duct exploration were performed for acute cholecystitis and cholelithiasis. Patient’s diabetes was out-of-control for most of her hospital stay. Principal Dx Code: 574. 00 POA: Y Secondary Dx Code(s) & POAs: 789. 00 Y 250. 00 Y Principal Proc. Code: 51. 22 Secondary Proc. Code(s): 51. 51 DRG: 00413 CHOLECYST W CDE WO CC/MCC Weight:1. 62220 Payment: 9,887. 70 MLOS1: 4. 5000 continued… Part II Instructions: Use the grouper to assign the DRG only to each of the following cases. The codes are already given.
Use the following demographics: Male, age 65, d/c home, admit 1/10/08, discharged 1/15/08. Use “Y” for POA indicator on all just for example purposes! Include the DRG in the space provided below and answer any questions asked. Again, all incomplete or incorrect information will result in a 2 point deduction for each. 1 Principal diagnosis: 455. 0 Internal hemorrhoids Secondary diagnosis: 455. 4 External thrombosed hemorrhoids Principal procedure: 49. 46 Excision of hemorrhoids Other procedures 45. 24 Other endoscopy large intestine 96. 23 Dilation of anal sphincter DRG#/Description:___00349 Anal & Stomal PX WO CC/MCC_________ 2.
Principal diagnosis: 541 Appendicitis Secondary diagnosis: 401. 9 Hypertension Principal procedure: 47. 09 Appendectomy Other procedures: 87. 73 IVP 91. 12 Microscopic exam of specimen DRG#/Description:__00343 APPY WO COMP PDX WO CC/MCC__________ 3. Principal diagnosis: 428. 0 Congestive Heart Failure Secondary diagnosis 174. 8 Breast Cancer Principal procedure: 85. 43 Unilateral extended simple mastectomy Which of the above codes will not allow you to group the DRG? Above code that would not allow to code was 174. 8 Breast Cancers. Why not? Reason behind why it would not allow to work was because claimed sex for code was wrong.
Was not for a male patient. What code would you need to change this to for a male patient in order to group the DRG? Code that changed it to was 175. 9 Neoplasm of unspecified male breast. DRG#/Description ___00983 EXT OR PX UNREL TO PDX WO CC/MCC_____________________ 4. Principal diagnosis: 560. 81 Intestinal or peritoneal adhesions with obstruction Secondary diagnosis: 560. 9 Obstruction of colon Principal procedure: 54. 59 Lysis of peritoneal adhesions DRG#/Description _00337 PERITONEAL ADHESIONLYSIS WO CC/MCC _________________________________________________________________________