Instructions Assume you are an auditor for a QIO and are scheduled to do a DRG v
ID: 245338 • Letter: I
Question
Instructions Assume you are an auditor for a QIO and are scheduled to do a DRG validation study at a local hospital. Using the validation case study provided and worksheet, determine whether the hospital inpatient coder assigned the correct ICD-10-CM/PCS codes and sequenced them properly per UHDDS definitions. 1. Review the principal procedure and indicate whether the correct condition was selected as the principal diagnosis. If it was incorrect, provide the correct principal diagnosis in the space provided 2. Review the remaining codes for accuracy and enter your findings as follows a. If the code is correct and no change is needed, enter a "C" in the assessment column b. If a code is missing, add it to the reviewer code column (next to the last available/blank Facility Code space and place an "M" in the assessment column c. If you identify an incorrect code (i.e. wrong specificity, missing digit etc.) is reported, enter the correct code into the reviewer code column (in the field next to the wrong code) and enter "I" in the assessment column d. If the code is not supported by the available documentation, but a physician query is necessary, enter the correct code (if the condition can be coded), then enter a "Q" in the assessment column and in the comment section, record your query question e. If the code needs to be deleted because it is either not supported by documentation (and a query is not appropriate) or because it is not reportable based on the UHDDS definition place an "X" in the assessment column. 3. Record your explanation of the error in the review comments space provided. Provide indexing and/or Coding Clinic References. 4. Calculate the before & after MS-DRG. If the MS-DRG has changed, using a hospital base rate of $5,000, indicate the amount of money over or underpaid as a result of the error. 5. Submit this assessment as directed on or before the designated due dateExplanation / Answer
Data element Facility code Reviewer code Assessment Reviewer comments Admitting diagnosis E86.0 E86.0 C Principal diagnosis K52.9 K52.9 C Other diagnosis E86.0 E86.0 C 2 I50.9 E11.9 I DM 3 F32.9 F32.9 C 4 G20 G20 C 5 I10 I10 C 6 J10.1 M H1N1 7 R10.31 M RLQ pain 8 F55.2 M laxative abuse Principal procedure BW03ZZZ M ctest x-ray Other procedure R72.90 M urine Analysis 2 Z11.2 M Strep test 3 Z13.1 M blood sugar 4 R74.0 M LDH test 5 B020ZZZ M CT scan