MS-DRG detailed review

In this episode we review the MS-DRG assignment process in detail with demonstration on how to find MDC's (Major Diagnostic Category) and the final DRG.
Resources:
MS-DRG definitions manual V38.0:
www.cms.gov/icd10m/version38-...
Hospital Acquired Conditions and the CC / MCC (video, quiz in its description):
• The HAC list
Present on Admission and the CC / MCC (video, quiz in its description):
• Present on admission i...
CC Exclusion list and demonstration video (quiz in its description):
• Playlist
Medical coding study guide:
www.thecodingguild.com/freebies
Let's connect! :)
/ bestmedicalcoding
[e-mail]
© 2021 The Coding Guild Ltd. Co. All rights reserved.
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The aim of this test video is to educate HIM professionals on the application of medical coding and billing rules and guidelines. The described scenarios are fictional, so are all 'treatments' outlined in the examples. The creator of this video is not licensed to practice medicine in any capacity and thus does not advise, endorse or otherwise recommend any treatment modality, drug or dosage for any disease or conditions mentioned in the content. The example scenarios are not intended to be interpreted as, or substitute medical advice or medical education. Seek medical counsel from a legally authorized healthcare practitioner for any and all questions regarding your, or others' medical care or medical training.

[@The2buttercup1]

I stumbled onto your videos, and I just want to say they are so helpful. You really explain things clearly and concisely. Thanks.

[@TheMedicalCodingGuild]

Hi Jacqueline! I am happy if the videos help you! I remember what it was like to be a brand new coder, or new in a specialty, and feel lost. At that time I had amazing mentors who helped me get started on a successful coding journey. I hope to pay it forward with the videos and help others the same way I was helped. :)

[@bingj.ccshim2807]

This is very informative and very helpful to me, especially right now I am self studying for CDIP certification. Thank you so much for these videos. I have watched 3 so far and bookmarked it, so I can revisit anytime I come across confusing case studies

[@TheMedicalCodingGuild]

Hi Bing J.! I am happy to hear that the videos are helping! MS-DRGs can be confusing with so many elements to consider: POA, HAC, principal dx, Pre-MDCs... But this is why we are here to help each other. :) Best of luck on your CDIP and let me know if you have DRG related questions!

[@Chorkymom]

I am sitting for my CCS next month and finally found out how to brush up THIS! Thanks SO MUCH!

[@TheMedicalCodingGuild]

Happy to help!! :) Good luck on your CCS! Have you seen my other video on the CCS question types regarding the dreaded 'highest DRG' questions?

[@Chorkymom]

@@TheMedicalCodingGuild I was watching yes, and the APC and OPPS too.

[@TheMedicalCodingGuild]

@@Chorkymom Then you are all covered! :D The best of luck for real!! It is a tough test but doable!!

[@Chorkymom]

@@TheMedicalCodingGuild Thanks! I need all the encouragement I can get..😃

[@TheMedicalCodingGuild]

@@Chorkymom I forgot to ask: how did the exam go?

[@pajm926]

Great explanation. Thank you!

[@TheMedicalCodingGuild]

Thank you pajm926! Let me know if you have questons!

[@rushidhruva]

YOU ARE AN AWESOME TEACHER!!!!!!!!! Thank you!!

[@TheMedicalCodingGuild]

Thank you Roopa! That is very kind of you! I hope the video helped you understand MS-DRG's a bit more! :)

[@csmith101]

THANK YOU! Please keep making videos and sharing. your wealth of knowledge!

[@TheMedicalCodingGuild]

Thank you Cheyenne! I am trying to upload as much as I can. :) Any topic requests?

[@csmith101]

@@TheMedicalCodingGuild Would you be willing to do a series on exam prep for coding certifications and/or coding for everything on pregnancy to labor and delivery? Or perhaps capturing acute care PCS charges appropriately?

[@csmith101]

@@TheMedicalCodingGuild thank you so much for uploading what you do. I’m listening as I cook! 🙂

[@TheMedicalCodingGuild]

OBGYN is my nemesis but I will see what I can do. :) For PCS I have a short video for now on how to pick the right root operation in 3 easy steps, please find it here: kzbin.info/www/bejne/rJ6ynYOribeHm6M I do plan on doing more PCS videos to help with correct coding. The exam prep series sounds interesting as well! Thank you for the recommendation! Which credential are you getting ready for?

[@csmith101]

@@TheMedicalCodingGuild thank you so much 😊

[@lindsaymartinez2468]

Great information!

[@TheMedicalCodingGuild]

Thank you Lindsay! Appreciate it! :)

[@santhoshreddy1786]

Very good explanation.. Keep going 😍

[@TheMedicalCodingGuild]

Thank you, I really appreaciate the feedback!!

[@geogeorge4369]

Thank you great information keep doing more vedios

[@TheMedicalCodingGuild]

Thank you so much! I try to upload every 3-4 days as life allows. Any topic requests?

[@alejandrolozano9987]

Greatly appreciate the lesson…I’m new to the healthcare analysis and I’m having a real hard time how to calculate the Capital FSP and Operating FSP…or if you recommend some website to reference please? I greatly appreciate your assistance

[@TheMedicalCodingGuild]

I am happy if you found it helpful! For FSP, is this what you need? resdac.org/cms-data/variables/claim-pps-capital-federal-specific-portion-fsp-amount

[@jessicacolon1376]

Thank you so much.

[@TheMedicalCodingGuild]

Hi Jessica! Thank you for checking it out! :) Any questions / concerns?

[@jessicacolon1376]

@@TheMedicalCodingGuild I will watch all your videos of MS-DRGS and I will get to you. Thank you.

[@TheMedicalCodingGuild]

@@jessicacolon1376 Sounds good!

[@ahmedaburady9288]

Cases of maternity problem like premature rupture of memberane which is medical then we made cs so it is surgical so , any case can be a combind DRG

[@TheMedicalCodingGuild]

Hi Ahmedaburady9288! Sure, as patient needs change, the DRG might change as well. They might arrive with a simple medical need but then need surgery and become a surgical DRG. The video looks at the very end of the process, when the patient has already left and we have all information necessary in order to assign the appropriate DRG. The point here is to see how the Grouper works. :)

[@santhoshreddy1786]

Hi Anna, Could you please explain on the FinalRule and CorrectionNotice of CMS website when to consider final rule and when to consider correction notice (time frame)

[@TheMedicalCodingGuild]

Will look into it! :)

[@sheenak.5662]

Great tutorial on DRG coding. I am just getting into this now and your explanation exceeded my expectation. Thank you so much. Could you recommend an online site where I can learn and become a certified DRG coder? I am an RN who does medical reviews and very interested in this specialty.

[@TheMedicalCodingGuild]

Hi there! Thank you for the positive feedback! :) Happy if the video helped! What you want to look for is inpatient coding. IP coders deal with DRGs. Credentials CCS and CIC. (I have a comparison video for these 2 if you are seeking more info on them.) But as an RN, I would go for inpatient Clinical Documentation Improvement (CDI). Very highly paid for RNs and you will be able to use your medical knowledge + DRGs. In coding you will have to 'shed' your RN-ness and can't interpret the note. Not sure you would enjoy that that much. What do you think? Would CDI sound good?

[@TheMedicalCodingGuild]

Oh, I didn't recommend sites: for IP coding AHIMA is the way to go. CCS credential. Yes, it does have outpatient coding included, but this is the gold standard for inpatient coding. AAPC's CIC is only inpatient related, but employers are not seeking it that much. Again, please see the comparison video for futher info.

[@santhoshreddy1786]

Please make a video on the impact of CC/MCC, POA, HAC on the DRG level.

[@TheMedicalCodingGuild]

Hi Santhosh! I already have - at least partially. Please check my other videos, you will find 2 episodes on the HAC and POA + 1 on the CC exclusion list. :)

[@saritaxsingh]

Thank you so much

[@TheMedicalCodingGuild]

Hi Saritaxsingh! You are very welcome! Let me know if you have questions! Best of luck on your exam!!

[@al-abbasgroupabs8624]

Thank you very much. Could you please explain Case Mix Index and the average cost per patient?

[@TheMedicalCodingGuild]

Sure! Great topic idea, thank you! :)

[@lindsaymartinez2468]

Great information . Thank you.

[@TheMedicalCodingGuild]

@@lindsaymartinez2468 Thank you Lindsay! (Sorry for the late reply, YT didn't notify me of your comment.)

[@santhoshreddy1786]

Hi Anna, I have a doubt, Few drg codes 793,794,790 doesn't need a CC/MCC codes on claim. So can we ignore the exclusions and HAC logic for these DRG codes. Please clarify me

[@TheMedicalCodingGuild]

Yes in these cases there is no differentiation for HAC from a financial viewpoint. Of course we still need to clarify which conditions were and weren't POA for other purposes. As for the exclusions: those only apply to CC/MCC. For neonates, as you pointed out, we don't have CC/MCC in these DRGs. For them the presence or absence of given diagnoses will decide the final DRG. As principal or secondary. These are called 'significant complicating dx'. You can find the exact dx list under the DRGs 793, 794, 790 separately.

[@santhoshreddy1786]

@@TheMedicalCodingGuild I completely agree with you Ma'am, to bill these DRGs at least one of the dx codes listed under each drg should be present to satisfy the drg 793,794,790. Thanks a lot for the explanation and quick response 🤩

[@TheMedicalCodingGuild]

@@santhoshreddy1786 Let me know if I can help with anything else! :)

[@osbermom9024]

I took the CCS exam in April and did not pass. I am taking it again this week!! My question is how are we to answer a question that asks us to choose the MDC with or without CC or MCC within a given scenario. We do not have the MDC categories in our code books , do we? I had several questions asking me to pick the appropriate category. I was lost. Help!

[@TheMedicalCodingGuild]

Hi Osber Mom! No, the MDCs are not in the book unfortunately. What you might be able to do is to exclude possible answers based on the body system you are in. F.e. MDC 04 is the respiratory system. If the question has a patient with a UTI, MDC 04 is not going to be good for you. You can also exclude answer choices by identifying whether or not your case has a valid CC or MCC code. This should be possible using your ICD-10-CM book. For more help on that please see the CCS exam questions video where I detail how to do this. I hope you pass this time!!

[@brosistass]

Hi mam, one doubt please, do we need to have CCS certificate if we need to get IP DRG job.please clarify

[@TheMedicalCodingGuild]

Hi Swapna Sri! The CCS is the most sought after in the US for any and all inpatient coding jobs. I can't speak for offshore companies, but American companies usually demand their contractors in other countries hold the CCS. Earn it if you can, it WILL help!!

[@brosistass]

@@TheMedicalCodingGuild I have CIC certification ,still need to take CCS mam

[@TheMedicalCodingGuild]

@@brosistass You don't have to take the CCS, but please understand that your opportunities with just the CIC will be limited if you want to do inpatient coding. It is just how it is. AHIMA's CCS is sought after while the CIC doesn't mean much unfortunately. As you know I hold both and opportunities really only opened up after I got my CCS. Before you make any decision, please check out my other vide where I compare the CIC with the CCS so that you see what the differences are. Also, check with your local employers. They might accept the CIC without a CCS. Best of luck!!

[@brosistass]

@@TheMedicalCodingGuild thank you somuch for your valuable feedback, surely I will look all the videos, very knowledgeable

[@TheMedicalCodingGuild]

@@brosistass Thank you for the kind words! Let me know if you have any more questions and I will try to help. :)

[@MrRedered]

hello great video and thx for sharing .im knew at this and a little confused .how would you figure out this code please ? claim # 09-21026-163-490 . would i start 026 and then 02616 or different .i would greatly appreciate .im gonna subscribe .thx again.

[@TheMedicalCodingGuild]

Hi Red E Red! Thanks for subscribing! :) More helpful videos on the way! As for the claim: I cannot pull this for you. You know HIPAA: we are only allowed to look at patient data that relates to our daily job functions. I am happy to help if you can give me diagnosis and procedure codes but please understand that there is no way I can look at your patient's paperwork myself without going to jail for it. I am sorry!