DRG Validation Case Study Patient: Loretta Lind DOB 9/18/1949 MR# 2254893 Admiss
ID: 245286 • Letter: D
Question
DRG Validation Case Study Patient: Loretta Lind DOB 9/18/1949 MR# 2254893 Admission Date: 01/27/2016 Discharge Date: 02/3/2016 Admitting Diagnosis: dehydration, possible H1N1 Discharge Diagnosis: viral gastroenteritis, dehydration, DM, HTN, Parkinson's HISTORY AND PHYSICAL Chief Complaint: nausea, vomiting and diarrhea. HPl: This is a 63 year old female who has been seen in the past-most recently for cataract surgery in August of 2012. She has been admitted to the hospital on several occasions. She has Parkinson's disease. For the last several days she has been nauseous and vomited frequently. She has been feeling poorly in general. She complains of a fever earlier, cough and chills; possible H1N1 influenza. Patient did not receive the flu shot this year. She presented to the ED where she appeared dehydrated. She was seen and evaluated by Dr. Jenkins and is now being admitted to the hospital for treatment of the same MEDICAL HISTORY: The patient had an enlarged spleen at age 5. She had a herniorraphy at age 18 and again in 2006. She had meningitis in 1986 and has DM which requires daily insulin and hypertension. She has had Parkinsonism since 1983 and suffers from occasional depression. She is allergic to PCN. FAMILY HISTORY: She has a strong family history of breast cancer, mother and father currently under treatment for colon cancer. Two siblings are alive and both are obese and a sister with COPD. SOCIAL HISTORY: patient was a 1 pack a day smoker until 2 years ago when she quit. Alcohol use: glass of wine nightly. She lives alone ROS: No additional complaints all body systems reviewed. EXAM: GENERAL: Patient appears pale, ill and lying quietly in bed CONSTITUTIONAL: T-101.6, P-80 R 20 BP-160/90 SKIN: warm and dry. Evidence of dehydration; dry mucous membranes. Suspicious looking mole with irregular borders on her left forearm.Explanation / Answer
DRG(Diagnosis Related Groupings)Validation helpful for good and equal coding and billing process..It compares the report given by the hospital for patient claim and the information is there in the medical record were same..The auditor is a incharge person to validate the primary diagnosis,secondary diagnosis and procedures affecting the MS-DRG..
?As per Uniform Hospital Discharge Data Set(UHDDS)
?For principal diagnosis conditions still to be added
?1,Principal Diagnosis: Hyperthermia,Dehydration,Parkinsonism,DM,Hypertension,Possible H1N1 Influenza
?2, b, 'M' code is missing and it to be added..For discharge diagnosis: Viral gastro enteritis,Leukocytosis,Anemia,appendicitis to be added..
?3, In principal diagnosis still some more to be added..to keep the principal diagnosis effective review the full medical history and its record to find out the condition that must be added as a principal diagnosis..coding clinic references ICD-10-CM official Guidelines will be helpful..
4, MS-DRG validation is a one more process to determine thet accurate inpatient reimbursement under ICD-10-CM there is a error in principal diagnosis.So there is a correction in amount of money to be paid..We added extra diagnosis so the amount will be more than the previous amount..
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