Coding for Quality: Documentation and Coding Tips for Gastrointestinal Disorders (DRG 174 & 182)

IPRO continues to provide tools to assist hospitals in reducing payment errors. This booklet is intended to assist hospital in reducing payment errors due to inappropriate admissions and incorrect coding/DRG assignment associated with DRG 174/175, Gastrointestinal Hemorrhage, age > 17 with/without CC and DRG 182/183, Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders, age > 17 with/without CC.

Analysis of data from Medicare 7th Scope of Work (SOW), which ended July 2005, indicates that IPRO's coding denial rates are 22% for DRG 174 and 20% for DRG 182. Most often, the resulting IPRO-assigned DRG for these cases was the lower-weighted DRG from that particular DRG pair (DRG 182 became DRG 183 and DRG 174 became DRG 175), and from DRG 174 to DRG 182 (also a lower-weighted DRG). DRG 182 and 183 short stay is also a CMS payment error target area. Based on analysis of DRGs 174/175 and 182/183, cases paid under these DRGs have a significant potential for admission denial and coding/DRG errors.

Coding plays a vital role in payment, reporting, and accurate data collection. Being proactive about making changes in coding, auditing and monitoring is essential. Hospitals may want to examine their billing for DRG 182 and the higher-paying DRG 174 and should follow Coding Clinic guidelines to ensure accuracy in ICD-9-CM coding and DRG assignment.

The Coding for Quality: Documentation and Coding Tips for Gastrointestinal Disorders (in pdf format).