StudentShare
Contact Us
Sign In / Sign Up for FREE
Search
Go to advanced search...

Diagnosis Related Groups - Assignment Example

Cite this document
Summary
In the paper “Diagnosis Related Groups” the author analyzes the system, which sets a price per case treated. This is essentially a patient classification scheme that is based on a relationship of the type of patient to the costs incurred by the hospital in treating that care…
Download full paper File format: .doc, available for editing
GRAB THE BEST PAPER96.4% of users find it useful
Diagnosis Related Groups
Read Text Preview

Extract of sample "Diagnosis Related Groups"

Download file to see previous pages

DRG 468 thus pays for discharge in which the patient undergoes an operating room procedure entirely unrelated to this admission's principal diagnosis. This is against the PPS classification of discharges of clinically coherent groups. Although this is possible in some cases, DRG 468 can be an example of DRG creep. The attending physician may misspecify the principal diagnosis, secondary diagnosis, or the procedure on the attestation sheet. It can also be the result of miscoding, where the hospital assigns an incorrect numeric code to the diseases or procedures which had been correctly attested by the physician in charge.

In some cases to avoid investigation, the hospital may substitute a secondary diagnosis for the correct principal diagnosis. Therefore for an appropriation of facts, auditing and review are necessary that would identify discharges in which coding rules are either ignored or not applied appropriately. DRG 468 is assigned when all the operating room procedures are unrelated to the major diagnostic category for which the patient had been admitted. Most often, these patients are admitted with a principal diagnosis that does not need any surgery.

 To assess the appropriateness, the ICD-9-CM coding guidelines should be applied to do the initial coding and for auditing if such has been used. The principal diagnosis is always the reason for admission, which should be backed by records indicating circumstances at admission, diagnostic workup, and therapy provided. The scenario is not an admission of the patient to treat two conditions, it is rather two conditions present during admission. While auditing and reviewing, it is to be determined whether the principal diagnosis was the reason for admission and treatment.

If at admission, there were more than one diagnosis, the use of guidelines for selecting the principal diagnosis would be used with consideration of circumstances at admission, diagnosis workup, and the therapy provided. The principal procedure must be performed for definitive treatment, not for diagnostic purposes, exploratory purposes, or for a complication. If there are two procedures done, then the one most related to the principal diagnosis would be selected as the principal procedure. The procedure must be significant as defined by the Uniform Hospital Discharge Data Set would be used, and for this to qualify, it must be surgical under anesthesia with the operator being specially trained.

The audit must look at the detailed documentation in the medical record. There must be enough proof and substantiation that it was medically necessary. The coding should be done from the narrative description of the procedure, not from the written title of the procedure. The approach and closure of the procedure are an integral part of one significant procedure, not two separate.

...Download file to see next pages Read More
Cite this document
  • APA
  • MLA
  • CHICAGO
(Diagnosis Related Groups Assignment Example | Topics and Well Written Essays - 750 words, n.d.)
Diagnosis Related Groups Assignment Example | Topics and Well Written Essays - 750 words. Retrieved from https://studentshare.org/health-sciences-medicine/1518980-diagnosis-related-groups
(Diagnosis Related Groups Assignment Example | Topics and Well Written Essays - 750 Words)
Diagnosis Related Groups Assignment Example | Topics and Well Written Essays - 750 Words. https://studentshare.org/health-sciences-medicine/1518980-diagnosis-related-groups.
“Diagnosis Related Groups Assignment Example | Topics and Well Written Essays - 750 Words”. https://studentshare.org/health-sciences-medicine/1518980-diagnosis-related-groups.
  • Cited: 0 times

CHECK THESE SAMPLES OF Diagnosis Related Groups

Payment Systems: Coding. Medical Coding Process

The Medicare Severity Diagnosis Related Groups (MS-DRGs) work to adjust payment mechanisms for health system providers.... Patients are connected to a MS-DRG system by taking their ‘age, diagnosis, surgical procedures, and other information' into account; and hospitals attach this information on their bills in order to enable the Meidcare to determine how much the hospitals have to be paid (U....
1 Pages (250 words) Essay

ECO: Capitation Assignment

Diagnosis Related Groups (DRGs) In the Diagnosis Related Groups health care program, DRGs pays health care providers are paid on prospective terms while factoring in diagnoses and procedures.... These are determined and classified to give them codes referred to as Diagnosis Related Groups (DRGs)....
3 Pages (750 words) Assignment

Hospital vs Case-Mix Funding Systems

On the other hand, the casemix funding system is based on diagnosis-related groups which are Both of these systems address problems being faced in health care financing.... Diagnosis-related groups – Diagnosis-related groups or DRGs are “based on the principle that diagnosis and other patient characteristics can be categorized in terms of the total quantity of resources used in treating patients” (Government of Hong Kong, 2008, p....
12 Pages (3000 words) Essay

Prospective Payment Systems and Diagnosis-Related Groups

As a mark of a movement towards it, the US government has introduced this Prospective Payment System for their people based on Diagnosis- related groups.... Though the system has gone through many phases, it is now running as the crux of health department Prospective Payment Systems and Diagnosis-related groups The prospect of saving a human life has indeed achieved its primal importance among the governments the world.... As a mark of a movement towards it, the US government has introduced this Prospective Payment System for their people based on Diagnosis- related groups....
2 Pages (500 words) Research Paper

Job Description Report

Assigning and Complying: Assigns Diagnosis-related groups (DRGs) and performs coding compliance reviews.... ang=en&job=868263 Coder Job Description: Outpatient Coder:An outpatient coder must know how to code multiple areas efficiently, related to the services performed at an outpatient hospital or a hospital owned facility that is classified as outpatient.... This is a diagnosis and procedure categorization search tool based on the latest ....
2 Pages (500 words) Essay

The California Sutter Health Approach

"The California Sutter Health Approach" paper looks at the steps that the California Sutter Health has taken to ensure that it is able to get more patients to pay for their treatment.... It will also investigate whether there are other ways of doing what California Sutter Health has done.... hellip; The costs of medication have gone up and even those with insurance are now unable to afford health care....
6 Pages (1500 words) Case Study

Rehabilitation Medicine Administration: The Australian National Diagnosis Related Groups

The Diagnosis Related Groups (DRGs)There are a number of casemix classifications.... The Australian National Diagnosis Related Groups (AN-DRG) emerged in the mid-1980s.... The pioneering diagnosis related Group (DRG) classification, although it is useful with acute care, it proves inadequate for the sub-acute and non-acute care.... With DRGs, the care and diagnosis of a patient who has been discharged from a health institution are recorded as principal or secondary diagnosis....
9 Pages (2250 words) Essay

Challenges Facing Casemix Funding System

asemix funding model uses the 'Diagnosis Related Groups', DRGs classification system.... Australian Refined diagnosis related Group', AR-DRG version 6 is the relevant form of casemix to the patients in acute hospitals.... The information from casemix funding is important to policymakers as it allows them to have a clear understanding of the nature of service delivery in health care and its related complexities....
6 Pages (1500 words) Assignment
sponsored ads
We use cookies to create the best experience for you. Keep on browsing if you are OK with that, or find out how to manage cookies.
Contact Us