How many of you have received formal training in APR DRG?

Transcription

1 1 Let s Play APR DRG! Candace Blankenship, BSN, RN, CCDS Member of Maryland ACDIS Deborah Neville, RHIA Director, Revenue Cycle, Coding and Compliance, Elsevier At the completion of this educational activity, learners will be able to improve their CDI practice through: Identification and capture of secondary diagnoses that influence quality scores for the primary surveillance DRGs of CHF, COPD, pneumonia, CVA, and AMI Identification and capture of secondary diagnoses that influence quality scoring for the surgical patient population Development of APR DRG profile tools for their practice s most frequent DRGs that will focus their chart review and supply data for provider education and EMR management 2 How many of you have received formal training in APR DRG? 3 1

2 4 So Why Do We Think We Can Help Other CDI Specialists With APR DRG Scoring? Elsevier has a long history of providing education to the healthcare workforce. Maryland ACDIS members have a unique practice. Maryland uses only APR DRG for both reimbursement and quality scoring. And Maryland scores for ALL PAYERS, not just Medicare patients. S O I 1 Let s Play APR-DRG! R O M 4 5 In MS DRG, you get one chance to impact the relative weight and LOS for the assigned DRG MS DRG CC/MCC 6 2

3 7 In APR DRG, you get 69,000 chances to change the relative weight, LOS, and quality scores for the assigned DRG APR DRG 25 Secondary Diagnoses An APR DRG chart review takes longer than a MS DRG chart review. 8 Case Study ED Record 72 year old female presents to ED complaining of symptoms of dysuria, fever, and AMS. Admitted for AMS and treatment of UTI. Labs: UC: E. coli History & Physical PMH: Hypothyroid Home Rx: Synthroid QUERY Assessment Plan: UTI. Culture + for E. coli. Continue antibiotics. Consult ID. Negative for hematuria. AMS. Likely due to UTI. Looks dry. Continue gentle IV hydration. Hypothyroid. Continue Synthroid. Discharge Summary AMS has resolved. Continue on oral abx. Follow up outpatient with PCP. 9 3

4 10 MS DRG MS DRG 689 Kidney/UTI with MCC N390 Urinary tract infection, site not specified Weight ALOS 4.9 APR 463 Kidney UTI Weight ALOS 3.33 SOI 2 Moderate ROM 2 Minor B9620 Unspecified E. coli cause of disease G9341 Metabolic encephalopathy 3 Major 3 Major E039 Hypothyroidism, unspecified Case Study ED Record 72 year old female presents to ED complaining of symptoms of dysuria, fever, and AMS. Admitted for AMS and treatment of UTI. Labs: UC: E. coli History & Physical PMH: Hypothyroid Home Rx: Synthroid QUERY Assessment Plan: UTI. Culture + for E. coli. Continue antibiotics. Consult ID. Negative for hematuria. AMS. Likely due to UTI. Looks dry. Continue gentle IV hydration. Hypothyroid. Continue Synthroid. Discharge Summary AMS has resolved. Continue on oral abx. Follow up outpatient with PCP. 11 MS DRG MS DRG Weight ALOS 4.9 APR 463 Kidney UTI Weight ALOS 4.61 SOI 3Major ROM 3Major 689 Kidney/UTI with MCC N390 Urinary tract infection, site not specified B9620 Unspecified E. coli cause of disease G9341 Metabolic encephalopathy E870 Hypernatremia E860 Dehydration 3 Major 2Mod 2 Mod 3 Major 3 Major E039 Hypothyroidism, unspecified 12 4

5 13 Dehydration increases SOI for patients > 70 Dehydration w/electrolyte abnormality increases ROM APR DRG provides an accurate description of the complicated patient. 14 What Motivates Me? Acute on Chronic Systolic CHF Relative Wgt ALOS MS DRG 293 Heart Failure & Shock w/o CC/MCC APR DRG 194 Heart Failure

6 16 Build an APR DRG profile for your most frequently occurring primary DRGs. Congestive Heart Failure 17 QUERY YOURSELF The patient has a current documented diagnosis of CHF. Based on your many years of clinical experience caring for patients with CHF, could you further describe the patient for the coder? 18 6

7 19 Heart Failure Classification Class I II III IV Class A B C D Patient Symptoms No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath). Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath). Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea. Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases. Objective Assessment No objective evidence of cardiovascular disease. No symptoms and no limitation in ordinary physical activity. Objective evidence of minimal cardiovascular disease. Mild symptoms and slight limitation during ordinary activity. Comfortable at rest. Objective evidence of moderately severe cardiovascular disease. Marked limitation in activity due to symptoms, even during less than ordinary activity. Comfortable only at rest. Objective evidence of severe cardiovascular disease. Severe limitations. Experiences symptoms even while at rest. American Heart Association CHF NYHA Class 4D Unable to carry on any physical activity without discomfort Symptoms of heart failure at rest If any physical activity is undertaken, discomfort increases Objective evidence of severe cardiovascular disease Severe limitations 20 CHF NYHA Class 4D Unable to carry on physical activity without discomfort Debility Skin breakdown due to pressure DVT or PE 21 7

8 22 CHF NYSE Class 4D I5023 Acute on chronic systolic (congestive) heart failure R5381 Other malaise * DRG Weight ALOS 3.0 DRG Weight ALOS 2.79 SOI ROM 293 Heart Failure & Shock (without CC/MCC) 194 HeartFailure * Denotes that this secondary diagnosis will have a direct impact on the primary DRG scoring. Not every secondary diagnosis will impact your primary APR DRG. 23 CHF NYHA Class 4D Symptoms of heart failure at rest Edema Ascites/anasarca NSVT Weight loss/cardiac cachexia Unstable angina Ischemic cardiomyopathy Home O2 use 24 8

9 25 CHF NYHA Class 4D I5023 Acute on chronic systolic (congestive) heart failure DRG 293 Heart Failure & Shock (with CC) Weight ALOS 4.3 DRG Weight ALOS 3.64 SOI ROM 194 HeartFailure 2 Moderate 2 Moderate I472 Ventricular tachycardia 3 Major* 3 Major* I255 Ischemic cardiomyopathy 2 Mod* I200 Unstable angina * R5381 Other malaise R600 Localized edema R634 Abnormal weight loss In the APR DRG grouper, secondary diagnoses are arranged in a hierarchy Primary DRG CC or MCC Secondary diagnoses that directly impact the primary DRG Secondary diagnoses that do not directly impact the primary DRG 26 CHF NYHA Class 4D If any physical activity is undertaken, discomfort increases Objective evidence of severe cardiovascular disease: Pulmonary HTN Valvular heart disease Chronic passive congestion of liver CKD Cardiorenal syndrome Demand ischemia Electrolyte abnormalities Metabolic alkalosis with respiratory acidosis 27 9

10 28 CHF NYHA Class 4D I5023 Acute on chronic systolic (congestive) heart failure DRG 293 Heart Failure & Shock (with CC) Weight ALOS 4.3 DRG Weight ALOS 5.28 SOI ROM 194 HeartFailure 3 Major 3 Major I472 Ventricular tachycardia 3 Major* 3 Major* E874 Mixed disorder of acid base 3 Major* 3 Major* I272 Other secondary pulm HTN 2 Mod * 2 Mod * E878 Other d/o of electrolyte bal 2 Mod* 2 Mod* K761 Chronic passive liver cong 1Minor 2Mod* N183 CKD, stage 3 (moderate) 1Minor 2Mod* E871 Hypo osmo and hyponatrem 2 Mod* E8342 Hypomagnesemia 2 Mod* I255 Ischemic cardiomyopathy 2 Mod* 1Minor I248 Other forms of acute isch 2 Mod* heart dz R5381 Other malaise R600 Localized edema R634 Abnormal weight loss I081 Rheum d/o of both mitral/tri 2 Mod Cardiogenic Shock 29 CHF NYHA Class 4D I5023 Acute on chronic systolic (congestive) heart failure DRG 293 Heart Failure & Shock (with MCC) Weight ALOS 5.8 DRG 194 HeartFailure Weight ALOS 8.76 SOI 4 Extreme ROM 4 Extreme R570 Cardiogenic shock 4 Extreme 4 Extreme I472 Ventricular tachycardia 3 Major* 3 Major* E874 Mixed disorder of acid base 3 Major* 3 Major* I272 Other secondary pulm HTN 2 Mod * 2 Mod * E878 Other d/o of electrolyte bal 2 Mod* 2 Mod* K761 Chronic passive liver cong 1Minor 2Mod* N183 CKD, stage 3 (moderate) 2 Mod* E871 Hypo osmo and hyponatrem 2 Mod* E8342 Hypomagnesemia 2 Mod* I255 Ischemic cardiomyopathy 2 Mod* I248 Other forms of acute isch 2 Mod* heart dz R5381 Other malaise R600 Localized edema 30 10

11 31 Some secondary diagnoses are considered integral to the primary APR DRG by the provider and are often not documented as separate conditions. Alarm fatigue in both the providers and nursing staff prevents accurate documentation of arrhythmias and electrical conduction defects. 32 CHF NYHA Stage 4D I5023 Acute on chronic systolic (congestive) heart failure DRG 293 Heart Failure & Shock (with MCC) Weight ALOS 5.8 DRG Weight ALOS 5.28 SOI ROM 194 HeartFailure 3 Major 3 Major R570 Cardiogenic shock 4 Extreme 4 Extreme I255 Ischemic cardiomyopathy 2 Mod N183 CKD, stage 3 (moderate) 2 Mod I248 Other forms of acute ischemic 2 Mod heart disease R5381 Other malaise R600 Localized edema I12.9 Hypertensive with CKD stage 1 4 or unspecified CKD 33 11

12 34 CHF APR DRG Profile Unable to carry out physical activity without discomfort: Debility clinical indicators: Skin breakdown clinical indicators: DVT or PE clinical indicators: Provider documentation of condition of debility PT/OT consult: Order indication, PT/OT assessment Nursing staff documentation of Braden score Provider documentation of skin interruption (weeping, ulcer, etc.) Nursing skin assessment/braden score Wound nurse consult: Order indication, assessment Initial provider exam documenting unilateral extremity swelling Vascular studies: Order indication and final report CT chest or VQ scan: Order indication and final report Symptoms of heart failure at rest: (1 of 2) Edema Provider documentation of edema in exam portion of H&P Ascites/anasarca Provider documentation of anasarca in exam portion of H&P Ascites noted as an incidental finding in CT chest or CXR report Indicator for IR paracentesis order NSVT/arrhythmias: Provider documentation of arrhythmia event Nursing documentation of arrhythmia event AICD/PPM interrogation recording 12 lead EKG Cath lab event log Unintentional wgt loss/cardiac cachexia: Provider documentation in the exam section or problem list of the H&P Admission nursing assessment, nutritional section Nursing documentation for % meal intake Nutritionist consult: Order indication and assessment Diet order (calorie count, increase protein, supplements) Admission serum albumin or prealbumin BMI (admission and dry wgt) PT/OT assessment of muscle strength 35 Symptoms of heart failure at rest: (2 of 2) Unstable angina: Provider documentation of condition of unstable angina Provider documentation of chest pain at rest Indicator on anti anginals (ranexa, isosorbide, etc.) Ischemic cardiomyopathy: Provider documentation of ischemic cardiomyopathy, cardiomyopathy, cardiomegaly, or LVH with hx of CAD CXR report documenting cardiomegaly EKG report indicating LVH Cath lab report indicating CAD, cardiomyopathy Echo report documenting cardiomyopathy or LVH Home O2 use: Provider documenting home O2 use, chronic respiratory failure Admission nursing assessment indicating DME of home O2 Nursing documentation of patient s need for supplemental O2 use to maintain O2 saturations 36 12

13 37 Objective evidence of severe cardiovascular disease: (1 of 3) Pulmonary HTN: Provider documentation of pulmonary HTN, PH, PHTN Provider documentation of OSA/CPAP use (etiology of condition) Provider documentation of right heart failure CXR report documenting enlarged pulmonary arteries, enlarged right atrium 12 lead EKG documents right axis deviation, right atrial enlargement, RBBB Echo documents tricuspid regurgitation, right ventricular hypertrophy, elevated pulmonary pressure Right heart cath documents pulmonary hypertension, elevated pulmonary pressures Valvular heart disease: Chronic passive liver congestion: Provider documentation of valvular heart disease in H&P, progress notes Provider documents murmur in exam section of H&P Echo documents valvular regurgitation or stenosis Provider documentation of chronic passive congestion of liver Elevation of AST/ALT with no documented underlying liver disease Objective evidence of severe cardiovascular disease: (2 of 3) CKD: Provider documentation of CKD (stage defined for coder) Nephrology consult indication and assessment Laboratory results document a consistent GFR of less than 60 Cardiorenal syndrome: Provider documentation of cardiorenal syndrome or CHF with CKD Nephrology consult indication and assessment Clinical results indicating EF < 50% and GFR < 60 Demand ischemia: Provider documentation of demand ischemia, elevation of troponin, troponemia Laboratory results document abnormal troponin levels 38 Objective evidence of severe cardiovascular disease: (3 of 3) Electrolyte abnormality: Metabolic alkalosis Metabolic acidosis Respiratory alkalosis Respiratory acidosis Provider documentation of hypo/hypernatremia, hypo/hyperkalemia, hypomagnesia, hypo/hyperphosphatemia, hypochloremia Provider documents indication for electrolyte replacement Provider orders electrolyte replacement (no codeable indicator) Laboratory report documents electrolyte abnormality Provider documentation of metabolic alkalosis, metabolic acidosis, respiratory alkalosis, respiratory acidosis, mixed acidbase disorder, alkalemia, lactic acidosis ABG or VBG documents abnormal ph or HCO3 Laboratory report documents abnormal serum CO2, abnormal chloride, abnormal lactic acid 39 13

14 40 COPD End Stage COPD Chronic cough Difficulty finishing a meal due to shortness of breath Sudden, acute exacerbations, or worsening of the condition Hypoxia Oxygen dependence SOB with moderate activity 41 End Stage COPD J441 Chronic obstructive pulmonary disease with acute exac DRG 191 COPD w/cc Weight A LOS 4.0 DRG 140 COPD Weight A LOS 4.69 SOI 3 Major ROM 3 Major Secondary Dx SOI ROM J9611 Chronic respiratory failure 3Major* 2Mod* R64 Cachexia 2 Mod* 3 Major* Z9981 Dependence on supplemental 2Mod* 2 Mod* oxygen Z681 Body mass index 19 or less J209 Acute bronchitis, unspecified J440 Chronic obstructive pulmonary disease with LRI X X 42 14

15 43 DRG 191 COPD w/cc Weight ALOS 4.0 DRG 140 COPD Weight ALOS 4.69 SOI 3 Major ROM 3 Major End Stage COPD J441 Chronic obstructive pulmonary disease with acute exac J9611 Chronic respiratory failure 3Major* 2Mod E874 Mixed disorder of acid base 3 Major* 3 Major* E870 Hyperosmo and hypernatremia 2 Mod* 3 Major* I471 Supraventricular tachycardia 2 Mod* E1165 Type 2DM with hyperglycemia 2 Mod* 2 Mod I4510 Unspecified RBBB 2 Major M810 Osteoporosis Z7952 Long term steroid use E785 Hyperlipidemia R64 Cachexia 2 Mod* 3 Major F17213 Nicotine depend, w/d Z9981 Dependence on supplemental 2Mod 2 Mod oxygen Z681 Body mass index 19 or less J209 Acute bronchitis, unspecified J440 Chronic obstructive pulmonary disease with LRI X X The status of a secondary diagnosis that directly influences the primary APR DRG is fluid. It can be elevated or demoted based on the complexity of the patient. 44 DRG 191 COPD w/mcc Weight ALOS 4.8 DRG 140 COPD Weight ALOS 4.69 SOI 3 Major ROM 4 Extreme End Stage COPD J441 Chronic obstructive pulmonary disease with acute exac J9622 Acute and chronic resp failure 4Extreme 4Extreme E874 Mixed disorder of acid base 3 Major* 3 Major* I471 Supraventricular tachycardia 2 Mod* E1165 Type 2DM with hyperglycemia 2 Mod* 2 Mod I4510 Unspecified RBBB 2 Mod M810 Osteoporosis Z7952 Long term steroid use E785 Hyperlipidemia R64 Cachexia 2 Mod* 3 Major* F17213 Nicotine depend, w/d Z9981 Dependence on supplemental 2Mod* 2 Mod* oxygen Z681 Body mass index 19 or less J209 Acute bronchitis, unspecified J440 Chronic obstructive pulmonary disease with LRI X X 45 15

16 46 Pneumonia Coding Clinic, Third Quarter 2016 Not a chronic illness Not a predictable disease based on comorbidities Simple versus complex Anticipated elimination of the simple sepsis dx 47 Pneumonia With COPD Exacerbation J440 COPD with acute lower respiratory infection DRG 190 COPD W/MCC Weight ALOS 4.8 J159 Unspecified bacterial pneumonia 3Major* 3Major* E870 Hyperosmolality and 2Mod* 3 Major* hypernatremia E860 Dehydration 2 Mod* J441 COPD with acute exacerbation R0902 Hypoxemia Y95 Nosocomial condition X X DRG 140 COPD Weight ALOS 4.69 SOI 3 Major ROM 3 Major 48 16

17 49 Pneumonia J159 Unspecified bacterial pneumonia DRG 194 Simple Pneumonia w/cc Weight ALOS 4.3 E870 Hyperosmolality and hypernatremia 2Mod* 3 Major* E860 Dehydration 2 Mod R0902 Hypoxemia Y95 Nosocomial condition DRG 139 Other Pneumonia Weight ALOS 3.61 SOI 2 Moderate ROM 2 Moderate CVA 50 CVA DRG 065 CVA w/cc Weight ALOS 4.0 DRG 045 CVA w/infarct Weight ALOS 3.57 SOI 2 Moderate ROM I63232 Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries G8191 Hemiplegia, unsp affect rt 2Mod* 1Minor* R1311 Dysphagia, oral phase 2 Mod R1312 Dysphagia, oropharyngeal phase 2 Mod I160 Hypertensive urgency E785 Hyperlipidemia R471 Dysarthria R29810 Facial weakness R29710 NIHSS score

18 52 NIHSS scoring does not improve your SOI or ROM scoring. Glasgow Coma Scale has a significant impact on SOI and ROM scoring when documented in its 3 parts. CVA DRG 065 CVA w/cc Weight ALOS 4.0 DRG 045 CVA W Infarct Weight ALOS 5.69 SOI 3 Moderate ROM 2 Moderate I63232 Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries G8191 Hemiplegia, unsp affect rt 2Mod* 1Minor* I119 Hypertensive heart disease 1Minor 2Mod* w/o heart failure I471 Supraventricular Tach 2 Mod* I4510 Unspecified right bundle 2 Mod* branch block R1312 Dysphagia, oral phase 2 Mod* R1312 Dysphagia, oropharyngeal phase 2 Mod* I071 Rheumatic tricuspid insuff 2 Mod* F17213 Nicotine dependence, cigarettes with withdrawal I160 Hypertensive urgency E785 Hyperlipidemia R471 Dysarthria R29810 Facial weakness R29710 NIHSS score Secondary diagnoses that describe conditions outside of the primary APR DRG s body system will have a greater impact on SOI and ROM scores

19 55 AMI AMI DRG AMI w/cc Weight ALOS 3.4 DRG AMI Weight ALOS 5.18 SOI 3 Moderate ROM 3 Moderate I2119 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall I472 Ventricular tachycardia 3Major* 3Major* I071 Rheumatic tricuspid insuff 2 Mod* E8342 Hypomagnesemia 2 Mod* E1165 T2 DM with hyperglycemia 2Mod* 2 Mod* I119 Hypertensive heart disease 2Mod* w/o HF E785 Hyperlipidemia, unspec E876 Hyperkalemia 56 APR DRG and the Surgical Patient 57 19

20 58 K3580 Unspecified acute appendicitis E669 Obesity, unspecified 1Minor 1Minor Z6835 Body mass index (BMI) 35 DRG Appendectomy Weight ALOS 2.0 DRG Appendectomy Weight ALOS 1.48 SOI ROM M1612 Unilateral primary OA, left hip E669 Obesity, unspecified 2 Mod* * Z6835 Body mass index (BMI) 35 DRG Major Joint w/o MCC Weight ALOS 2.9 DRG Major Joint w/o MCC Weight ALOS 3.43 SOI 2 Moderate ROM 59 The secondary diagnosis of obesity has an impact on risk adjustment scoring for the abdominal surgical patient The secondary diagnosis of obesity has an impact on the SOI/ROM for the surgical hip patient 60 20

21 61 A robust EMR is your best hope for accurate documentation for the surgical patient population. K3580 Unspecified acute appendicitis DRG Appendectomy Weight ALOS 2.0 E8351 Hypocalcemia 2 Mod* * E669 Obesity, unspecified 1Minor 1Minor Z6835 Body mass index (BMI) 35 DRG Appendectomy Weight ALOS 3.61 SOI 2 Minor ROM 62 With the exception of hypokalemia, electrolyte imbalances will impact the SOI/ROM of the general surgical patient

22 64 M1612 Unilateral primary OA, left hip E669 Obesity, unspecified 2 Mod* * Z6835 Body mass index (BMI) 35 DRG Major Joint w/o MCC Weight ALOS 2.9 DRG Major Joint w/o MCC Weight ALOS 3.43 SOI 2 Moderate ROM M1612 Unilateral primary OA, left hip DRG Major Joint w/o MCC Weight ALOS 2.9 E669 Obesity, unspecified 2 Mod* * Z6835 Body mass index (BMI) 35 I081 Rheumatic d/o of mitr/tric 2 Mod* I119 HTN heart dz w/o HF 2 Mod* I447 Left bundle branch blk 2 Mod* E8351 Hypocalcemia 2 Mod* I2510 Atherosclerotic heart dz DRG Major Joint w/o MCC Weight ALOS 4.71 SOI 3 Major ROM 2 Moderate 65 Create internal coding guidelines that define the coding validity of preadmission provider notes

23 67 CVA DRG 065 CVA w/cc Weight ALOS 4.0 DRG 045 CVA W Infarct Weight ALOS 3.57 SOI 2 Moderate ROM I63232 Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries G8191 Hemiplegia, unsp affect rt 2Mod* 1Minor* R1311 Dysphagia, oral phase 2 Mod R1312 Dysphagia, oropharyngeal phase 2 Mod I160 Hypertensive urgency E785 Hyperlipidemia R471 Dysarthria R29810 Facial weakness R29710 NIHSS score 10 CVA DRG 065 CVA w/cc Weight ALOS 4.0 DRG 045 CVA W Infarct Weight ALOS 5.69 SOI 3 Moderate ROM 2 Moderate I63232 Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries G8191 Hemiplegia, unsp affect rt 2Mod* 1Minor* I119 Hypertensive heart disease w/o heart failure 1Minor 2Mod* I471 Supraventricular Tach 2 Mod* I4510 Unspecified right bundle branch block 2 Mod* R1312 Dysphagia, oral phase 2 Mod* R1312 Dysphagia, oropharyngeal phase 2 Mod* I071 Rheumatic tricuspid insuff 2 Mod* F17213 Nicotine dependence, cigarettes with withdrawal I160 Hypertensive urgency E785 Hyperlipidemia R471 Dysarthria R29810 Facial weakness R29710 NIHSS score M1612 Unilateral primary OA, left hip E669 Obesity, unspecified 2 Mod* * Z6835 Body mass index (BMI) 35 DRG Major Joint w/o MCC Weight ALOS 2.9 DRG Major Joint w/o MCC Weight ALOS 3.43 SOI 2 Moderate ROM 69 23

24 70 M1612 Unilateral primary OA left hip DRG Appendectomy Weight ALOS 2.0 E8351 Hypocalcemia 2 Mod* E669 Obesity, unsp 2 Mod Z6835 Body mass index (BMI) 35 DRG Appendectomy Weight ALOS 3.43 SOI 2 Minor ROM M1612 Unilateral primary OA left hip DRG Appendectomy Weight ALOS 2.0 F3340 MDD, recurrent, remission 2 Mod* E8351 Hypocalcemia 2 Mod E669 Obesity, unsp 2 Mod Z6835 Body mass index (BMI) 35 DRG Appendectomy Weight ALOS 3.43 SOI 2 Minor ROM 71 M1612 Unilateral primary OA left hip DRG Appendectomy Weight ALOS 2.0 E1140 T2 DM with neuropathy 2 Mod 2 Mod* F3340 MDD, recurrent, remission 2 Mod E8351 Hypocalcemia 2 Mod E669 Obesity, unsp 2 Mod Z6835 Body mass index (BMI) 35 DRG Appendectomy Weight ALOS 3.43 SOI 2 Minor ROM 2 Minor 72 24

25 73 It is harder to move the SOI/ROM scores on a same day surgical patient then it is to move the SOI/ROM scores on a medical admission. Handouts As you entered the presentation, a Maryland ACDIS member gave you an APR DRG tip card and a hard copy of the CHF APR DRG profile. We hope that these tools will help strengthen your CDI practice. More copies are available at the Elsevier booth in the exhibit hall. 74 Thank you. Questions? Candace.Blankenship@medstar.net In order to receive your continuing education certificate(s) for this program, you must complete the online evaluation. The link can be found in the continuing education section at the front of the program guide