In a recent Journal of the American Medical Association (JAMA) a study on the highest reimbursed DRG (Diagnostic Related Group) trends from 2012 to 2016 was released. Medicare DRGs or Medicare Severity DRG (MS-DRGs) payment system includes the capture ICD-10-CM codes for complications and comorbidities which has a significant impact to disease severity, payment, and overall healthcare inpatient data.

This study used retrospective cohort study used data from the all-payer National Inpatient Sample for admissions assigned to 1 of the top 20 highest reimbursed DRG families at US acute care hospitals from January 1, 2012, to December 31, 2016. Data were analyzed from July 10, 2018, to May 29, 2019.

The study found that of these 20 top DRG families during this timeframe, that there was 15 DRGs which had an increase in major complications and comorbidities (MCC) but not an associated disease severity or risk-adjusted mortality. The study did recognize that the coded data is directly linked to the clinical documentation and that many hospitals have initiated clinical documentation improvement/integrity (CDI) programs with a focus on capturing valid secondary diagnoses.

The top 10 DRG families in the study were:

  1. Sepsis
  2. Lower extremity joint replacement
  3. Vaginal delivery
  4. ECMO or Tracheostomy
  5. Infectious diseases
  6. Cesarean delivery
  7. Heart failure
  8. Bowel Procedure
  9. Spinal fusion
  10. PCI with DES (Percutaneous Coronary Intervention with Drug Eluting Stent)

To review the full study, go to: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2773778

It would be interesting to compare your own hospital DRG data with this study timeframe, again focusing on the highest reimbursed DRG families. Having ongoing clinical documentation and coding improvement activities in place is a best practice due to the complexity of clinical documentation, the ICD-10-CM classification system, and Diagnostic Related Groups (DRGs).

Each and every day, the hospital inpatient coding must be complete, precise, and compliant in order to obtain accurate results in severity, mortality, and payment.  Take the time to discuss your current improvement activities and begin to take the steps needed to achieve clinical data truthfulness and success. Start by contacting Reimbursement Management Consultants, Inc. (RMC) to learn more about MS-DRGs, documentation and medical coding.

Reach out to Reimbursement Management Consultants (RMC) for assistance with medical coding support, auditing, compliance, and CDI. RMC is a Woman-owned, US-based, and operated company which specializes in a variety of medical coding compliance consulting services. Click here for more information

Written By: Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA Approved ICD-10-CM/PCS Trainer