HCG identified several opportunities to educate coders in genitourinary diagnoses, capturing a higher level of specificity in the urinary diagnoses, and missed Excludes1 notes.  Most of the diagnosis coding errors pertained to incorrect coding of CC’s (conditions classified as a complication or comorbidity) and impacted the MS-DRG assignment.

MS-DRG 807 – Vaginal Delivery Without Sterilization/D&C without CC/MCC

OB coding seems to be coming to the forefront of coding errors this year.  Many coders think that OB charts are the easiest to code.  However, from the data we’ve reviewed, we have identified CC secondary diagnosis coding is lacking and the errors for missing or incorrectly coded diagnoses have an impact on the MS-DRG assignment.

MS-DRG 871 and 872 – Septicemia or Severe Sepsis with MCC and without MCC

As expected, Sepsis was one of the problem areas identified in our audit data.  Several errors identified pertained to the principal diagnosis selection of Sepsis.  We also found severe Sepsis not correctly coded.  Several of our recommended changes to the Sepsis MS-DRG’s pertained to missing or incorrectly reported MCC’s (major complications or comorbidity) and CC’s (complication or comorbidity) that were unrelated to the Sepsis diagnosis.

Overall, it appears coders still struggle to code to the highest level of specificity in ICD-10-CM, impacting the reporting of MCC’s and CC’s and ultimately affecting the MS-DRG assignment.  HCG recommends focused audits on codes that are considered MCC’s and CC’s, and conditions that are coded using an “unspecified” code.  Coders should be educated on coding to the highest level of specificity based on the provider’s documentation.

Are any of these areas your organization is struggling with? Contact us today to get started with a focused audit review! We will work with you to identify areas of opportunity, complete with the education to help your team succeed.