Inpatient Facility Coding & Compliance Alert

Question: A patient admitted for major chest trauma later develops a pressure ulcer. Which MS-DRG should he be grouped into? Also, what are the guidelines for reimbursement of the added costs of pressure ulcer treatment?

Mississippi Subscriber

Answer: The MS-DRG for major chest trauma without CC/MCC is MS-DRG 185. However, hospitals are no longer rewarded for conditions that were preventable in the hospital .Medicare requires the patient’s documentation to contain information on secondary diagnoses which were present on admission (POA). If a patient acquires a condition that is on the “hospital acquired conditions (HAC)” list and it was not present on admission, Medicare would consider it grouped into an MS-DRG as if the condition was not present and the hospital would not be paid for the extra costs as the occurrence of the condition should have been prevented beforehand. However, for a secondary diagnosis which is POA, they are considered as CC or MCC and the case grouped into a higher weighted MS-DRG.