Inpatient Facility Coding & Compliance Alert

Question: A patient was admitted for observation of suspected cardiovascular disease. What is the correct DRG assignment?

Colorado Subscriber

Answer:  Be careful using the word observation in these types of cases.  Physicians do use this terminology, but there was an actual admission as an inpatient for evaluation of a suspected cardiovascular disease. Until you have more information, your best choice is MS-DRG 313 (Chest pain). This DRG applies when the principal diagnosis is chest pain or precordial pain, or when the patient is admitted for evaluation related to chest pain or suspected cardiovascular issues.

Remember: Because chest pain is a symptom code, two important rules apply:

·         Report chest pain as the principal diagnosis when it is followed by contrasting/comparative diagnoses (such as congestive heart failure, CHF)

·         Do not code check pain as the principal diagnosis when a related definitive diagnosis has been established, such as atrial fibrillation.

You can change the principal diagnosis when the physician determines the underlying cause of chest pain. For example, tests might reveal myocardial infarction, angina, coronary artery disease, gastroesophageal reflux disease, complications with a cardiac device or implant, or any number of other conditions.

Note: Unless the evaluation results in more specific diagnoses and identification of the underlying causes, this type of case would quickly become a candidate as an observation case versus an inpatient admission. If the patient was admitted, but nothing serious was found, then this case should be changed to outpatient observation.