Wiki Mutual exclusive codes

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We are having little debate in our organization , mutual exclusive codes can be grouped while calculating DRG , like critical E/M codes with ventilation codes ,Mutusl exclusive rules sre applicable on fee for service claims or DRG claims too ?
 
It's not really clear what you are asking here. Regarding mutually exclusive codes, I think you are speaking of codes that per CCI or CPT description should be billed together by the same provider on the same date of service, but I do not understand what this has to do with DRG calculation or what it is you mean by asking if these codes can be 'grouped'. DRG is an inpatient facility reimbursement methodology and these claim types are not submitted with CPT codes, which are only used on outpatient facility and professional claims. Perhaps if you could provide a little more detail or give an example of a coding scenario you are faced with to illustrate what the question is we might be able to assist more.
 
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The problem is regarding ventilation code with E/M codes in DRG calculation , the provider has coded both and the auditor is saying that ventilation code can not be coded with e/m code so should be omitted from drg calculation ,by doing that we are getting a totally different DRG, my question is if the provider has coded e/m code with ventilation code do we have to choose e/m code and ignore ventilation code or we can code ventilation code as it effects the DRG while E/M code does not .
 
I still do not understand what you are talking about and you have not given us a coded example to look at. E/M coding has nothing at all to do with DRG calculation - whether or not an E/M was coded should not make any difference to a DRG because E/M is a physician service and a DRG is a classification of a facility service. DRGs are determined by ICD-10 diagnoses and procedures, patient age, gender, discharge status - there is not even a place in a DRG grouper to enter an E/M code. E/M services should not figure into this unless your facility or payer is using some special customized type of DRG grouper. Can you provide an example with actual codes and DRGs and explain what kind of DRG calculator you are using to show what you mean? Otherwise I'm somewhat at a loss as to how to help you here.
 
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