Question

284 Section 5 • COMPLIANCE CASE 5-5 Medicare-Severity Diagnosis-Related Group Changes You just received an MS-DRG change letter from the QIO. The health record shows that the patient was admitted to the hospital with a high fever and difficulty in breathing. A chest x-ray was taken and showed no signs of pneumonia. White blood cell count (WBC) was 17.4, blood cultures grew pseudomonas, arterial blood gases ABGs) CO, rate was 49.6, and the rate was 53.2. The patient was diagnosed with septicemia and new-onset asthma. The patient was treated with intravenous (IV) antibiotics, respiratory therapy, and bronchodilators. Since both of the diagnoses met the definition of principal diagnosis, the coder chose septicemia as the principal diagnosis since the reimbursement was higher. The MS-DRG change notice said that the principal diagnosis should have been asthma. Write a letter to support your choice of principal diagnosis.

Answer 1

Subject: MS-DRG, Principal diagnosis

Hi Team,

We have received the MS-DRG change notification.

Please let us explain the reasons for the selection of Septicemia as the principal diagnosis,

• ABG analysis shows respiratory acidosis, hypercarbia (CO2 – 49.6) which is more suggestive of septicemia than asthma, where in asthma it can be either respiratory acidosis or alkalosis and the chances for respiratory alkalosis is more.
• Blood culture analysis shows the presence of pseudomonas, which is the primary cause of the disease. Patient experienced breathing difficulty as part of the course of disease.

Hence the principal diagnosis is considered as Septicemia with respect to primary etiology and asthma as a new-onset disease.

Thanks and Regards,