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Medical Coding News Archives

Be Aware of FY2009 MS-DRG Relative Weight Revisions

 
December 23, 2008:

In the transition from charged-based to cost-based relative weight calculations, CMS has significantly revised the MS-DRG relative weight (RW) values for fiscal year 2009. Coding professionals and other hospital staff should be aware of these revisions because previous optimization strategies may no longer be valid. In general, DRG subgroups with a “with MCC” split had the most substantial RW changes, with the “with MCC” RW values rising, in some cases very dramatically.

Coders must be aware of these revisions and follow coding guidelines scrupulously, particularly that involving the definition of principal diagnosis. For example, DRG 186 (Respiratory failure) has a RW of 1.3488 and no severity split. Contrast that to DRG 193 (Simple pneumonia with MCC), RW 1.4327; DRG 196 (Interstitial lung disease with MCC), RW 1.6022; DRG 186 (Pleural effusion with MCC), RW 1.6252; or DRG 199 (Pneumothorax with MCC), RW 1.7401.  Although sequencing the respiratory failure as a secondary diagnosis that would function as the MCC would provide the highest reimbursement for the case, it may not be appropriate to do so. Coding guidelines dictate that the circumstances of the admission should determine which diagnosis is selected as principal diagnosis.

Some of the revised RW values are not consistent across DRG subgroups in each MDC, but coders must assign and report codes for every procedure performed and documented in the medical record. For example, DRG 250 (PTCA without stent with MCC) has a RW of 2.9915, but DRG 248 (PTCA with non-drug eluting stent with MCC or 4+ vessels/stents) has a RW of only 2.8046.  CMS is expected to make revisions to the inconsistencies for next year, but in the meantime, hospital staffs are expected to follow proper coding compliance strategies.

 

 
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