Communicate with coders to assign proper discharge codes
Proper assignment of discharge codes can make a big difference in a hospital’s reimbursement. Unfortunately those who know most about discharge plans—case managers—are not always responsible for assigning these codes.
Assigning the correct MS-DRG requires reporting the patient’s age, gender, discharge status, principal diagnosis, secondary diagnosis and procedures performed. The discharge status has equal weight with diagnosis and procedures, and not everyone appreciates that, according to a Curaspan Connections article entitled “Closing the Gap Between Case Managers and Coders” written by Jackie Birmingham, RN, BSN, MS, vice president of regulatory monitoring and clinical leadership at Curaspan Health Group.
Coders are ultimately responsible for assigning discharge codes. They typically rely on what the physician initially ordered for postacute care. However, the case manager who facilitates the transition of care may have additional information that is valuable to the coders—including where the patient ultimately went, what level of care the patient received, and when the services began, Birmingham wrote. Failing to communicate that information can lead to an inaccurate claim, which can result in financial or legal penalties.
Transfer DRGs
Assigning the correct discharge code is particularly important with respect to transfer DRGs, which are subject to transfer rules that can lead to reduced reimbursement. Most notably, if a patient is a assigned a transfer DRG and is discharged to non-IPPS postacute facility following a short stay, the hospital may receive a reduced payment.
For example, if a patient is discharged to a SNF to receive skilled care (code 03) before his or her stay reaches the geometric mean LOS (GMLOS), the hospital will receive a reduced payment. However if that same patient receives basic care at the SNF, the hospital would receive a full DRG payment. The difference could mean thousands of dollars.
For more information about discharge status codes and transfer DRGs, read the “Pay attention to transfer DRGs and discharge status codes” article in the February issue of the Case Management Monthly newsletter.
About the Author: Ben Amirault is the editor for the case management market at HCPro. Ben writes and edits the monthly newsletter as well as the weekly e-newsletter. Ben also organizes case management audio conferences and manages the Case Management Mentor blog. To contact him with questions, comments, or to contribute to the blog email bamirault@hcpro.com.
Eileen Sullivan | Dec 22, 2010 | Reply
Please calrify is d/c to long term care (custodial care)is 04.
Our coders are using 03, which is SAR and covered by medicare.
Robert Hodges, BSN, MSN, RN | Dec 22, 2010 | Reply
The problem I see with this concept is that the coders can only code what the provider documents. Only in rare cases is other clinical documentation addressed by coders and in those cases that documentation is usually referred to by the provider in their note. Case managers may have the information, but unless the provider documents it then coders cannot use it.