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Posted By Christie on 02-10-2006, 16:55:00 in Radiology
Hello List,

Our radiologist was a co-surgeon for repairing AAA & inserting endovascular implantation.

My question is there are 2 ICD-9 DX codes and then it lists
"Related DRG's and has 110 and 111". What are DRG's and are they listed in the ICD-9 book or somewhere else?

Thanks
Comments (5)
Posted By Christie on 02-13-2006, 20:55:00
THANKS AGAIN, STACY, AS ALWAYS. I PRINTED OUT YOUR REPLY.
Posted By Jacqui on 02-13-2006, 15:52:00
Thanks, Stacie. That was very helpful. I'll take that info to him &
I'm sure he'll appreciate it too.
Jacqui
Posted By STACIE on 02-11-2006, 01:03:00
Hi Jacqui,

This is the other Stacie....:-)

The services are all considered as part of the DRG payment for the hospital.
Outlier refers to those stays that are longer than the average length of
stay for a particular DRG.

The doctor really needs to consider his reimbursement under MPFS and whether
or not his reimbursement covers his time. He should talk to someone at the
facility in the finance area to determine the actual cost to the hospital
and then together they could make a recommendation as to whether or not to
continue the services.

Stacie L. Buck, RHIA, LHRM, Vice President
Southeast Radiology Management
"Your Radiology Business Experts"

Specializing in:
- Billing & Collections
- Outsource Coding
- Consulting
- Practice Management

Phone (772) 600-0324
Fax (772) 600-0327
www.seradmgt.com
Posted By Jacqui on 02-10-2006, 23:53:00
Stacy,
When a patient is in the hospital under a particular DRG, how are the
costs of diagnostic exams covered? Are they included in the DRG, or
are those the "outlyers" we hear about? I have a radiologist who is
doing numerous declots and is disappointed w/ the reimbursement he's
receiving & wonders how much the hospital is receiving, and is it worthit to continue be tied up for so long doing the declots.
So - I'm trying to find answers to as many questions as I can before wemeet again.
Jacqui
Posted By Stacy on 02-10-2006, 20:07:00
DRG means "Diagnosis Related Group." DRGs are the system used to determine payment for hospital inpatients. Inpatient hospital payments are made based on the diagnosis group rather than the CPT code.

CMS defines Diagnosis Related Groups (DRGs) as "A classification system that groups patients according to diagnosis, type of treatment, age, and other relevant criteria. Under the prospective payment system, hospitals are paid a set fee for treating patients in a single DRG category, regardless of the actual cost of care for the individual."

DRG codes and groupings are not located in the ICD-9 book. They are available in various coding software, as well as a paper version.

DRG 110 is: MAJOR CARDIOVASCULAR PROCEDURES W CC.
Major Diagnostic Category (MDC): 05 DISEASES & DISORDERS OF THE CIRCULATORY SYSTEM
Relative Weight: 3.8417

DRG 111 is: MAJOR CARDIOVASCULAR PROCEDURES W/O CC
Major Diagnostic Category (MDC): 05 DISEASES & DISORDERS OF THE CIRCULATORY SYSTEM
Relative Weight: 2.4840

Hope this helps!

Stacy Gregory, RCC, CPC
Gregory Medical Consulting Services
stacygregory@wamail.net
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