Modifying DRG-PPS to Include Only Diagnoses Present on Admission

Abstract

To be consistent with pay-for-performance principles and make claims data more useful for quality assurance, incorporating POA coding into DRG-PPS could produce sizable savings for Medicare.

ICD-10 hospital discharge diagnosis codes were sensitive for identifying pulmonary embolism but not deep vein thrombosis

“…Guidelines require coding all clinical or psychosocial problems that coexist at the time of admission, develop subsequently, and affect length of stay or impact patient care by requiring additional diagnostic or therapeutic procedures or increased nursing care. Hence, coding PE is often critical for DRG assignment, whereas adding a secondary diagnosis code of DVT does not change DRG assignment for most patients hospitalized with medical or surgical conditions other than VTE [29]. Consistently with previous studies [14,30], our findings also suggest that clinicians may refrain from identifying postoperative VTE in hospital claims data.…”

Do the AHRQ Patient Safety Indicators Flag Conditions That Are Present at the Time of Hospital Admission?

“…This wide variation in coding practices reinforces the importance of standardized PoA coding rules and training. 21,22 Second, the findings apply to only the University of Michigan and it is unclear whether the results at other hospitals are likely to be similar because our hospital is a referral center, has a complex case-mix and may admit a higher percentage of patients for whom conditions that are flagged by the PSIs are present on admission. Still, it is likely that other hospitals will have at least some cases in the numerator of the PSIs that are false positives because the relevant diagnosis was present on admission.…”

Identification of Hospital-Acquired Catheter-Associated Urinary Tract Infections From Medicare Claims

“…18 Recently Zhan et al showed that uniform and accurate POA coding would face many challenges as well. 24 These limitations may affect our estimates to some degree but should not significantly alter the insights.…”