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Discussion: Documentation and DRG Assignment

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Discussion 1: Documentation and DRG Assignment
Scenario 1: Documentation and DRG Assignment
“You are a health information management (HIM) professional practicing in a 350-bed community hospital. You are analyzing a patient’s medical record to determine the appropriate diagnosis-related group (DRG) assignment. The patient complained of shortness of breath and chest pain on admission and received a cardiac catheteri­zation as part of a cardiac workup.

The physician determined the final diagnosis to be chronic obstructive pulmonary disease (COPD). The physician documented “possi­ble valvular disorder or endocarditis” on the history and physical. If a cardiac condi­tion is coded, DRG 124 will be assigned, and the hospital will receive over $11,750. If COPD is considered to be the principal diagnosis, DRG 088 will be assigned. The re­imbursement for this diagnosis is $7,300, because this DRG does not recognize the catheterization procedure.

At this hospital, a cardiac catheterization costs $5,500. You are now facing an ethical issue.”
Question
“What should you do?”
Please see the rubric download for more details.
Remember to include an appropriate discussion post “label” included in the list provided in the January 11th course announcement.

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