To see how various grouper software vendors applied the 20% add-on to inpatients with COVID-19 infections, Deborah Gardner-Brown, founder of Sepsis Integrity Review Services in New Jersey, modeled several “COVID-serious admissions” with different versions. She found the groupers weren’t applied consistently, which affects payment (see story, p. 1).[1] The codes at the bottom of the chart propagate these DRGs, she said. Contact Gardner-Brown at deborah@rra-inc.com.
|
DRG Description |
Relative intensity weight (RIW) Version 37.0 October 1, 2019 thru September 30, 2020 with/without add-on |
RIW Version 38.0 October 1, 2020 thru September, 2021 with fed add-on |
RIW Version 38.1(p) January 1, 2021 thru September 30, 2021 w/o fed add-on |
AMLOS |
|---|---|---|---|---|
|
003 ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURE |
22.7447/18.9539 $282,509.00/$263,059.00 |
22.7893 $287,250.00 |
18.9911/ $239,374.00/ |
30.2 |
|
004 ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES |
13.8526/11.5438 $173,551.00/$145,261.00 |
14.2344 $179,418.00 |
11.8620/ $149,515.00/ |
24.5 |
|
177 Respiratory infections and inflammation with MCC (U07.1) |
2.2694/1.8912 $31,619.00/$26,984.00 |
2.2144 $27,911.00 |
1.8453/ $23,259.00/ |
6.8 |
|
189 Pulmonary edema and respiratory failure |
1.4588/1.2157 $21,686.00/$18,701.00 |
1.4698 $18,525.00 |
1.2248/ $15,438.00/ |
4.6 |
|
193 Simple pneumonia and pleurisy with MCC (J12.82) |
1.6002/1.3335 $23,481.00/$20,150.00 |
1.5728 $19,825.00 |
1.3107/ $16,520.00/ |
5.1 |
|
871 SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC |
2.2396/1.8663 $31,252.00/$26,679.00 |
2.2418 $28,257.00 |
1.8682/ $23,547.00/ |
6.2 |
|
870 SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS |
7.5892/6.3243 $96,803.00/$116,163.00 |
7.7098 $97,178.00 |
6.4248/ $80,981.00/ |
14.5 |
|
280 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC |
1.9571/1.6309 $27,791.00/$23,794.00 |
1.9514 $24,597.00 |
1.6262/ $20,497.00/ |
5.4 |
