Kim is an HIM instructor at a

Kim is an HIM instructor at a local community college where she teaches courses related to coding and reimbursement. Last semester, students had trouble with the concept of how coding impacts MS-DRG assignment, so she had created the following examples to illustrate the concept. This semester, the issue is how and when it is appropriate to bypass an edit related to CPT coding and APCs. Follow the instructions given to gain a deeper understanding of these coding and reimbursement concepts. Identify the MS-DRG for the following scenario: A 78-year-old female is discharged home with the following diagnoses: Principal Dx- acute systolic, CHF Additional Dx-Lupus (SLE), Insulin-dependent type 1 diabetes- uncontrolled. Diagnosis Codes:___________________________________________ MS-DRG:___________________________________ If the same patient also had a diagnosis of an acute exacerbation of COPD, what is the MS-DRG? Diagnosis Codes:_____________________________________________ MS-DRG:_____________________________________ If the patient in the first example also had a diagnosis of gram-negative pneumonia, what is the MS-DRG? Diagnosis Codes:____________________________________________ MS-DRG:________________________________ Now, consider that the same patient in the first scenario had to have a total system, open biventricular pacemaker inserted in the chest while admitted, with leads into the right atrium and ventricle inserted percutaneously. What MS-DRG do you get now? Diagnosis and PCS Codes:______________________________________ MS-DRG:_________________________________ A 72-year-old male has an ESWL performed for a right renal calculus. At the same operative session, the same physician removes a malignant lesion from his back resulting in a 3 cm. defect and performs an intermediate repair. a. Provide the CPT codes that should be assigned for this case along with their corresponding APC. b. When this case is coded using the encoder, an edit is given. Explain the edit. c. Identify if you should bypass the edit and, if so, the step(s) that would be required.

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