Part I: Encoder DRG and Relative Weight Calculations Utilize the

Part I: Encoder DRG and Relative Weight Calculations Utilize the 3M Encoder to complete this assignment. Insert the age and gender of the patients noted below. The Admission and Discharge Dates are: 2/10/24 – 2/13/24 Make sure the “Product” is set to DRGFINDER Hit Continue. Patient Disposition: Select either Home, Skilled Nursing Facility, etc. based on the case scenario. You must do this for proper grouping. Insert the admission diagnosis – Use the principal diagnosis within the case scenario as your admission diagnosis. Insert the principal diagnosis (this is the same for the admission diagnosis) Insert any secondary diagnoses (do not change the order). Insert the principal procedure codes (do not change the order). Insert any secondary procedure codes (do not change the order). On the top of the Grouper screen is the Medicare DRG, Relative Weight, and Reimbursement Total – this will change as you insert diagnoses/procedures. Do not use the Reimbursement Total from the encoder as this will not be used in the below calculations. Do not round up the relative weights – this will impact your reimbursement totals. Under ICD-10 Summary, you can locate the MDC Information and contains the weight, Average length of stay (ALOS), and gross length of stay (GLOS). Calculate the reimbursement amount for each case as noted in the Example #1 by multiplying the relative weight by the facility rate of $8,000. Identify differences among the diagnostic and procedural codes, DRG assignment, CCs, DRG weight, reimbursement amount, etc. INPATIENT ENCODER GROUPER TABLE Do not change any of the codes or order of such codes. CASE NUMBER PATIENT INFORMATION ICD-10-CM/PCS CODES MDC, DRG #, AND DRG WEIGHT: REIMBURSEMENT AMOUNT ($8,000 X DRG WEIGHT) Example 29-year-old male with acute appendicitis who underwent a laparoscopic appendectomy. The patient was discharged home. K35.80 0DTJ4ZZ MDC 006 DRG 343 DRG Weight 1.1540 $8,000 x 1.1540 = $9,232 This may be different at the time you complete the assignment since the encoder is linked to Medicare reimbursement. 1 65-year-old male admitted with Urosepsis due to staphylococcus aureus. The patient was treated with antibiotics and discharged to home. N39.0 B95.8 MDC DRG DRG Weight 2 80-year-old female treated for staphylococcal sepsis with antibiotics and discharged to home. A41.2 MDC DRG DRG Weight 3 93-year-old female with Type II diabetes mellitus and diabetic peripheral angiopathy, admitted for treatment of severe sepsis due to staphylococcal aureus pneumonia with respiratory failure. Patient treated with mechanical ventilation for 75 hours and antibiotics. Patient was discharged to home. A41.01 R65.20 J15.211 J96.00 E11.51 0BH17EZ 5A09457 MDC DRG DRG Weight 4. 85-year-old male admitted with SIRS due to staph aureus septicemia with respiratory failure and septic shock. Patient treated with mechanical ventilation for 100 hours and high dose Linezolid infusion. Patient was discharged to home. A41.01 R65.21 J96.00 0BH17EZ 5A09557 MDC DRG DRG Weight 5. 65-year-old male admitted with CAD and unstable angina, had left and right cardiac catheterization with angiography; discharged to home. I25.119 4A023N8 B2060ZZ MDC DRG DRG Weight 6. 68-year-old female with CAD with unstable angina and chronic total occlusion of coronary artery, had left and right cardiac catheterization with angiography, followed by CABG of 3 native arteries and cardiopulmonary bypass. Discharged to a skilled nursing facility. I25.119 I25.82 021209W 5A1221Z 4A023N8 B2060ZZ MDC DRG DRG Weight 7. 82-year-old female with CAD and unstable angina, had left and right cardiac catheterization with angiography, followed by PTCA of 3 native arteries; discharged to a skilled nursing facility. I25.119 02723ZZ 4A023N8 B2060ZZ MDC DRG DRG Weight 8. 82-year-old female with CAD and unstable angina, had left and right cardiac catheterization and angiography, followed by PTCA of 3 native arteries, with non-drug eluting stent inserted into one coronary artery; discharged to a skilled nursing facility. I25.119 02703DZ 02713ZZ 4A023N8 B2060ZZ MDC DRG DRG Weight 9. 65-year-old female with CAD and congestive heart failure; she underwent left and right cardiac catheterization and angiography, followed by PTCA of 3 native arteries, with drug eluting stents inserted into one coronary artery; discharged to a skilled nursing facility. I25.110 I50.9 027234Z 4A023N8 B2060ZZ MDC DRG DRG Weight Part II: Encoder DRG and Relative Weight Essay After you have completed the above calculations, in 4-sentences each, describe your findings. This should address all these elements: Describe the financial impact incorrect coding would have on the revenue cycle of an organization if the coder incorrectly coded for 100 charts or more? What impact does incorrect coding have on data, analytics, and the representation of services utilized regarding risk adjustment/value-based fundamentals? Part III: DRGs and Relative Weights Use the 3M Encoder to complete the various coding scenarios based on the patient information below: Patient Information: Gender: M Age 68 Dates of Service: 5/8/24 – 5/10/24 Record Assessment at Various Stages by Coder: The physician states, “probable urinary sepsis” and all clinical evidence (blood cultures, mental status changes) points to that as the main reason for admission. The underlying cause (such as E. coli septicemia) would need to be verified. Because the patient has renal insufficiency, the coder needs to query the physician to see if this is more appropriately coded to severe sepsis. Because official coding guidelines do allow for coding “probable” at present, it is technically correct to code sepsis; however, a query to the physician would be indicated to obtain the more appropriate information. For urinary sepsis, there is no ICD-10 code. However, it appears the physician may mean either urinary tract infection (N39.0) or severe sepsis (septicemia), coded to R65.20. The coder should query for the cause-and-effect relationship of positive blood culture E. coli to sepsis (A41.51) and would need more information from the chart to determine if the patient had acute renal failure and the severe sepsis (R65.20) with organ dysfunction for acute renal failure (N17.9). The patient was treated with IV hydration. Clarify with the physician dehydration (E86.0) is a coded. The patient was intubated (0BH17EZ) and placed on continuous mechanical ventilation for 24 hours (5A09457) Instructions: Review each case for DRGs and RWs. Do not round up the relative weights – this will impact the results. Do not change the order of the codes nor the codes themselves. Scenario 1: On the patient information screen, place the patient’s gender, age, and admit/discharge dates. For Product, be sure it states “DRGFINDER”. Click on Continue Click on Home, self-care For the Admission Diagnosis, enter R50.9 (Fever), click Click on Add diagnosis (Principal Diagnosis), N39.0 (UTI) Click on Add diagnosis, B96.20 (E. coli) Click on Options on the top of the screen > Present on Admission > add POAs for all diagnoses Review DRG and Relative Weight from top of screen Scenario 2: On the patient information screen update the gender, age, and admit / discharge dates. For Product, be sure it states “DRGFINDER”. Click on Continue Click on Home, self-care For the Admission Diagnosis, enter N39.0 (UTI), click continue Click on Add diagnosis (Principal Diagnosis), add A41.51 (sepsis due to E.coli) Click on Add diagnosis, add R65.20 (Sepsis) Click on Options on the top of the screen > Present on Admission > add POAs for all diagnoses Review DRG and Relative Weight from on top of screen Scenario 3: On the patient information screen update the gender, age, and admit / discharge dates. For Product, be sure it states “DRGFINDER”. Click on Continue Click on SNF for discharge disposition For the Admission Diagnosis, enter S72.001A (Fracture, femur, right), click continue Click on Add diagnosis (Principal), S72.001A (Fracture, femur, right) Click on Add A41.51 (septicemia due to E.coli) Click on Add diagnosis, add R65.20 (Severe sepsis) Click on Add diagnosis as N39.0 (UTI), click continue Click on Add diagnosis, add N17.9 (Acute kidney failure, unspecified) Click on Add diagnosis, add W06.xxxA (Fall from bed, initial encounter) Click on Add diagnosis, add Y93.9 (Activity, unspecified) Click on Add diagnosis, add Y92.230 (Place of occurrence, patient room in LTC facility) Click on Add diagnosis, add Y99.9 (Unspecified external cause status) Click on Options > Present on Admission > add POA “Y” for all diagnoses except Y93.9 and Y99.9. Review DRG and Relative Weight from on top of screen Scenario 4: On the patient information screen update the gender, age, and admit / discharge dates. For Product, be sure it states “DRGFINDER”. Click on Continue Click on Short-term hospital For the Admission Diagnosis, enter R50.9 (Fever), click continue Click on Add diagnosis (Principal diagnosis), add A41.51 (septicemia due to E.coli) Click on Add diagnosis, add R65.20 (Severe sepsis) Click on Add diagnosis, add N39.0 (UTI) Click on Add diagnosis, add N17.9 (Acute kidney failure, unspecified) Click on Add diagnosis, add E86.0 (Dehydration) Click on Add procedure, add 0BH17EZ (intubation) Click on Add procedure, add 5A1955Z (Continuous invasive mechanical ventilation for greater than 96 consecutive hours). Click on Options > Present on Admission > add POAs for all diagnoses Review DRG and Relative Weight from on top of screen Part IV: MS-DRGs King County Regional Medical Center’s Top 10 MS-DRGs for FY 2023 Formulas Step 1: To calculate the total weights, work across the rows and multiply the number of cases by the relative weight for each row = “total weights” Do not round up. MS-DRG 775: Example: 2,013 x 0.5865 = 1180.6245 Step 2: There are three totals to calculate. Add up the number of cases – working down the column – place answer in the blue box next to Totals. Add up the Relative Weights – working down the column – place answer in the blue box next to Totals. Add up the Total Weights – working down the column – place answer in the blue box next to Totals. Do not round up any of these. Step 3: To find the Case Mix Index, divide the total relative weight by the Total Number of Cases. Do not round up. Total Relative Weights = Case Mix Index Total Number of Cases Step 4: To determine the Average MS-DRG payment, the Case Mix Index is multiplied by hospital rate of $6,100.00. Round up to two decimal points. Case Mix Index multiplied by $6,100.00 = Average MS-DRG Payment MS-DRG Description Number of Cases Relative Weight Total Weights 775 Vaginal delivery w/o complicating diagnoses 2,013 0.5865 1180.6245 795 Normal newborn 1,958 0.1758 313 Chest pain 1,262 0.6621 282 Acute MI, discharged alive w/o CC/MCC 987 0.7557 065 Intracranial hemorrhage or cerebral infarction w CC or TPA in 24 hrs 1257 1.0593 251 Percutaneous Cardiovascular proc w/o coronary artery stent w/o MCC 561 1.6863 249 Percutaneous cardiovascular proc w non-drug-eluting stent w/o MCC 496 1.9140 343 Appendectomy w/o complicated principal diagnosis w/o CC/MCC 454 1.0099 195 Simple pneumonia & pleurisy w/o CC/MCC 383 0.7111 236 Coronary artery bypass w/o cardiac cath w/o MCC 269 4.8380 Totals Case Mix Index Average MS-DRG Payment Answer These Questions Response A. Which DRG brings in the highest amount of reimbursement? B. Which MS-DRGs has the highest relative weight? Part V: Revenue Cycle Management Essay Based on this assignment, in a few sentences, answer the questions below. Label each paragraph with either a number or a question. What expectations did you have, if any, of these activities? How did this assignment challenge your expectations? What did you learn from this assignment pertaining to coding and revenue cycle management? What surprised you about this assignment? What feedback would you provide on this assignment?

******CLICK ORDER NOW BELOW AND OUR WRITERS WILL WRITE AN ANSWER TO THIS ASSIGNMENT OR ANY OTHER ASSIGNMENT, DISCUSSION, ESSAY, HOMEWORK OR QUESTION YOU MAY HAVE. OUR PAPERS ARE PLAGIARISM FREE*******."