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New Mexico Medical Review Association (NMMRA). Coding for Payment Accuracy. DRGs 079, 080, 089 and 090. Comparative DRGs. DRG 079 - Respiratory infection and inflammation, age 18 or older, with CC DRG 080 - Respiratory infection and inflammation, age 18 or older, without CC

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comparative drgs
Comparative DRGs

DRG 079 - Respiratory infection and inflammation, age 18 or older, with CC

DRG 080 - Respiratory infection and inflammation, age 18 or older, without CC

DRG 089 - Simple pneumonia and pleurisy, age 18 or older, with CC

DRG 090 - Simple pneumonia and pleurisy, age 18 or older, without CC

comparative drgs4
DRG 079

Relative Weight (RW)

1.6501

Length of Stay (LOS)

8.5

Projected payment $6,765*

DRG 080

Relative Weight (RW)

0.9373

Length of Stay (LOS)

5.8

Projected payment $3,843*

Comparative DRGs
  • Projected payment based on average Medicare base rate for 1998
comparative drgs5
DRG 089

Relative Weight (RW)

1.0647

Length of Stay (LOS)

6.0

Projected payment $4,365*

DRG 090

Relative Weight (RW)

0.6590

Length of Stay (LOS)

4.2

Projected payment $2,702*

Comparative DRGs
  • Projected payment based on average Medicare base rate for 1998
drgs 079 080 089 and 090 issues
DRGs 079, 080, 089 and 090Issues
  • Simple pneumonia vs. complex pneumonia
  • Documentation
simple vs complex pneumonia
Simple vs. Complex Pneumonia

DRGs 079, 080, 089 and 090

1) Adenovirus

2) Respiratory syncytial virus (RSV)

3) Parainfluenza virus

4) Other and unspecified viral

5) Pneumococcal (streptococcus pneumoniae) (lobar)

  • Organisms classified as simple pneumonia
simple vs complex pneumonia8
Simple vs. Complex Pneumonia

DRGs 079, 080, 089 and 090

6) Hemophilus influenzae

7) Streptococcus (A, B, other)

8) Unspecified bacteria

9) Mycoplasma pneumoniae

10) Chlamydia

11) Unspecified organism

simple vs complex pneumonia9
Simple vs. Complex Pneumonia

DRGs 079, 080, 089 and 090

1) Klebsiella

2) Pseudomonas

3) Staphylococcus (aureus, other and unspecified)

  • Organisms classified as complex pneumonia

4) Anaerobes

5) E. coli

6) Gram-negative bacteria

7) Legionnaires’

8) Other specified bacteria

simple vs complex pneumonia10
Simple vs. Complex Pneumonia

DRGs 079, 080, 089 and 090

1) Cytomegalic inclusion disease, whooping cough, anthrax, aspergillosis, other systemic mycoses and other infectious diseases classified elsewhere

2) Aspiration pneumonia

  • Other complex pneumonias
drgs 079 080 089 and 090 documentation
- Emergency reports

- History and physical (H&P)

- Progress notes

- Laboratory reports

- X-ray reports

- Medication sheets

- Respiratory therapy notes

- Discharge summary

- Graphics record

DRGs 079, 080, 089 and 090 Documentation
  • Where to find documentation:
drgs 079 080 089 and 090 documentation12
- Fever

- Chills

- Cough

- Production of sputum

- Quality of sputum

- Pleuritic chest pain

- Pleural effusion

- Tachypnea

- Dyspnea

DRGs 079, 080, 089 and 090 Documentation
  • Pneumonia signs and symptoms:
drgs 079 080 089 and 090 documentation13
Patient was transferred from nursing home

Patient has a history of vomiting

Patient has a history of difficulty swallowing (dysphagia)

Patient has NG tube

DRGs 079, 080, 089 and 090 Documentation
  • Aspiration pneumonia* signs and symptoms:

- H&P or emergency department notes indicating:

* If aspiration pneumonia is documented or indicated, coder should check for evidence of bacterial pneumonia

drgs 079 080 089 and 090 documentation14
- Elevated white blood cell count

- Chest x-ray — see infiltrates or consolidation

- Positive sputum culture

DRGs 079, 080, 089 and 090 Documentation
  • Pneumonia — lab:

Note: Physician must make connection between positive sputum culture and pneumonia

drgs 079 080 089 and 090 documentation15
DRGs 079, 080, 089 and 090 Documentation

The physician is responsible for making the diagnosis of

pneumonia and determining the type of pneumonia

drgs 079 080 089 and 090 documentation16
- Antibiotic therapy

- Oxygen therapy

- Other respiratory therapy

- Thoracentesis for pleural effusion

DRGs 079, 080, 089 and 090 Documentation
  • Pneumonia treatment:
contact nmmra

Contact NMMRA:

P.O. Box 3200

Albuquerque, New Mexico 87190-3200

505.998.9898 phone

505.998.9899 fax

www.nmmra.org

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