The role of the physician is crucial in achieving these goals, since the physician ultimately controls the length of stay and physician documentation drives ICD-9 coding and DRG assignment.
It is important to understand that while you may not use possible or probable diagnoses for professional reimbursement, they are acceptable for DRG assignment.
Physician understanding of the DRG system and appropriate documentation are the keys to success for both parties.
If this is all that is documented in the DIG summary, this case will code to DRG 29: traumatic stupor and coma, age >1 7, coma < 1 hour, with no complications or co-morbidities.
This will code to DRG 90: simple pneumonia, age >17, with no complications or co-morbidities.
As such, the case now codes to DRG 89: simple pneumonia, age 17, with a co-morbidity or complication.
It is important to note that certain cc's are considered to be expected with the principle diagnosis, and therefore will not change the DRG.
This documentation would code to DRG 149: Major small and large bowel procedures without a comorbidity or complication.
By centralizing the coding system, Lanier's ONLINE DRG and ParaMetrix coders produce more consistent and accurate coding than traditional, paper-based systems.
ONLINE DRG's track record speaks for itself -- one group using Lanier Healthcare's ONLINE DRG realized complete system payback in just three months from increased revenues alone.
ONLINE DRG is just one member of Lanier Healthcare's HealthFrame(TM) family of systems and services which include: