Thus, the difference is 0.11 or nearly 10 percent which is a much more significant change than looking at all visits that simply contained the code! This means that narrowing the data to look at visits that are more likely to be similar gives a more accurate picture of how specificity is likely impacting reimbursement.Ĭlarissa George is a business intelligence specialist at 3M Health Information Systems. Average DRG weight for visits with a specific Atrial Fibrillation code was 1.25 whereas visits with an unspecific code were 1.14. However, the difference between the two DRG weights is larger. The overall DRG weight is also smaller in terms of total numbers (these visits were less complicated than the entire bucket of visits with Atrial Fibrillation). We can see there are significantly fewer visits where this is the case: 7,977 visits with a specified code and 7,095 visits with an unspecified code – which makes sense since we are trying to look at similar visits. I48.0 Paroxysmal atrial fibrillation I48.1 Persistent atrial fibrillation I48.2 Chronic atrial fibrillation I48.3 Typical atrial flutter I48.4 Atypical. Visits with Atrial Fibrillation as a Primary Diagnosis or Reason for Admitįor visits in January 2017 where Atrial Fibrillation was the primary diagnosis or reason for admission, we see the following numbers: This will help level the comparison as we review visits that are most likely to be similar. This shows that reimbursement can be affected by specificity, but it also raises another question: Did the visits with a more specific code just have more complicated reasons for admission that increased this group’s reimbursement? To examine this question, we will filter the data to review visits that only had Atrial Fibrillation as their primary diagnosis or reason for admission. The portal for rare diseases and orphan drugs Inheritance: Not applicable Age of onset: All ages ICD-10: Q24.5 ICD-11: BA83 LA8C.2 OMIM:. Indeed the average DRG weight is higher for visits with a specific code of Atrial Fibrillation than those that have the unspecific code by about 0.03. We would assume visits with more specific codes would have a higher average DRG weight than those that do not, but to double check our assumption let’s look at the following data for January 2017: For Atrial Fibrillation we will compare the 97,996 specific visits to the 62,087 unspecific visits. If the reimbursement rate is higher for visits with specific codes, then the average DRG weight will be higher than those that contain the unspecified code. 62,087 – Visits coded with the unspecified code of I4891.160,083 – Total Inpatient visits with one of the four specific atrial fibrillation codes.Recall that for Atrial Fibrillation in January 2017 there were: As a reminder, this data is from more than 1,000 3M client facilities. To simplify the discussion, I will use the same January 2017 data that Jason did in his blog. unspecific visits with Atrial Fibrillation.ĭRG Weights in Specific vs. ![]() Today, I will dig further into this question by examining the average DRG weights in specific vs. One of the questions raised at the end of Jason’s blog was how unspecified codes might affect reimbursement. He looked at the difference in specificity for Atrial Fibrillation from October 2015 to January 2017. In a recent blog, my colleague Jason Mark examined specificity with Atrial Fibrillation (irregular heartbeat) to see if there are noticeable shifts in the specificity of codes being used under ICD-10. It belongs to the MS-DRG group 308, 309, 310, 310, 791, 793, 793, and 793, and has no back-references or exclusions. In light of this, we viewed the advent of a new International Statistical Classification of Diseases and Related Health Problems, Tenth Revision ( ICD- 10) code for type 2 MI as a potential opportunity to more appropriately code, and thus differentiate, these patients.ICD-10: What about specificity and reimbursement? I48.91 is a billable/specific code for atrial fibrillation, a condition of irregular heartbeat, in the 2023 edition of ICD-10-CM. 2 In a 2018 study, 3 more than 25% of patients who were coded as having a type 1 MI actually had a type 2 MI. We have also observed that patients with type 2 MI and myocardial injury are often included in incentive programs, such as the Hospital Readmissions Reduction Program and Hospital Value-Based Purchasing program, as a result of incorrect attribution in coding. ![]() To the Editor We read with great interest the article by McCarthy et al 1 entitled “Misclassification of Myocardial Injury as Myocardial Infarction: Implications for Assessing Outcomes in Value-Based Programs.” Our experience has been consistent with the authors’ observation that nonischemic myocardial injury is often confused with type 2 myocardial infarction (MI) or even type 1 MI.
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