ICD-10-CM PCS Inpatient Coding

  DRG 003 – Tracheostomy with Long Ventilation and Serious Illness In hospital, sometimes we get very sick patients who stay long time and need big treatments. One of these serious cases go to DRG 003 . This DRG is for patients who get tracheostomy or ECMO and stay on ventilator for more than 96 hours , and also have major diagnosis that is not from face, mouth, or neck area. Also, patient must have at least one MCC (major complication or condition). This DRG is not based on diagnosis like other DRGs. It is based on procedures , and it comes in Pre-MDC category. These are highest-level DRGs for very complex patients. Example Case: Mistake in Procedure Coding Changed the DRG In one real case, a patient came to hospital with stroke and later needed tracheostomy to help with breathing. During this surgery, doctor did division of isthmus to reach the trachea. This is normal step when doing tracheostomy. But coder coded it as separate surgery , thinking it is a different pro...

  DRG 004: Understanding One of Inpatient Coding’s Most Complex Groupers In the world of inpatient medical coding, few Diagnosis-Related Groups (DRGs) carry as much clinical and financial weight as DRG 004 — Tracheostomy with Major Diagnosis or Extensive Procedure . This DRG falls under the Pre-Major Diagnostic Category (Pre-MDC) and stands apart from most groupers in the MS-DRG system by being procedure-driven rather than diagnosis-driven. DRG 004 is typically assigned when a patient undergoes a tracheostomy during their hospital stay in conjunction with a major diagnosis , such as sepsis, acute respiratory failure, or other life-threatening systemic conditions. It reflects high-complexity cases requiring long hospital stays, intensive care, and significant resource use. For coding professionals, DRG 004 demands not only precise procedural coding but also a deep understanding of supporting clinical conditions and documentation nuances. A Case Study: Missed Tracheostomy Proced...

Sepsis and Respiratory Failure: Sequencing the Principal Diagnosis Correctly By SZ Ahmed CCS Sepsis frequently coexists with organ dysfunction, such as acute respiratory failure, creating complexity for coding professionals tasked with selecting the principal diagnosis (PDX). According to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) guidelines, when both conditions are present on admission (POA) and treated, sepsis should be sequenced as the PDX if it is the underlying cause of the organ dysfunction. This article examines this guideline, offering practical examples to guide accurate coding and ensure proper Diagnosis-Related Group (DRG) assignments. Understanding Sepsis as the Driver When a patient presents with sepsis and respiratory failure, coders must determine the causal relationship. The ICD-10-CM Official Guidelines (Section I.C.1.d) state that if sepsis and acute organ dysfunction are both POA, and no other cause (e.g., trauma o...

Sepsis Coding: Ensuring the Principal Diagnosis Reflects Clinical Reality By SZ Ahmed, CCS Sepsis coding remains a high-stakes challenge for health information professionals. Accurate assignment of sepsis as the principal diagnosis (PDX) directly impacts Diagnosis-Related Group (DRG) assignments, reimbursement, and audit outcomes. The first rule of sepsis coding—clinical justification for sepsis as PDX—requires coders to verify its presence on admission (POA) and its role as the primary reason for hospitalization. This article explores this guideline, offering practical examples and strategies to ensure compliance and precision. the foundation of Sepsis as PDX Sepsis cannot be assigned as the PDX simply because it appears in the medical record. According to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) guidelines, sepsis must be POA, supported by clinical documentation (e.g., emergency department [ED] notes, history and physical [H&P...

Understanding Genetic Mutations in Medical Coding: Focus on MTHFR and Other Clinically Relevant Mutations In modern healthcare, genetic mutations play a growing role in diagnosis, treatment planning, and risk assessment—especially in specialties like obstetrics, oncology, neurology, and pediatrics. For medical coders, it is crucial to understand what genetic mutations are , how they are documented, and when they are clinically significant enough to be coded using ICD-10-CM. What Is a Genetic Mutation? A genetic mutation is a change or variation in a gene . These changes can be: Inherited from parents, or Acquired over a person’s lifetime Think of your DNA as an instruction manual for your body. A mutation is like a spelling mistake in that manual. Some mutations have no effect, some are beneficial, and others can cause serious medical conditions. Why So Many Mutations Exist Human genetic diversity is vast. Over 430 million genetic variants (mutations) have been identifie...

  Understanding E/M Codes: New vs Established Patients and How to Use Our Calculator Evaluation and Management (E/M) codes are essential for medical billing in outpatient and office settings, ensuring healthcare providers are accurately reimbursed for patient encounters. Understanding the difference between new and established patients and how to assign the correct E/M codes can streamline your practice’s billing process. Our free E/M Calculator , designed for Blogger, simplifies this task by calculating E/M codes based on the 2021 AMA CPT guidelines. In this article, we’ll explain what new and established patients are, what E/M codes represent in outpatient settings, and provide a step-by-step guide to using our E/M Calculator for accurate medical coding. What Are New and Established Patients? In medical coding, patient status determines which E/M code range to use. Here’s the difference: New Patients A new patient  is someone who has not received professional services...

E/M Calculator E/M Calculator Encounter Data Date of Service Patient Type Established New Medical Decision Making Number and Complexity of Problems 1 self-limited or minor problem 2 or more self-limited or minor problems 1 stable, chronic illness 1 acute, uncomplicated illness or injury 2 or more stable, chronic illnesses 1 chronic illness with exacerbation 1 acute illness with systemic symptoms 1 undiagnosed new problem with uncertain prognosis 1 chronic illness with severe exacerbation 1 acute or chronic illness that poses a threat to life Data Reviewed and Analyzed External Notes Reviewed Unique Tests Reviewed U...

  A Friendly Guide to 2025 CPT Codes for Arterial Catheterization and Angiography Hello, everyone. Let’s dive into the world of catheters, angiograms, and vascular families with a guide that’s as human as it gets—no robotic jargon here, just a chatty rundown to make your coding life easier. What’s Arterial Catheterization All About? In interventional radiology, arterial catheterization is like sending a tiny explorer into the body’s blood vessels to diagnose or treat issues. Think angiography (taking X-ray pictures of vessels), angioplasty (opening blocked arteries), or stent placement (propping vessels open). The arterial system is one of four vascular systems—alongside venous, pulmonary, and portal—and it’s where we’re focusing today. Procedures are split into two types: non-selective and selective catheter placements. Let’s break them down. Non-Selective Catheter Placement: The Basics Non-selective placement is when the catheter stays in the vessel it entered or only moves ...

  Guide to the Latest CPT Codes for AV Shuntograms: What You Need to Know If you’re diving into the world of AV shuntograms for dialysis patients, you’re in the right place. Let me tell you, keeping up with the latest CPT codes can feel like chasing a moving target. But don’t worry—I’ve got you covered with a fresh, easy-to-read guide on the current CPT codes for AV shuntogram procedures, straight from the heart of my notes and a recent PowerPoint I came across. Let’s break it down in a way that feels like a chat over coffee, not a lecture hall snooze-fest. Why AV Shuntograms Matter Picture this: you’re a patient with chronic kidney failure, and dialysis is your lifeline, happening every two or three days to clean your blood. To make that work long-term, doctors create an arteriovenous (AV) fistula or graft—a kind of superhighway for blood flow. But here’s the catch: the high-speed traffic of blood can cause clogs, like a busy road during rush hour. These blockages, called shunt...

Interventional Radiology in 2025:  Venography and CPT Codes for Success Interventional radiology (IR) is revolutionizing healthcare by offering minimally invasive alternatives to traditional surgery. Using advanced imaging techniques like X-rays, CT scans, ultrasounds, and MRIs, IR specialists perform precise procedures with smaller incisions, less pain, and faster recovery times. One critical IR procedure is venography , which visualizes veins to diagnose conditions like blood clots or vascular abnormalities. As we move into 2025, staying updated with the latest Current Procedural Terminology (CPT) codes is essential for medical coders, radiologists, and practice managers. This article dives into IR, focusing on venography, and provides the 2025 CPT codes to ensure accurate billing and compliance. Whether you’re a healthcare professional or curious about IR, this guide will help you navigate the evolving landscape of medical coding. What’s Venography, and Why Should You Care? Pi...

Mechanical Ventilation Hours Calculator Mechanical Ventilation Hours Calculator Enter start and end date/time of mechanical ventilation to calculate duration and get the ICD-10-PCS code. Start Date and Time: Please enter a valid start date and time. End Date and Time: Please enter a valid end date and time after the start. Calculate Hours Reset Results:

  Navigating the Latest HCPCS Level II Code Updates for 2025: What You Need to Know As we step into 2025, staying updated with the latest HCPCS Level II code changes is critical for healthcare providers, coders, and billing professionals. These updates, issued annually by the Centers for Medicare & Medicaid Services (CMS), play a pivotal role in ensuring accurate medical billing and compliance with federal guidelines. Understanding these changes can prevent claim denials, ensure proper reimbursement, and maintain regulatory compliance. What Are HCPCS Level II Codes? The Healthcare Common Procedure Coding System (HCPCS) Level II codes are alphanumeric codes used to describe non-physician services, equipment, supplies, and other healthcare items not covered by CPT (Current Procedural Terminology) codes. These include: Durable Medical Equipment (DME) Prosthetics and orthotics Ambulance services Certain drugs and biologicals Each year, CMS revises these codes to reflect...

Medical Coding Tetris Toggle Panel Pause A B C D Score: 0 Incorrect: 0/10 Streak: 0 Left Right Down Rotate Place Medical Coding Tetris Rules - Answer 20 ICD-10-CM questions to place tetrominoes. - Correct answer letter (A, B, C, D) appears on tetromino. - Correct answers let you position tetromino freely. - Incorrect answers place tetromino randomly. - 3 correct answers in a row grants a Hammer Brick ('I' shape, marked 'X'). - Hammer Brick clears all bricks on the board when placed, scoring 10 points per block. - Use arrow keys (PC) or touch buttons (mobile) to move and rotate. - Press Enter (PC) or Place button (mobile) to lock tetromino. - Tetrominoes fall every second after 5 seconds, speeding up e...