Case Presentations for ICD-10

2 3M Health Information Systems © 3M All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. SOB cough pulmonary infiltrate  Patient admitted for SOB productive cough fever 101.  O2 sat 60% Infiltrate LLL Chest Treated IV antibiotics no clearing  Await pulmonary consult  Noted to be visibly dyspneic using accessory muscles to breath. O2 sats were in the 80 – 90% range on 100% NRB. HR 120, BP 90/50.  Patient continued to desat; ABGs RA pH 7.20 pO2 55 pC02.  Bronchoscopy

3 3M Health Information Systems © 3M All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Case Study This report includes data produced by 3M’s proprietary APR-DRG Software. All copyrights in and to APR-DRG Classification System and all APR-DRG Code Assignments are owned by 3M. All rights reserved

4 3M Health Information Systems © 3M All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Case Study dysuria fever AMS  Patient admitted with dysuria, fever, altered mental status.  “Urosepsis” documented in progress notes.  Lab reports showed serum creatinine and BUN levels of 4.5 & 50, respectively. Low urinary output  Physician ordered 1L of IV NS wide open with maintenance IV fluids of 150 cc/hr to follow.  Serial creatinine and BUN levels declined over the next 3 days to 1.2 & 24, respectively.

5 3M Health Information Systems © 3M All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. This report includes data produced by 3M’s proprietary APR-DRG Software. All copyrights in and to APR-DRG Classification System and all APR-DRG Code Assignments are owned by 3M. All rights reserved. BeforeAfter PDx:Urinary tract infection SDx:AML Coronary artery dz Hypertension Hyperlipidemia Procedures: APR DRG: SOI Level: APR Weight: ROM Level: Exp. Mort Rate: PDx:Sepsis SDx:Add: Acute renal failure with acute tubular necrosis Query for corresponding diagnosis Procedures: AMS dysuria and fever % % APR DRG: SOI Level: APR Weight: ROM Level: Exp. Mort Rate: MS-DRG: 690 (without MCC) Relative weight: MS-DRG: 871 (with MCC) Relative weight:

6 3M Health Information Systems © 3M All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Case Study Neuro/Trauma  Patient admitted with traumatic subdural hemorrhage.  H&P s “significant amount of midline shift over 1 cm…largely symptomatic from her right sided subdural hematoma.”  SEPS drain was placed in ICU without successful drainage.  CT of head “left-to-right midline shift of 11mm…there may be early herniation as well.”  Patient expired.

7 3M Health Information Systems © 3M All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. This report includes data produced by 3M’s proprietary APR-DRG Software. All copyrights in and to APR-DRG Classification System and all APR-DRG Code Assignments are owned by 3M. All rights reserved. BeforeAfter PDx:Traumatic subdural hemorrhage, no LOC SDx:Alzheimer’s dementia Unspecified fall Palliative care APR DRG: SOI Level: APR Weight: ROM Level: Exp. Mort Rate: PDx:Same SDx:Add: Herniation of brain Sample Case Neuro % % APR DRG: SOI Level: APR Weight: ROM Level: Exp. Mort Rate: MS-DRG: 087 (without CC/MCC) CMI: LOS: 2.2 MS-DRG: 085 (with MCC) CMI: LOS: 4.9

8 3M Health Information Systems © 3M All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Case Study Pulmonary  Patient admitted through ED with obtundation labored breathing, and fever. Contusion of head. Diagnosed with pneumonia.  Temp 102.9, BP 97/57; O 2 sat 84% on R/A. WBCs 20,000 with left shift. BUN/Creatinine = 49/2.1. ABGs: pH 7.33; pCO 2 60; pO Changed to 100% NRB mask.  BP started to drop: 85/57, 97/46, 90/60. Placed on Levophed 90cc/hr. BP cont’d to drop. Dopamine.added. Received IV Rocephin and IV Flagyl.  Patient became unresponsive to tactile and verbal stimuli. Cardiac arrest occurred.  Patient was subsequently intubated and expired.

9 3M Health Information Systems © 3M All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. This report includes data produced by 3M’s proprietary APR-DRG Software. All copyrights in and to APR-DRG Classification System and all APR-DRG Code Assignments are owned by 3M. All rights reserved. BeforeAfter PDx:Pneumonia SDx:Atrial fibrillation Left heart failure Atelectasis Hypotension Cystic kidney disease Edema Renal insufficiency History of colon CA Procedures: Mech vent & intub APR DRG: SOI Level: APR Weight: ROM Level: Exp. Mort Rate: PDx:Sepsis SDx:Add: Septic shock Acute renal failure Acute respiratory failure Coma Pneumonia Query for corresponding diagnoses and for principal diagnosis Procedures: Mech vent & intubation Sample Case: Pulmonary Medicine % % APR DRG: SOI Level: APR Weight: ROM Level: Exp. Mort Rate: MS-DRG: 194 (with CC) Relative weight: MS-DRG: 871 (with MCC) Relative weight:

10 3M Health Information Systems © 3M All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Impact of Responding to Query Impact w/ Response to Query  RW =  GLOS = 8.98  SOI = 3 Major  ROM = 2 Moderate Impact w/o Response to Query  RW =  GLOS = 8.98  SOI = 2 Moderate  ROM = 2 Moderate Query: “ Patient had a magnesium level of 1.6 and received magnesium sulfate. Please provide a corresponding diagnosis for the treatment provided.” ** CDI seeks documentation of “ hypomagnesemia “ Cranial Procedure

Impact of Documentation MS-DRG Bowel Procedure with CC PDx: Colon cancer SDx: Dehydration Post-op ileus (codes to ) “Ulcer/Wound” noted by RN PPx: Left hemicolectomy MS-DRG Bowel Procedure with MCC PDx: Colon cancer SDx: Acute Renal Failure – ATN Expected ileus (560.1) Pressure Ulcer, site unspecific PPx: Left hemicolectomy APR DRG:221 SOI Level:2 APR Weight: ROM Level:1 Peer Group 0.0% APR DRG:221 SOI Level:3 APR Weight: ROM Level:3 Peer Group 2.5% Highest MS- DRG payment MS-DRG Bowel Procedure with MCC PDx: Colon cancer SDx: Acute Renal Failure – ATN Expected ileus (560.1) Pressure Ulcer Stage IV on Sacrum PPx: Left hemicolectomy APR DRG:221 SOI Level:4 APR Weight: ROM Level:4 Peer Group 24.2% 11

12 3M Health Information Systems © 3M All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. ―Acute renal “insufficiency” SOI 1; ROM 1 ―Acute kidney injury (AKI) SOI 3; ROM 3 ―Acute kidney failure SOI 3; ROM 3 Versus ― Acute kidney failure “ due to” Acute tubular necrosis SOI 4; ROM 4 Cortical necrosis SOI 4; ROM 3 Medullary (papillary) necrosis SOI 4; ROM 3 Acute Kidney Failure Documentation Impact of Appropriate Documentation on SOI and ROM and Physician Scorecard