Cracking the Code
Incorrectly Assigned Diagnosis-related Group (DRG)
For inpatient encounters, there are many factors that will affect the correct assignment of a Diagnosis-related group (DRG); incorrectly assigned primary diagnosis and procedure codes are at the top of this list. DRG reimbursement is based on the care that patient needed during their hospital stay. When diagnosis and procedure codes are reported incorrectly, this may cause a hospital to bill an incorrect DRG (which may result in an over or underpayment from the third-party insurance company for those inpatient services). Coding a procedure with the wrong approach or root operation will cause a shift in the DRG assignment. It is extremely important for inpatient coders to ensure they are reporting accurate diagnoses and procedure codes, so hospitals will receive proper reimbursement for their services.