DRG Test Flashcards
What does DRG stand for?
Diagnosis Related Group
What does MDC stand for?
Major Diagnostic Category
What does C/C stand for?
Complication/Comorbidity
What does G/Los stand for?
Geometric Length of Stay
What does CMS stand for?
Center for Medicare Medicaid Services
What is an MDC?
One of 26 subdivisions to which all of the ICD-9 CM codes have been assigned on the basis of organ system.
DRG assignment is based on what?
Principal Diagnosis, Secondary Diagnosis, C/C, Principal and Secondary Procedure.
What are the two special DRG’s?
981-Extensive operating room procedure unrelated to principal diagnosis.
986-Prostatic OR procedure unrelated to principal diagnosis.
What is relative weight?
The more it weighs, the more it pays.
What is a case-mix index?
It is the sum of all DRG relative weights divided by the total number of Medicare patients treated by the hospital over a specific period of time.
Operating Room procedure categories are what?
Hierarchical and based on intensity of resource consumption.
A patient with multiple OR procedures will be assigned to the surgical group based on what?
The most resource intensive procedure.
Hierarchical structure is from where to where on a decision tree?
Left to Right
What does POA stand for?
Present on Admission
What is the definition of POA?
Present at the time the order for inpatient admission occurs.
What is a POA assigned to?
The principal and secondary diagnosis as well as external cause of injury codes.
What does a (Y) represent for POA’s?
Yes. Present at the time of inpatient admission.
What does (N) represent for POA’s?
No. Not present at the time of inpatient admission.
What does (U) represent for POA’s?
Unknown. Documentation is insufficient to determine if condition is present on admission.
What does (W) represent for POA’s?
Clinically Undetermined. Provider is unable to clinically determine whether condition was present on admission or not.
What is MEDPAR?
The Medicare Provider Analysis and Review file. It stores twenty percent of the bills that hospitals submit for payment for inpatient services rendered to Medicare Beneficiaries.
In what setting are DRGs used?
Inpatient
A patient can have how many DRGs per visit?
One
What is the type of software used to help determine DRGs?
A grouper
