MS-DRG?

[Howard S Shubs]

Where might I find discussion this topic? I wrote an MS-DRG grouper in
2007 and have been keeping it up to date since. At the moment, I've got
a question for which I've not found a way to get an answer. Just in
case this is the right newsgroup, here's the question.

This is all in terms of ICD-9. I have a principal DX and a secondary
DX, 66940 and 67082 (similar to 67002, but new this year). DX 67082 is
a complication, but it's excluded with this principal DX. Yet
everything I've been able to check, including my own grouper, yields a
result of DRG 774 (with complication) instead of 775 (no complication).
Both the Definitions Manual (the Book) and every other grouper I've
tried does the same thing. Even older versions of this grouper and
prior ones, when using 67002 as the secondary, group it the same way.
But it's *excluded*! What's up with that? I need an answer that
satisfies both me and my QA person.

I can knock out three apparently unrelated complication bits on
exclusion with the rest of the CC/MCC bits, and get it to group the way
we think it should, but that disagrees with /everything/ else I've been
able to find. According to the raw data, there are three versions of
DRG 774. The third one doesn't require any complication bits other than
the one remaining bit 67082 and 67002 have after exclusion, so it seems
to me that 774 *is*, in fact, the correct answer.

So why is this excluded if it's not going to matter? Neither of us has
a clinical background, so maybe we just have to accept it as given? Is
there a counter-example which might help?

--
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