Impact of Coding Guidelines on DRGs

August 17, 2017

The ICD-10-CM Official Guidelines for Coding and Reporting and the AHA Coding Clinic instructions have different impacts on the MS-DRG and APR-DRG grouper logic as do the codebook instructional notes. The guidelines change over time and require careful monitoring for DRG impact and compliant code assignment. As part of an overall quality assurance plan to minimize coding errors and retrospective adjustments or denials, these guidelines should be tested for impact on reimbursement, coding, case mix, and monitored for proper use.

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Learning outcomes

By the end of this webinar participants will be able to:

  • Recall the coding guidelines for injury and trauma sequence and code instructions
  • Identify AHA Coding Clinic guidance that generate significant procedures with DRG impact
  • Examine ICD-10-CM codebook “code also” and “code additional” instructions to capture missed CC/MCC/SOI
  • Compare the grouper impact of specific examples on MS-DRGs and APR-DRGs



Deborah Gardner-Brown, RHIT, CCS, C-CDI, CI-CDI, CDIP, CCDS, CCMSCP,CPMA is the founder and President of Reimbursement Review Associates, Inc. in NJ.  Ms. Brown has more than 30 years’ experience in both hospital and professional coding and Revenue Cycle Management. She has held positions as director, administrator, and consultant in both acute care and outpatient health care settings. Ms. Brown’s expertise includes a range of Revenue Cycle and Compliance Surveillance programs/projects including performance improvement, data quality/analytics, utilization, quality, CDIP metrics management.

Ms. Brown is an accomplished auditor for E&M/CPT, APG, APC and MS-DRG, APR-DRG validation for coding compliance in both the acute care and outpatient care settings. She has been an active speaker for several state component professional associations over the past 5 years. She is also an AHIMA approved ICD-10-CM/PCS Trainer that has developed and presented educational material on several ICD-10-CM/PCS and CDI topics.

She holds the AHIMA credentials of RHIT, CCS, and CDIP. She is also certified as an  C-CDI (Certified in Clinical Documentation Integrity), CI-CDI (Certified Instructor- Clinical Documentation Integrity) from the AIHCD, CCDS (Certified Clinical Documentation Specialist) from ACDIS, CPMA (Certified Professional Medical Auditor) from the AAPC, and CCMSCP (Certified CMS Compliance Professional) from the Progressive Health Care Compliance Institute. Ms. Brown is the founder of the NJ ACDIS state chapter association, and a member of AHIMA, NJHIMA, HCCA, AAPC, NJACDIS, AIHCD, WBL,MGMA, and ACDIS.

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