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Decoding I-10 Dilemmas - DRG 455

Published on 

Wednesday, August 3, 2016

 | RAC Information 
 | FAQ 

Dilemma:

I have a claim where an anterior fusion was performed in the morning then the patient was brought back to the OR for a posterior fusion in the afternoon. The encoder groups these two procedures to DRG 455 Combined Anterior/Posterior Spinal Fusion without CC/MCC. Is this correct?

Solution:

DRG 455 is correct because it reflects that an Anterior and a Posterior fusion were performed during that admission. It is not an issue, from a coding standpoint, that the procedures were performed at two separate operative episodes.

Resources:

  • TruCode Encoder
Article Author: Anita Meyers, RHIT, CCS
Anita Meyers, RHIT, CCS, is an Inpatient Coding Professional at Medical Management Plus. Anita has over twenty-six years of experience in inpatient and outpatient coding including 17 years of work at AQAF reviewing inpatient and outpatient records from Alabama hospitals. In addition to reviewing records she was the team leader in Beneficiary Services where she participated in case review activities, received and processed beneficiary complaints and handled fee-for-service denials for home health, hospice and skilled nursing facility services. Prior to joining the MMP team, Anita left AQAF to become an inpatient contract coder and worked at various hospitals in central Alabama. In her current position, Anita is an integral part of the Inpatient Services at Medical Management Plus.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.