3M DRG Mismatch Training

Hi there! Welcome to the DRG Mismatch Training Module!

This module is designed to help you resolve a DRG Mismatch notification. You will focus on the steps needed to clear system prompts, review DRG reconciliation, and compare the working DRG and final DRG to assign a reason code.

Learning Objectives:

  1. Utilize 3M application to resolve a DRG Mismatch notification/alert.
  2. Explain the importance of DRG reconciliation.
  3. Compare the working DRG and final DRG in relation to selecting a reason code.

 

Good luck !

 

Module 1: DRG Mismatch

Overview

DRG Mismatch

A DRG mismatch can occur for a number of reasons, causing an error notification or alert.

Imagine that you are a consultant responsible for reviewing the DRG reconciliation process. While reconciling this week’s report, you receive a notice that there is a DRG Mismatch. You need to clear it so you can submit the codes back to the abstract. What do you do?

Close the Alert

Critical Information Identified

The first step is to close the alert, so you can correct the notification.

Assess the Final DRG Comparison Tab

What is a Reason Code?

Working DRG and Final Coded DRG

Your next step is to review the working DRG and final DRG to determine why there was a DRG mismatch. This is perhaps the most common method for DRG reconciliation. The reconciliation review is triggered when the final coded DRG differs from the working DRG assigned by CDI professional.

Comparing the DRGs

When we compare the working DRG to the Final Coded DRG we are looking for differences between the two code sets.

The comparison is essentially reviewing how well the CDI specialist and Coder are coming to the same conclusion on the appropriate codes applied to the medical record.

DRG Assignment Process

During the coding and DRG assignment process, there are various versions of the DRG that can take place. Understanding these versions of the DRG can also provide insight into the difference between the working DRG and final coded DRG. Match the term with the appropriate description.

  • Admitting DRG
    Assigned at admission
  • Working DRG
    As currently documented
  • Presumptive DRG
    Pending query
  • Final DRG
    After query resolved

Reason for DRG Mismatch

Patient Discharge

The patient was discharged on Sunday evening and it now ready for final coding Monday morning.

Physician Documentation

The attending provider dictated the discharge summary on Sunday answered a query from Saturday documented in the progress note.

Diagnosis and Assigned Code

The diagnosis “acute on chronic CHF” was autosuggested and coder would add to their coding summary.

Given the above scenario, which reason code would you select as to why there was a DRG mismatch?

  • Coding Opportunity
  • Subsequent Documentation
  • Coding Guidelines

Add Reason

Complete!

Thank you for completing the DRG Mismatch Module!

Now, you can submit your codes back to the abstract or send to billing.

Looking Ahead…….

Module 2: Submitting Codes Back to the Abstract