2023 DRG Expert - Volume 1 & 2 (eBook)

Optum | 2023 | Karen Krawzik; Anita Schmidt

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2024 eBook
149.95 2024 Spiral
149.95

149.95
List Price Per User

Item #: EDRG23
ISBN: 9781622548194
Available: NOW








The DRG Expert has been a trusted and comprehensive reference to the DRG classification system for more than 25 years. Organized by major diagnostic category (MDC), the convenient and innovative book layout follows the logical MS-DRG decision process. This is a must-have reference for those who need to verify DRG information and accurately assign MS-DRGs concurrently or retrospectively based on ICD-10-CM methodology, which goes into effect October 1, 2022.
  • Optum Edge — Visual indicators notify you of special alerts. Easily identify CC and MCC restrictions, special payment status, transfer DRG status, surgical/medical partitioning, and other requirements.
  • Optum Edge — Medicare CMS rate structure. Updated to provide current relative weight (RW), geometric mean length-of-stay (GMLOS), and arithmetic mean length-of-stay (AMLOS) for each MS-DRG under IPPS.
  • Optum Edge — MS-DRG structure. Every diagnosis and procedure code that defines each DRG is listed.
  • Optum Edge — LTC-DRG crosswalk and current rate structure. Know what the RW and length-of-stay data are for each MS-DRG under the LTCH prospective payment system.
  • Optum Edge — MDC diagnosis list. Complete list of mutually exclusive diagnoses defining each MDC.
  • Optum Edge — Transfer DRG symbol. Indicates a DRG selected as a qualified discharge that may be paid at the per diem rate.
  • Optum Edge — Average national payment. Listed for every MS-DRG as a quick benchmark comparison.
  • Easily locate the correct DRG. Use the exclusive numeric or alphabetic indexes to quickly identify a DRG based on its diagnosis or procedure code.
  • Surgical hierarchy table. Quickly find the DRG hierarchy for multiple procedure cases to help you assign the code that reflects the greatest resource utilization.
  • Alphabetic and numeric indexes. Search for DRGs by the numeric codes or by code titles for fast look-up.
  • Icons indicate which CC subclass the DRG belongs to based on the presence or absence of CCs or major CCs (MCCs).
  • Complete list of diagnoses considered CCs and MCCs.
  • List of those principal diagnoses that are their own CC and their own MCC.
  • Full titles for each MS-DRG. Selection of the correct DRG begins with knowing its accurate and complete description.

Karen Krawzik, RHIT, CCS, AHIMA-approved ICD-10-CM/PCS Trainer

Ms. Krawzik has expertise in ICD-10-CM, ICD-9-CM, CPT®/HCPCS, DRG and data quality and analytics, with more than 30 years’ experience coding in multiple settings, including inpatient, observation, ambulatory surgery, ancillary and emergency room. She has served as a DRG analyst and auditor of commercial and government payer claims, as a contract administrator, and worked on a team providing enterprise-wide conversion of the ICD-9-CM code set to ICD-10. More recently, she has been developing print and electronic content related to ICD-10-CM and ICD-10-PCS coding systems, MS-DRGs and HCCs. Ms. Krawzik is credentialed by the American Health Information Management Association (AHIMA) as a Registered Health Information Technician (RHIT) and a Certified Coding Specialist (CCS) and is an AHIMA-approved ICD-10-CM/PCS trainer. She is an active member of AHIMA and the Missouri Health Information Management Association.

CPT is a registered trademark of the American Medical Association.

Anita Schmidt, BS, RHIA, AHIMA-approved ICD-10-CM/PCS Trainer

Ms. Schmidt has expertise in ICD-10-CM/PCS, DRG, and CPT® with more than 15 years’ experience in coding in multiple settings, including inpatient, observation, and same-day surgery. Her experience includes analysis of medical record documentation, assignment of ICD-10-CM and PCS codes, and DRG validation. She has conducted training for ICD-10-CM/PCS and electronic health record. She has also collaborated with clinical documentation specialists to identify documentation needs and potential areas for physician education. Most recently she has been developing content for resource and educational products related to ICD-10-CM, ICD-10-PCS, DRG, and CPT®. Ms. Schmidt is an AHIMA-approved ICD-10-CM/PCS trainer and is an active member of the American Health Information Management Association (AHIMA) and the Minnesota Health Information Management Association (MHIMA).

CPT is a registered trademark of the American Medical Association.



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