2024 DRG Expert - Volume 1 & 2 (eBook)

• 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 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.

Ms. Anderson is a Registered Nurse and CDI Specialist/Educator with more than 20 years of experience in the healthcare profession. She obtained her BSN at the University of Minnesota and spent most of her bedside nursing career on Medical-Surgical care units. Her clinical documentation experience began in 2007, covering CDI specialist training, education development, and physician engagement. She has served as a CDI Team Lead and consultant, working with senior leadership to incorporate CDI work into documentation compliance and quality metrics. Ms. Anderson also has a BS degree in Biology (Winthrop University), with research experience in liver cancer and radiation-induced leukemia. She has presented at the state and national levels for the Association of Clinical Documentation Integrity Specialists (ACDIS) and has served as a co-lead for the Minnesota state chapter.