You're a coder who's reviewing the record of a 62-year-old woman who was admitted to the hospital
with shortness of breath and minor chest pain. The doctor diagnosed the patient with Staphylococcus
aureus pneumonia and you assigned a code of 482.41. Additionally, you coded decompensated chronic
systolic congestive heart failure (as documented by the physician) as 428.22 and 428.0. The coding system
grouped the information into MS-DRG 178 (RW: 1.4860). The hospital has a base rate of $4,500.
What is the hospital's reimbursement for this patient under the PPS?
A. $6,687
B. $10,360
C. $3,028.26
D. $4,500
There are no tutors here who have expertise in this subject area.
Please use your text, study materials, and a good search engine or two to find your answers.
1. Go to http://www.google.com or http://www.bing.com
2. Type in MS-DRG 178 (RW: 1.4860) (or whatever search terms you need). Press Enter.
3. Read different search results until you find what you need.
4. Re-search with different search terms if you don't find all you need.
To determine the hospital's reimbursement for this patient under the PPS (Prospective Payment System), we need to use the provided information, including the assigned diagnosis codes and the MS-DRG (Medicare Severity Diagnosis-Related Group).
First, let's break down the diagnosis codes:
1. Staphylococcus aureus pneumonia is coded as 482.41.
2. Decompensated chronic systolic congestive heart failure is coded as both 428.22 and 428.0.
Now, we need to find the proper MS-DRG based on these diagnosis codes. MS-DRGs are used to categorize patients into groups that are clinically similar and have similar resource utilization.
Based on the codes provided, we would refer to the MS-DRG table or software to find the appropriate group. The given MS-DRG for this case is 178, with a relative weight (RW) value of 1.4860.
Next, we need to calculate the reimbursement by multiplying the RW by the base rate of the hospital. The base rate mentioned is $4,500.
Reimbursement = RW * Base Rate
Reimbursement = 1.4860 * $4,500
Calculating this, we get a reimbursement of $6,687.
Therefore, the correct answer is A. $6,687.