Basics of DRG code 871, 872 and 870

DRG codes 871, 872 and 870 are used for coding sepsis related diagnosis. These codes fall under ground MDC 18 Infectious & Parasitic Diseases, Systemic or Unspecified Sites Septicemia or Severe Sepsis.

DRG codes 871 & 872 are coded based on with or without MCC codes. And DRG code 870 is coded when the patient is under Mechanical ventilation (MV) for more than > 96 hours.

Description of DRG code 871 and 870

DRG 870 SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS

DRG 871 SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC

DRG 872 SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC

Effect of MCC on DRG and its reimbursement

When we add a admit dx and Principal diagnosis (for e.g. A41.9, sepsis unspecified) in ICD-10 section in 3M, DRG code 872 is reflected with 018 MDC group code as shown below. The reimbursement cost for the below DRG is $4728. This DRG code is “Septicemia or sever sepsis without MV(mechanical ventilation)>96 hours without MCC”. Since this is no MCC code and no code for MV >96 hours, DRG code 872 is coded.

Now when we add a MCC (Major Complication or Comorbidity) code A066 as secondary diagnosis, the DRG code changes to 871 which say “Septicemia or severe sepsis without MV> 96 hours with MCC”

Also you can see below the MCC code has changed  reimbursement amount from $4728 to $7988. This is the effect of MCC code on DRG code and the reimbursement cost. So, Inpatient coders should not missed these MCC condition while coding the medical report, since MCC codes have lot of effect on the treatment cost.

Effect of ICD-10 PCS code on Mechanical Ventilation on DRG code

Now, when we add a ICD-10 PCS code 5A1955Z  “Respiratory Ventilation, Greater than 96 Consecutive Hours” the DRG code changes to 870.

Also the estimated reimbursement cost increased to $24948. See the addition of just one ICD-10 PCS code 5A1955Z, has increase the cost of reimbursement almost 4 times. 

Since, Sepsis, one of the most frequent and life-threatening complications on intensive care units (ICUs), is associated with a need for mechanical ventilation (MV) as well as adverse respiratory outcomes in hospitalized individuals. The patient is having a life-threatening condition and is on MV, this requires extra care and hence the cost of treatment also increases vastly (from $7988 to $24948) as you can see in below image.

This is why inpatient coding is very complex. Each code especially the CC & MCC needs to be captured everything when present, they have lot of impact on the reimbursement.

List of  PRINCIPAL DIAGNOSIS for DRG code 871 and 870

A021 Salmonella sepsis
A207 Septicemic plague
A227 Anthrax sepsis
A267 Erysipelothrix sepsis
A327 Listerial sepsis
A391 Waterhouse-Friderichsen syndrome
A392 Acute meningococcemia
A393 Chronic meningococcemia
A394 Meningococcemia, unspecified
A3989 Other meningococcal infections
A399 Meningococcal infection, unspecified
A400 Sepsis due to streptococcus, group A
A401 Sepsis due to streptococcus, group B
A403 Sepsis due to Streptococcus pneumoniae
A408 Other streptococcal sepsis
A409 Streptococcal sepsis, unspecified
A4101 Sepsis due to Methicillin susceptible Staphylococcus aureus
A4102 Sepsis due to Methicillin resistant Staphylococcus aureus
A411 Sepsis due to other specified staphylococcus
A412 Sepsis due to unspecified staphylococcus
A413 Sepsis due to Hemophilus influenzae
A414 Sepsis due to anaerobes
A4150 Gram-negative sepsis, unspecified
A4151 Sepsis due to Escherichia coli [E. coli]
A4152 Sepsis due to Pseudomonas
A4153 Sepsis due to Serratia
A4159 Other Gram-negative sepsis
A4181 Sepsis due to Enterococcus
A4189 Other specified sepsis
A419 Sepsis, unspecified organism
A427 Actinomycotic sepsis
A5486 Gonococcal sepsis
B007 Disseminated herpesviral disease
B377 Candidal sepsis
R571 Hypovolemic shock
R578 Other shock
R6520 Severe sepsis without septic shock
R6521 Severe sepsis with septic shock
R7881 Bacteremia