ICD-10 Clinic Advanced - Book 13: Inside the DRG System

How a coded record becomes a payment: why grouping exists at all, what the grouper reads, major diagnostic categories, the split between surgical and medical, complications and comorbidities and what they change, the relative weight, the base rate arithmetic, outliers and transfers, what the present on admission field does to the whole calculation, and where the coder sits in it. Written so that a coder can follow the money without becoming an accountant.

The ten chapters:

1. Why a payment system needs groups

2. What the grouper reads

3. Major diagnostic categories

4. The surgical and medical split

5. Complications and comorbidities

6. The relative weight

7. The base rate arithmetic

8. Outliers and transfers

9. What present on admission changes

10. Where the coder sits in all this

Twenty-five A4 pages in full colour. Every chapter closes with its rule stated in a single line, so you can revise the whole book from the rules alone. Then a two-page Coding Lab working full records step by step, a page of the eight pitfalls that cost the most marks, fifteen practice questions with a worked answer for every one, and a glossary.

Written in short sentences and plain English, for readers whose first language is not English and clearer for everyone else because of it.

Grouping systems differ between countries and between payers, so the numbers used here are worked examples chosen to make the arithmetic clear. The method is the same everywhere. Always use your own hospital's current weights and rates for real work. Instant PDF download. By M.R. Sterling.