VALIDATION OF DRG 14

Specific Cerebrovascular Disorders

Except Transient Ischemic Attacks

RICHARD P. KUSSEROW

JANUARY 1988
INSPECTOR GENERAL

OAI-09-86-00052  EXECUTIVE SUMRY 
PURPOSE : The purpose of this inspection was to conduct a

review of hospital discharge claims paid under Diagnosis

Related Group (DRG) 14 , Specific Cerebrovascular Disorders

Except Transient Ischemic Attacks. 
BACKGROUND  The Office of Inspector General (OIG) analyzed all
DRGs to determine the potential for erroneous payment based on 
coding. 
incorrect or manipulative 
Three DRGs, including
, were selected for review. 
DRG 14  This report deals only with
the findings related to DRG 14. A sample of 10 hospitals in

Region IX was selected for the inspection.

MAJOR FINDINGS  Over 15 percent of the cases reviewed were
14. 
erroneously assigned to DRG  This resulted in $108 353
in net overpayments to the 10 hospitals reviewed. 
The
proj ected net 
overpayment for all hospitals in the San 
871. If 
Francisco region is $5 231  these findings are
representative of the nation
, the national impact would be

approximately $31. 5 million annually.

The primary causes of the erroneous DRG assignments and 
overpayments to the hospitals include: 
physician
failure to correctly identify the principal

diagnosis or to state it with sufficient specificity,

resul ting in vague diagnoses which are subj 
ect to incorrect
coding; 
insufficient documentation in the medical record to

substantiate clinical diagnoses;

variable coding practices prompting improper coding of the

principal diagnosis by hospital 
staff; and

inaccurate diagnosis for stroke symptoms of some elderly 
patients with multiple disabilities
, resulting in faulty
principal diagnoses and frequent misassignment of the 
DRG. 
RECOMMENDATIONS: 
The Health Care Financing Administration 
(HCFA) should

advise all peer review organizations 
(PROs) of the

vulnerabili ty of DRG 14 and suggest focused reviews of

DRG 14 cases at hospitals with high numbers of such claims.  The HCFA Response 
By agreeing that DRG 14 is vulnerable

and by emphasizing the PROs
' 20 percent random audit
, HCFA

indicated its acceptance of this recommendation.

The HCFA should instruct the PROs to initiate intensified

educational efforts toward improving physician designation

of principal diagnoses.

The HCFA Response 
The HCFA agreed with this

recommendation. The 
OIG will distribute this report to the
PROs. 
The HCFA should provide sufficient resources and monitoring

of fiscal intermediaries to enhance their capability to

provide complete claims data on request in a timely 

manner. 
The HCFA Response 
According to HCFA
, sufficient funding is

not available to restructure fiscal intermediary data in a 
form more useful for OIG studies such as DRG 14. 
The OIG
will work with HCFA to resolve these problems.  TABLE OF CONTENTS

Page 
EXECUTIVE SUMARY 
INTRODUCTION 
BACKGROUND 
PURPOSE 
DRG 14 CODING PROBLEMS

METHODOLOGY 
WHAT IS A STROKE? 

FINDINGS 
SIGNIFICANT OVERPAYMENTS RESULTED FROM ERRORS

IN DRG ASSIGNMENT

MOST ERRORS INVOLVED INCORRECT OR NONSPECIFIC

IDENTIFICATION OF THE PRINCIPAL DIAGNOSIS

CODERS INCORRECTLY TRANSLATED PHYSICIANS' 
NARRATIVE IN 11 PERCENT OF ERRORS

THREE ADMISSIONS WERE UNNECESSARY

RECOMMENDATIONS 
APPENDICES 
APPENDIX A:  CHARACTERISTICS OF SAMPLE HOSPITALS 
APPENDIX B:  METHOD FOR PROJECTING COST AVOIDANCE 
APPENDIX C:  ANALYSIS OF DRG 14 CLAIMS BY HOSPITAL AND CASE 
APPENDIX D:  TYPES OF ERRORS WHICH AFFECT DRG ASSIGNMENT  INTRODUCTION

BACKGROUND 
Under section 
1886( d) of the Social Security Act
the Social Security Amendments of 1983 (P.
 , enacted by

prospecti ve  L. 98-21), a

payment system (PPS) for Medicare payment of
inpatient hospital services was established effective with

hospi tal cost reporting periods beginning on or after

October 1, 1983. Under this system
, Medicare payment is

made at a predetermined
, specific rate for each discharge.

All discharges are classified according to a list of

diagnosis related groups 
(DRGs).

The DRGs are based on a coding classification using the

International Classification of Diseases

, 9th Revision

Clinical Modification (ICD-9-CM). This classification

system was designed for the collection of morbidity and

mortali ty statistics and not for reimbursement purposes.

Incorrect application of the ICD-9-CM codes can lead to 
incorrect payments to hospitals. 
General  The Office of Inspector
(OIG) therefore has been concerned with the validity
of payments to hospitals under 
PPS. 
Beginning in late 1984
, the OIG undertook studies on the

validi ty of reimbursement under PPS. All 
DRGs were analyzed
tially to determine their potential for erroneous

pini ayment. 
Based on the results
, three DRG categories were

selected for review because they were thought to be

particularly vulnerable to miscoding and other errors by the

provider communi ty--DRG 88 (Chronic Obstructive Pulmonary

Disease), DRG 82 (Respiratory 
Neoplasms), and DRG 14

(Specific Cerebrovascular Disorders Except Transient

Ischemic Attacks). Together
, these three DRG categories

consti tute approximately 6 percent of total PPS reimbursements.

Reports on DRG 88 and DRG 82 have already been 

issued. 
PURPOSE 
This report focuses on DRG 14
, emphasizing some of the

special problems in diagnosing and coding stroke patients

under PPS. In 1984
, DRG 14 was the fourth most frequently

occurring DRG and ranked third in total 
reimbursement. 
DRG 14 CODING PROBLEMS

Diagnosis Is Of ten Difficult

Diagnosing stroke patients is often difficult

frail 
, especially

, elderly patients with a variety of chronic 
conditions.
The conditions grouped into DRG 14 are closely related to
 , and 17. 
DRGs 15 , 16 Faulty diagnosis or misunderstanding on
the part of coders, intentional or otherwise, can lead to
improper assignment and reimbursement of the 
DRG.
It is important to emphasize that the OIG is not second-
guessing physician diagnoses when reviewing medical records 
to validate that the case has been assigned to an appropriate
DRG. Rather 
, the purpose of the validation is to assure that 
the medical record contains adequate documentation to support 
the principal diagnosis, any co-morbidities and complications

noted 
, and the sequencing of these. 
In pilot studies of DRG 14
conducted in 1984, the most common reason for misassignment was
failure to provide such documentation. 
This inspection
confirmed those preliminary findings. 
Hospi tals May Manipulate To Bring About DRG Creep

The term " 
DRG creep" is widely used by the provider community
to describe the practice of diagnosing and coding conditions

other than those justified by the medical record in order to

obtain higher paying DRGs. It is, therefore, a concern of the

OIG. 
The DRG 14 is particularly vulnerable to creep activity because 
of the combined effect of the fOllowing issues: 
High Weight  The DRG 14 has a relative weight of 1. 3527.
The average relative weight for all medical DRGs is . 
9404.
The relative weight multiplied by the blended payment 
amount specific to each hospital results in the 
reimbursement amount. Therefore
, the higher the relative
weight 
, the more reimbursement the provider receives. 
Because of this, there are incentives for hospitals and
physicians to manipulate principal diagnoses and place 
claims in the DRG 14 category which properly belong in

other diagnosis related groups.

Documentation 
The Uniform Hospital Discharge Data Set 
(UHDDS) defines principal diagnosis as "
the condition 
established after study to be chiefly responsible for 
occasioning the admission of the patient to the hospital for 
care. " The principal diagnosis determines the DRG

assignment 
, and the physician is responsible for accurately 
attesting to it. Physicians
, however, do not consistently
apply the UHDDS definition of principal diagnosis in their 
documentation practices. 
Sequencing Inconsistencies 
Sequencing is the order in

which the discharge diagnoses are listed and depends

upon the condition that was chiefly responsible for

occasioning the patient' s admission to the hospital.
 Since not all coders will interpret and code the same

information the same way, DRG 14 is vulnerable.

The combination of higher than average relative weight, lack

of consistency by physicians in their documentation, and

diverse interpretations of diagnostic information by coders

produces a climate conducive to DRG creep. 
Basic Coding Errors Are Common

At the time this inspection was initiated, little definitive

errors. 
work had been published regarding ICD-9-CM coding 
Two 
studies by the Institute of Medicine in 1977 and 1980

however , found error rates of over 30 percent among
hospi tal-coded data. Unfortunately, even though the provider 
communi ty acknowledges a high error rate in coding, until

recently there were few definitive studies to determine how

errors. 
coding errors translate into DRG 
METHODOLOGY 
To verify that cases were properly coded and payments were
correct 
, medical records were reviewed for a sample of medical 
discharges which had been reimbursed as DRG 14. A sample of 10
hospitals was identified from all PPS hospitals in Region IX. 
Since the number of DRG 14 discharges in the sample hospitals 
varied from 0 to 188, OIG staff reviewed all cases assigned to 
DRG 14 for discharges that occurred between October 1
, 1983 and

September 1, 1984. Some of the sample hospitals were under PPS 
for only a few months during this period, and one had no PPS 
cases. A total of 355 records and claims were reviewed. 
(Appendix A lists each hospital showing the number of beds

PPS start date, and size of sample.  It is not known how many
of these cases were reviewed by peer review organizations 
taken. 
(PROs) or what action the PROs may have  The California 
PRO was not designated until after the period covered by this

inspection. 
The 10 hospitals were selected from a computer-generated
list of random numbers. Stratification of the hospitals was
based on bed size 
, as follows: 
less than 100 beds  - 2 hospitals 
101 to 299 beds - 3 hospitals
300 or more beds 
- 5 hospitals 
The inspection focused on a review of the complete medical 
record for each DRG 14 admission included in the sample. 
The 
fiscal intermediaries identified the DRG 14 claims and provided 
payment information. The 
DRG 14 review procedure was tested in

a pilot study conducted in four Region IX hospitals during

FY 1984.  Region IX contracted with the American Medical Records
Association 
(AMRA) and the California Medical Records
Association 
(CMRA) for the services of medical records
cases. 
specialists to review the DRG 14  These groups are
professional organizations of registered record
administrators 
(RRAs) and accredited record technicians 
(ARTs)
who manage medical record functions in health care facilities.
The AMRA is also the credentialing body for medical record
professionals. All 
ICD-9-CM code assignments made by the
staff. 
reviewers were verified by an RRA on the OIG 
All cases
in which the DRG assignment was changed or the hospital 
admission was questioned were reviewed by OIG staff 
physicians. 
The following steps were carried out in the DRG validation

process: 
Examine  physician attestation sheets to determine 
principal and other diagnoses and procedures reported by 
the physician. 
Review  medical records to determine if the information

attested to by the physician is substantiated.

Code the diagnoses and procedures.

Abstract data from medical records onto the 

worksheet. 
OIG' s 
Compare  codes assigned by OIG reviewer to the codes on the 
bill. 
medical record and 
Identify 
medical records in which discrepancies have
occurred. 
Photocopy 
the medical record for those cases which could 
resul t in a change of DRG assignment or denial of the
admission. 
Refer 
records with errors in DRG assignment or questionable 
admission to a physician reviewer.  WHT IS A 
STROKE? 
According to several neurologists and other experts who

were interviewed by the OIG inspection team, a stroke

or cerebrovascular accident (CVA), occurs when there is

a blockage or restriction of normal blood supply to the

nerve cells of the brain. This blockage may result in

injury to the nervous system and thus affect body

functioning, as manifested by paralysis, loss of

sensation 
, visual or speech problems, or
cognitive/emotional disturbances. 
Strokes are commonly
caused by either (1) a blood clot f9rmed in one of the 
arteries of the brain (cerebral thrombosis), ( 2) a clot
formed in the heart or in a blood vessel of the neck 
which travels to the brain and obstructs the normal flow 
of blood (cerebral embolism), or (3) bleeding through 
weak spots or aneurysms in a cerebral blood vessel

(cerebral hemorrhage).

Physicians emphasized the difficul 
ty involved in
diagnosing stroke patients. Frequently, other unrelated
conditions 
, such as hypoglycemia, benign tumors 
subdural hematoma, and epilepsy, can cause symptoms that
resemble strokes. For other patients, particularly
elderly individuals with complicating diseases, precise
diagnosis of a stroke is not an easy task. 
The CVA is classified clinically according to the
duration of symptoms. 
If the symptoms of a stroke are
completely resolved wi 
thin 24 hours, the condition is 
(TIA). If 
called a transient ischemic attack 
the stroke 
lasts longer than 24 hours, it is a complete stroke, or
CVA. A 
CVA may be maj or or minor according to the
degree of neurological impairment. 
Treatment given during, or immediately after
, a major
stroke is designed to monitor the patient and prevent
further complications. This 
includes steps to prevent
further neurological or coronary damage. 
Once the acute 
phase has passed, the patient begins a program of 
rehabilitation and supportive care. 
Depending on the location and type, TIAs are treated 
surgery. 
with drug therapy or vascular  Treatment for a 
TIA can be more aggressive than for an actual CVA since 
the objective is to prevent a CVA from occurring.  FINDINGS

SIGNIFICANT OVERPAYMENTS RESULTED FROM ERRORS IN DRG ASSIGNMENT

Of the 355 records reviewed
, 55 were found to be assigned

erroneously to DRG
admissions.  , and 3 represented inappropriate

These 
table:  resul ts are summarized in the fOllowing

DRG 14 CLAIMS

Percent of all cases in error

15. 
Total overpayment for 10 hospitals

108  353 
proj ected overpayment 
, Region IX  231  871 
proj ected national 
overpayment* 
$31  538  229 
*Appendix B shows the data used to calculate the cost

avoidance proj ections . 
Hospi tal payments are based upon the weight of the DRG

mul tiplied by the hospital'
beneficiary  s blended rate and adjusted for the

s deductible and other variables. 
The weight of
each correct DRG was subtracted from the weight of DRG 14 and

the result multiplied by the hospital'

s blended rate to arrive

at the amount overpaid. 
Most of the identified errors resulted in a lower weight being

assigned. 
Coding changes which did not affect the DRG

assignment were not counted as errors and therefore are not

identified in this report. 
An additional amount of $15 
paid for three admissions determined not to be medically 425 was 
necessary. 
This amount was not counted
Details of the overpayment calculation f,o rh oewaecvhe rc,a sien  ctahne  tboet
 al.
found in Appendix 

MOST ERRORS INVOLVED INCORRECT OR NONSPECIFIC IDENTIFICATION OF

THE PRINCIPAL DIAGNOSIS

In 44 (80 percent) of the erroneous cases

, the DRG was based on

a principal diagnosis attested to by the attending physician
and coded wi 
thin the medical record. 
In each of these cases
the principal diagnosis shown on the attestation form did not 
match the correct principal diagnosis as substantiated by the 
documentation in the medical record. 
Appendix D lists the
types of errors which affect DRG assignment.  The first step in the assignment of a case to a particular DRG

is the designation by the attending physician of the principal

diagnosis , secondary diagnoses, and procedures performed.
the physician is unaware of the UHDDS definition of principal

diagnosis or is inconsistent in applying it
, erroneous DRG

assignments are inevitable.

The OIG inspection revealed that sometimes a patient may be 
given a tentative diagnosis of a TIA and may be discharged 
wi thin 2 or 3 days. However, the T IA may extend and become
a CVA. Often 
, the patient is then readmitted with a CVA as the
principal diagnosis. 
Patients also may be treated differently
depending on their age and general 
debili tated patients often exhibit condition. Older, more
CVA symptoms and are given a
tentative diagnosis of CVA. 
Such patients are not always
treated aggressively, which might paradoxically reveal a less 
severe condition. Thus
, they are discharged with a principal
diagnosis " 
after study" of CVA when, in fact, no real study was
done , and the patients actually had TIAs or some different 
condi tion. Conversely, younger patients with tentative initial

diagnoses of TIA are usually given quite aggressive treatment.
During the course of such treatment
, the diagnosis may be

changed from TIA to a more serious CVA condition. 
This does

not mean that all debilitated patients should be given

extensive testing, but the failure to do so sometimes leads to

improper diagnosis. 
CODERS INCORRECTLY TRASLATED 
PHYSICIANS' NARRATIVE IN 
11 PERCENT OF ERRORS

In six (10. 9 percent) of the miscoded cases reviewed
, coders
selected the wrong codes to translate the physicians ' narrative
descriptions of the principal diagnoses. In 
cases  each of these
, the physician had correctly identified and attested to 
the acute condition which necessitated admission. The error
was made by the coder and was not identified in any subsequent 
review done by the hospital. 
It was not wi thin the scope of
this inspection to determine whether or not the coding errors 
were intentional. 
THREE ADMISSIONS WERE 
UNECESSARY 
In addition to errors in DRG assignments
, three cases reviewed

by OIG physicians were found to lack sufficient documentation

to justify admission to the hospital. 
The total dollar amount

of unnecessary admissions was $15 
425. However
, this figure

has not been included in the calculation of total error

amounts.  The fOllowing charts summarize the findings in the sample

hospi tals:

ERROR  RATES  AND OVERPAYMENT 
SAMPLE 
# UNNEC. 
HOSP.  SIZE  REASS.  ADMISS.  NET 
ERROR  OVERPAYMENT 
15. 
185  $ 13 334 
14. 
092 
11.1 
467 
11.1 
, 688 
22. 
154 
18. 
631 
20. 
581 
21. 7  406 
Totals 
355 
15.  $108  353 
REASONS FOR OVERPAYMENT

Percent
Percent	 Of All 
Cases
Total  Errors 
Reviewed 
Physician documentation

error;  medical  80.  12.

record does 
not substantiate diagnoSis; 
or recording of vague
diagnoses 
subj ect
misinterpretation by
coding clerks 
Coding error resulting in 
10. 
miscoding of principal 1. 7 
diagnosis 
Other types of 
coding
errors 
Total 
Coding Errors	
100.  15.  RECOMMENDATIONS 
RECOMMENDATION #l--INITIATE AN EDUCATIONAL PROGRAM FOR

PHYSICIANS 
FINDING: Physicians often fail 
to correctly identify the
principal diagnosis or state it 
wi th sufficient specificity.
This results in vague diagnoses which are subj 
ect to incorrect
coding. 
RECOMMENDATION: The Health Care Financing Administration

should initiate an educational program to improve physician

documentation and designation of principal diagnoses with an

emphasis on (1) requiring the UHDDS definition as opposed to

final diagnosis, discharge diagnosis, or primary diagnosis;

(2) the importance of specificity in identifying the principal

diagnosis; and (3) the proper sequencing of the principal and

secondary diagnoses. 
This program should incorporate
, at a minimum, the following

elements: 
The PRO contact with individual physicians and medical

staff. 
utilization of professional and specialty organizations

of physicians in disseminating information through

national meetings, seminars, and publications.

The HCFA and/or PRO contact with hospital and medical record

administrators to inform them of their responsibilities

whenever the physician 
s designation of principal diagnosis

is in error according to UHDDS guidelines. 
In these
si tuations 
, coders should consult with the attending
physician
, present UHDDS guidelines
attestation.  , and request that he or
she sign an' amended 
Interaction between the 
medical record department and the physician has been a long-
standing and necessary process which should not change under
PPS. Likewise 
, coders should review the entire medical 
record to identify the principal diagnosis
, secondary
diagnoses and procedures performed rather than simply 
assigning codes to the physician 
s narrative diagnoses.
Al though the 
attending physician is ultimately responsible
for attesting to the principal diagnosis
, secondary

diagnoses 
, and procedures performed, it is in the best

interest of the hospital to bring errors to the physician
attention
, given the fact that the hospital may be liable 
and the physician may be subject to fine
, imprisonment, or
civil penalty under applicable Federal laws.  THE HCFA RESPONSE: The 
HCFA agreed with this recommendation.

The OIG will distribute this report to the 

PROs. 
RECOMMENDATION #2--ADVISE THE PROs OF THE VULNERABILITY OF

DRG 14 AND REQUIRE FOCUSED REVIEWS

FINDING: Regarding the 
identification of patterns of
abuse

this inspection showed that such patterns are clearly 
evident when many cases in a single DRG are 
reviewed.

Patterns may not be equally obvious in PRO reviews of

randomly selected cases of all 
DRGs.

RECOMMENDATION: The 
HCFA should advise the PROs of the

vulnerabili ty of DRG 
14 and should require PROs to conduct

focused reviews in hospitals with higher than average numbers 
14. 
of cases grouped to DRG 
identified When a potentially abusive case is
, a number of other cases in the same DRG should be
reviewed. 
THE HCFA RESPONSE: By 
agreeing that DRG 14 is vulnerable

and by emphasizing the PROs
' 20 percent random audit
indicated its acceptance of this recommendation.
 , HCFA

RECOMMENDATION #3--INCREASE MONITORING OF FISCAL INTERMEDIARY

PERFORMCE 
FINDING: Fiscal intermediary 
data were incomplete and 
turnaround time was slow. 
RECOMMENDATION: The 
HCFA should provide sufficient
 resources 
and adequate monitoring of fiscal intermediaries to 
enhance
their capability to provide complete claims data in 
manner.  a timely 
THE HCFA RESPONSE: 
According to HCFA
, sufficient funding is
not available to restructure fiscal intermediary data in a 
form. 
more useful 
The OIG will work with HCFA to resolve 
this problem.
 APPENDIX A

CHARACTERISTICS OF SAMPLE 
HOSPITALS

DRG 14--SPECIFIC 
CEREBROVASCULAR
 DISEASE EXCEPT TIA

BED  PPS START DATE INSPECTION 
HOSPITAL  SIZE  SAMPLE 
DATE 
BEGUN  SIZE 
300  June 1984  April 24  1985 
300  October 1983  April 
1985  185 
693  July 1984  April 
1985 
209  June 1984  April 
1985 
July 1984  May 24  1985 
January 1984  April 
1985 
116  January 1984 
April 20  1985 
409  September 1984 
343  July 1984  February 4  1985 
140  April 1984 
February 5  1985  APPENDIX B

METHOD FOR PROJECTING COST AVOIDANCE

The fOllowing table presents the data used to calculate the

cost avoidance proj ections: 
Errors per

Amount  Record 
strata  # of  # of  Errors  Reviewed
Hosp.  Records  Errors  (Dollars)  (Dollars) 
100 Beds

or less 
154  462

101-299 Beds	
688  316

631  423

406  105

300+ Beds 
334  290

185  092  325

467  163

581  129 
Totals (Unweighted)  355  108  353  305

(Weighted) 
246

The estimated cost avoidance
, for the time period studied
is $5 231  871 with a 90 percent confidence interval of
548  222 to $6 915  519. An estimated savings of
$31  538  229 would result from projecting the Region IX 
to the Nation. 
resul ts  This figure has a 90 percent
confidence interval of $21 407  476 to $41 668  981. The
average error rate, weighted for the number of records in
each hospital and adjusted for the stratification
, for
coding wi thin this DRG is 13. 9 percent. The coefficient
of variation for these data is 19. 56 percent.  ----------------------------------- --------------------- ------------------------ --
",.....::.'..'.'...  ""' )..  .! ..  " --- -j' -j'  ----"$: :$:,:$:q-:.:.q.! ', +  -,- .---'-'- -$:-.$::$:,-":,'+ ---- :$: 
APPENDIX C

ANAL YSIS OF DRG 14 CLAIMS BY HOSPITAL AND CASE

HOSP.  C;N: SOEO. FD( R1G: G.. ..  Df;'  OFv...  T:r  . i ..  lJ1hJ:TF.(  ..  EF.:F" Or;  Ac:-ruP(r4 Y  :1 :\ LC'.. P\' (.I:. l.\..' '' ir_: ' .,l". D I F' FERENCE 
35; 
1 .  $4 , 183  , 183
14- 1 . 3527'  ;:::0 
, 183 
",I: :!A  , 1 EJ3 
HOSP.  3rw5.. 27  , 183  18:;  $Cj 
BLENDED  1 ..  183  , 183 
1 . 3527 
RATE  1.t.:,  8592 DENY
 , 183  657  $1 , 526
1 . 3527 
$4 , 183  , 183
1 . 3527 
$3C)92. 33  $4 , 183 183 
3527' 
$Q'  183  "lLf 
14- 11  . -3:5- $4 j 1S::;  ::t:1.  11.8.  $C)
'-.4.. I  1 f33  183
3527 
1 ..  $4 , 183  183
'I:4 
35:27  6673 
183  :f2 \ 063 
1 . 3527  , 1 2()
1.4  ""1:'-', , 183  $:"'1. , 183  $: i)
1.4  . '3'''w5..2:: ,7/   o. 4857  =tA ,)  118833   $:1 '1 5108:2::  68J:1(J 
1 . 35::::7  , 183  183 
i . 3527  =.:O
183  $4 j 18:; 
3527  :,1:0
1 .  $4" 183  183 
1 '7  1 . 35'::7  $:4  $:0
2()  .14  1.., 3527"  , 1.  $L;. 'l :l 8  :1:;) 
.. 1  1 . 3527  i.  $4. ,/ l.E:3  ;::O 
,.r;  :1.  3527  18.  ::::4 , 18, 
1. .  j 183 
t:..:'  1 .IT  3527  " 1.  :fO
153 
"..'L1:I   1 4,  35::7"  , 183  , 11.i8':3 3 ::t()
1. .3527  $LJ , 183  $:(. ',J  183
":0  1 . 35:: 
t:4  , 183 
, 18:::  $:0
1 Lj,
 1 . 3527  :$A  18:: 
1 . 3527  $4" 183  !!",  1i.s
 ::;
1 . 3527 
, 183 , 18:; 
3c)  1 . 3527  $!i 
183  $4 , 183 
1 . 3527  $4 , 183  , 183 
..1':  3527  :$:0 
1 .  $4 , 183  183
':I  3527 
1 .  $4 , 183  $4 , 183
1 . 3527 
$4 , 183  , 183
1 . 3527 
$4 , 183  , 183 
3527 
1 .  183  $4 , 183
1 . 3386 
$4 , 139  , 139
3527 
1 u  $4 , 183 $:4  183 
1 . 3386  O. 6604 
$4 , 139 042  , 097
1 . 3527  O. 6673  $4, 183  $2 , 063  $2, 120
123  1 . 3527  1 . 136  $4 , 183  $3 , 51. 3  $670
14.  1 . 3 j27 
, 183 $4 I 183 
3527 
1 ..  :':4  183  $it , 183 
3527 
14- 11.  ..  3386  c) IItitJ 7::  :$A  , 1 83  $2 ,  ()1,  $:2 , 120
$4 , 139  $:tl  139 
14,  1. 3527  :$:0
$L).  183  $4 I 1 E:; 
'R"_"'__--
TOTAL  $192  287 $178 I 953  . 3 , 334  ---- ------------...,."..:..'- .  '.-/_:- .--- -'. -.;j'.-  -- -----.-. .p.-.  ..-  """:'-'".--....,:-:.:.,.- /  - ---------.--- ---- -..*.."'--"-.+..''"  .:''-'".'-..'.-- -""' ". ..,-.-...,.-- --.+$""-'""'.""''.'.- --' .; ';.".'-.".:'. ,";- ._:/-.!.  . ..-..-.-'..,-. .., ...,.--.'..,:;: :  -..'''.. .-'' -...';&.....-.-...-.''" ,-,"-.. --$--+:"$'-(:-;,$ ,!:',;((.-) :;.) - ---
REVIEW OF DRG 14 
- REGION 

HOSP.  CASE  ORIS  COFm.  I G  COFIS:"  ACTUAL
ND.  DRS  DRG  WT.  W.' "I.  EF\RO;',  ./ I S!:'"
F'Pj  F''f'-':'   I) I FF-EJ= E,.
14,  1 .. 3527 
3527  .1r-"&.,: -:  (:o  :;:c 
1 . . +1: 
3527  :$:5  6':: 
HOSP.  1 II  621  :$:5  621 
3527" 
1.,, 
BLENDED  1.4,  1.. 3527  I). 8979  66"2 11   wof....
RATE  3527  $ 1 
11!  1 .. . 621  L,.' 
3527  $-=5  ::5 
4155.  1 if
 111 .1  3527  :$=5  621  $t:  6::  :$:0
621
11. .44.   11  ."  335  ;2277   ::t5t 5 662211  $+5 '1:  wi__... 
.. 1  1 . 352.  $5  :$:5 
3527  ;+F-'IJ:   62  :t5  6:: 
1 4,  1 .. 
"I':.J 
../": I  621 
:1::5  t.i:':
13E: l. . 33 527  ().. 9297  ':.I.:-.t:  t;5  :;t:O 
1t.  :$:5  :1' CJ/:,  .:1  758 
1 II 35:'  1 . 102S:' 
1 ?  1.5 1. 35  c)" 6673  -)i  ::5  6:2  .:1' Li  5f;=3  ()3E 
1.L  .=+ 1 0: 33552277   c).. 9927  :t- WL11...'., ". -.;-,  .:;t1.:' .1 '  8494t8,
1 . . 621 
3527  $5 
1 " 
425  WL":.. 
35.  O. 681 2 
1 n . 621.  -'0, 
1.4  1 .. 3527"  :t5  =*:2  L...  $:2 
'J  t;'"''-r  t.'  ::t
.L "  1.i.  n'"  3' 527"  -::fJJ'.tc:_:   'l' ''I'i :f;.r:::  .;1'
1"1::- 1 n :3527  -:tf' :5  w:.J. ..  :tI:  -;tt-.' '
1.4  1. . 3527  -f.  -.1:1. :.
J.  J. .. 35:::.  :;1'5  0"'  :1:5  L1e, . 
-,c:.  'l-.1, 
.t II r:1""":",7   6''''1  -:ff"L"::  r:i) 
24  621 
3()  7279  :1::5  l..
'oJ.  11...  3::5;25277   :t5  662211   ,:1'  C)2::; 596 
"T-:  1.4  2'-1-4 11. .  33552277'   i)  1\ 7729  ::-0:  662""1:'J.   62:l  ,:t..  40:$9:0  
""IC"-.  1 . 33552277   $1:  6'L"o.t  $3  621  $:0 
1 .  621  621 
15 11 ..  33552277  0. 6673  $5  621  $$5 t:  6,"1
131 1. 3527 0. 6051  iI'  4. C\o- , 621  773 848 
621 
3527  $5  $2  $3 
1 .  621  621 
3527  $5  $5 
1 .  621  621 
3527  $5  $5 
1 .  621 
24 1. 3527 1). 7279  $5  $5  :::0 
621  025  596 
3527 
1 .  621  621
3527  $5 
1 .  621  ..c- 621 
3527 
1 . 3527  wL"..":. 1

1. . 
L"'  ---------.-,..- . ,'-";'-----..:. ; ,,--,.-- --\.'------,,: """.=:''. ''''.'':'',.',:. ".''...--.".......:...-.;..':-.. :. .:.."... .: ,:.",,."-'/;,' -- ".. :, =. -:-./,.;	  -( )-..-  - -()-.q.------------"-"~"."";~'-'-. ~--.-- : '-  ,.  ?,. , \  '_-,'-'.'-''',-:-.  j-.- ---"--:.":;$!-":- ..: :.-'- ('-;.'''y':_ '. - ----- --$$$((:-())'-----
REVIEW OF DRS 14 	- REGION 
I X

HOSP.  CANSEO .  ODRRIOG C ORF\. OFv' HI G.   COF;r= ACTlJAL  F;EV I SCD 
WT.  ERF:OR  F'P,Y 
D I FFEF1ENCE 
""1:..7

3'5""2":17	 
 ., 621
 , 621
 ::to 
14,  '7C'-',	 621 , 621

. 7."1;I:"..'"":'
  , 621
 , 621

":',J"',.	 , 621
 621

'" t: -. 
'''-J''. /	
3527
 :5 , t.. i , 621
 $:0 
0:-,  621
 621

14,	 '7C""'-" 
621

-:ll-.  $5  :;:5 , 6::0:1

$5 \ 621
 621

. 3527  $:0 
:;:5 , 621
 621

3527 
:$:5 , 621
 , 621

1.4	 .':I,.  o. 6673 
c:o  :t' 0: 4.l , 773
 848

-.W	 . 3527  857
0:0	 o. Lj, :$-:5  62 :i  '; c) 1 8
 :$:3 , 603

.L  ""C--' .:I.e::  - ""' 0  r:  ''R:'"L'".i. 
61.  .L  3":I5  27"  :.::5  621
 $$55  .::/2:l
, 621
 t;.21 
6""1  352:7 
621

1.4  ::::i  fj:: 
111_  "1r::J:'4','.- ,	.''"	"  1 " :=;.5 	 -ri::t'.e r:: :J  L'.' '-f :::6:- r...  4L:..: t :.  U:822 ) 
lit  35i2": 7	 $:5 , 62 j  :=; t,.  :to 
--c:,...	 , 62 
 , /;:,21 
1.4,  .L-.  .L  "7''1cJ.:..":."'-  Iri	  6677	 -:rt1.e ':::;:  , .'6!-." 2,:. 1 .i
I
.  ::f:2:5  '\I  76:7' 1::
  :'12  848

7c)  .L  c:....	 -.rFe:o - , uL.'.";,.'-.
 ....1t'.-. .t': :- t..  , .J
:t5  621

71.  21.
 $C) 
1 .	 .re= L",,'j
:.t5 
3527
 tJ:: 1

"7,  ,11	 ''7'' -C-.:...1 -
,. $5  62:211
  $:t::55 .,  66:2211

 :$:0 
iLl  -rC-"-7  98()9	 $5 
c).  621
 076

3527
 $4  54. 
$:5 , 621
 62::,

3527  ;!:O 
$5 , 621
 621

3527
'7c:-',  $5 , 621
 , t)21

$5 , 621
 $5 , 621

3527  8592 
3527  , 621
 570
 051 
, 621
 $5 , 621

3527 
1 .  $5 , 621
 621

3527 
$5 , 621
 $5 , 621

3527 
$5 , 621
 621

3527

3527  4857 DENY 
 , 621
 , 018  , 603

621
 621

3527

, 621
 $5 , 621

3527 
record  , 621
 , 621

record

3527 
-:1:''-,  , 621
 $5 , 621

$5 , 621
 $:5 , 621

":'--":1	 $5 , 621
 :t5  621
 ---------'"-.-- -------------. -".",,:-,''.'.':.'''..'''.-.-.' ..'. '.""".'...:''.  , '-.' :/,-  --------------------- -" ' ------:.".-::-.--j+:-: '"''=:=-' , , "::.' -,! -  -.:-. .--"-":.  -:-----. --.$..- (' )- -
REVIEW OF DRG 14 - REGION 

HaSP. CASE 
NO. ODRR I GG C aRR. ORIG  CORR. ACTUAL  F;E ,! I SEl) 
DRG  liJT .  l'-T.  ROR  P;'y'  DIFFERENCE 
3527 
:$=5 , 621
 $:5 , 621

3527 
$5 , 621
 621

-: t: .. -, $:5 
':'..o&  , 621
 621

3527 
, 621
 $5 , 621

c:'''' 
621
 621

14.  3527  $5 
, 621
 , 621

"'1:-'
100  3527  , 621.
 $:5  621

$5 , 621
 5 , 621

110012   1.4  351:2""7'7   621
 :$:5  621. 
, 621
 621

103  3527
 $:5 
1 ..

110045   I.C..a" II"" -,  :$-=5 'J6 t," L"...'L
  --t-:-r5= :,  L6/.,2.". '1Jj. 

106  "':"'wC".L'""./, '  $5 , 6L2'"1; 
 $5 , ,  2: 1
 $:0
107  c:r:'i  -J' .. IJw..:".1
 : , l.. ''. .L  ;$:O

108  C'''J  :$:5 , 621
 ;1:5 , 621

111009   3--:.!.5"'\1C.'L2':'"''. " 7"7  :t:5 o; 662211.
 :$::;=:55  : 662;:1:t.


621

:'1;5  6:i21.

""I: '"'''
 621
 :t5 , 621

1. ":'  1.4  3527
 621,
 621

3527 
621
 $5 , 621

114  -:C".--,
115  ":r..-L  $5 Ij  , 621

?-:1 
14,  3527  $:5  i:. , 621  :1,

:t-5  621

117  ""t:""""  :1;  C:i21. 
1 0  'j c:  .L  3";'5w.2.::7'l   $:5  621.  $5  t:. 21.  :$:0 
.LW  .L..  CIW,- '  , 621
 773  $2 
11  ..c:. a; 84. 
120S:'   7E:..-,  -.1F"r.:."   \i..J..&.. t:", .- 1

;":l  'J 
112212   1. .I.:   3-:5C"2.-7 
  6673
 :.t5 , 66:22 11

 $:,f:,25:   2J.  $2 , 848

123  3527  621
 :t=i , 621

124  .L  t:....
 $:5  621
 $:5 
621
 621

125  1.4  -: JJ:""":-I"   $5 
$:5 , 621
 621

126  3527  $5 
, 621
 $5 , 621

127 
. 3527 
, 621
 621

128  3527 
129  1 . 3527  $5, 662211

 $$55  ,,  662211


130  3527

, 621
 , 621

131  3527 
, 621
 621

132  3527 
, 621
 , 621

3527 
134  3527  , 621
 $5 , 621

135  3527  621
 , 621

136  3527  , 621
 , 621

621
 $5, 621

137  3527 
621
 621

138  3527 
$5 , 621
 , 621
 ---------' ,	 ----- ..-..--- --" -.:-::.  ,(- -.!-..- ''-:.'. ."&-:''' -'. "---;-).. --. ------------ -$$$-""-;"..$" ' -."'..- .," .',.".-",.'. ,- ----$-""'...".-.'. ," -.-.- ,':. .\,.. .:..; \:.".'."--'',."-,."--'."..., ---j:-"-  ""''- , --$$-(()j- ----
REVIEW OF DRG 14 - REGION 

HOSP.  CASE ORIG  CORF: .  ORIG 
COF.:F( .  ACTUP,L. REV I SED 
ND. DF  DRG  WT.  ERROR 
v..  I .  F'PI\"  PAY  DIFFERENCE 
139  14,  3527

1 .  621
 $0:-	 621 
140  3527  :f:O 
1 ..  621
 , 621

141  12 1. 3527  1 . 1136 DENY / * ::-t:  621
 627

114423   127 1. 3527  1 . 0408  $5 , 621
 7r,".:!.:.  $929946
 

1 . 3527 
144  1 . 3527  , 621
 , 621

$5 , 621
 621

145 
1 . 3527 
621
 621

146  $5
1 . 3527	
$5 , 621
 621

147  3527

1 M  $5 , 621
 621

148 
1 . 3527 
621
 621

149  3527  $5 
1 ..  $5 , 621
 $5 , 621

150  3527 
151  1 Lj	 1 . 3527  621
 $:5	 '-''.1 
1 .  :f:5 , 621
 :t5 
152  1 . 3527	 6:Z 
153  6". ..11

 ::t5	 t.21 
1 . 3527	
154  1 . 3527	 :;:::; , 62:1
 .ot"'  :to 
155  1. 3527'  ::ft5t:   WL,.":.,
 -I.  1:_ .1, 
156 no r-ecm- -r"  .1.  :t.	 i. I.L. 
157	 3527

$:5  621
 :!-r::
 621

158  .f ",r:,.
 -r. ,-! 1 
1. . .	 621
 6::1 
159  ..J
1 " .  5:-	 $:5	 621
 $1:	 621

16C  14.  of ""C:  812:3  375
 246

3527 
16c;: 2..   421 1 .. . :=)5  O"'. -:1t". e;	 621
 :tC

163  1. r.3 355:2:"7    () Co ti(:,  -J.  :'1:5  621.
 $2 	 ) 12
 1 017' 
1. .  :=j5  621
 :tt:	 621
 :to 
111666,.5    1J1.   .... 
.
 11 .r . .3 355::?:"7	 	 $:f1'5o: 
 , I6I'2''.i1
 
 --.:i11-:-r-_1: ::, 'L--1"L',.-. ..1
.
 
1 " 3:-;27	
167  3527  'o 621.
 0;0t.1"-",.1 , 4.
168  1. . 3527  621
 :t.t:'	 6:21 
1 n  621
 621

169 
i . 3527" 
170  3527  , 621
 621.

$.:5  621
 621

171  14- 3527

1 .  621.
 621

172  3527 
173  , 621
 $5 , 621

1 . 3527	
$5 , 621
 621

174  3527 
1 .  621
 $5, 621

175  3527

1 .  $5 , 621
 $5, 621

176  15 1. 3527  6673 
$5 , 621
 773
 848

177  1 . 3527 
178  3527  , 621
 , 621

179  3527  , 621
 , 621

1 .  621
 $5 , 621

180  3527 
1 .  621
 621

181  1 . 3527	 $5 , 621
 $5, 621

182  15 1. 3527  O. 6673  $5, 621
 $2 , 773
 $2, 848

183  3527 
1 .  $5 , 621
 621

184  1. .3527	 621
 , 621
 ------------------- --------- --------------- ------- ------.--------- ------- --- ----- ---- ---- ----.  ------  --------
REVIEW OF DRG 14 - REGION 
I X

HOSP. CASE 
NO. ODRR I GG C ORR. OF:IG  CORR. i:;CTUAL  REVISED 
DRG  l'JT .  WI.  ERROR 
F' (; \(  PI\'  D I FFTRENCE 
185  3527 
186  1 .  , 621  :::5 , 621
1 . 3527 
$5 , 621  $5 , 621
187  3527 
1 .  621  621 
188  3527 
1 .  621  $5 , 621 
TOTAL:  039  904 $979 813 $60 092  ------------------------------------------------------- -------------------------- --------------
':.'-.:.-"-:.." :  -- - ----  --- - .-..  $(; 
REVIEW OF DRG 14 - REGION 

CASE  ORIS  COF.:F.  OF:IG.  CORRECT 
HOSP.  NO.  DRG  DF,S  WE I GI'.I1'  WE I GHT  EFmDR  ICT!A.JA\/ L F;EIP.!( IiSYE D  D I FFEF.:ENCE 
"'t:-,
430  3527  0934  650  :1"  650  =*:0 
$:; , 650  183  467
3527 
$:7 , 650  650
HOSPITAL  3527  $7 $:0 
650  $7 , 650 
BLENDED  3527 
650  $7 , 650
RATE  3527 
650  $7 , 650
3527 
$5655.  $:7 , 650  $:7 , 650 
7t:1""" 
, 65c)  $7 , 650
3527 
:t:7  650  , 650 
$:(1 
TOTAL.  8 , 85t)  383  467 
:$:t)  IJ  ------ ------ --------.  ,,' ------ -  ------ ---- ------------------------.
':-'".-..-- --..- _. -.-- -- ---'-.." "-',"'.'',:":,' -'-;..-".-'"'' .:' '... . ...".-._: :-/./-   .-.. ..--.- -  '*, .....- --:$-'- p-(-::_ .. .'- -_. -_$';.'( --,-'  ;-' j.( -"-,y. -'-,"-..- --. --_..:.$ _:.. -. -...--.- 
REVIEW OF DRG 14 - REGION 
I X

CASE  ORIS  '-..1 I.i' ":':.., \t,:,'  I G  CDRR.  (,CTUi::L  SED
HOSP.  NO.  DF(G  DF::8  'Ji"  'JT"  Of':  E\/  D I FFEnENCE 
1:"'7  073  073
$6 
073  073
-: '1J:".". ," 7 073  $6, 073 
HOSPITAL 
-::t'.:.".a1  ""
 073  6 , 073
BLENDED  3527 
, 073  073
:$:6 
RATE  . 3527  073  073
3527  , 073  073 
4489.  :$0
1 c:  3527  6673  073  996  077 
;$:2: 
1 LI  3527  073  073
-:c="I
073 
OTS
7t: ,...- $6 , 
.L i
 073  $:6  f)7.
.a.  1.4  3527  :=t:6  ()73  $6 , 07 
::-44  ""1:"'-'  I)"  $:6  073  :1- ---/1r t-.'.J -.".  :f2 ! 611
:;527
$:6 , OT:'  6 ! 07'  :$:0
""1:J'"'. "'' :;J6  073  :$:6 , i)73
-=."C-1:.,1":'".  :$:6 ? 073  :$:6 , (J7:3  ::t()
3527  073  !)73 
, C73  :$:6 , 0"7:: 
TCJ r AI..  1 t)9 , 31 ()  1 ()3  62:  688  ----------------------------------------- ------------  ---- -- ------ --- ----. -------
REVIEW OF DRG 14 - REGION 

CASE ORIG
HOSP.  NO.  COF F, .  OF\! G.  COF,F: .  .ciCTU(.iL F,E'  ' I S::D 
DRG  DRG  l'-T.  WT.  EF,F:OR  FIiY 
D I FFEF,ENCE 
3527 
1 .  651  651 
HOSP 
BLENDED 
RATE 
$2698. 89 
TOTAL: 
651.  651  $i)  ------------------------- ---- ----- --":-'-.-,,,--- ------------ ----:-$- :::--:-  -------  --.;-.$--=-" -'"-:""""-"""-"" , ': '-- -- -----..  '-_.-- --.-- ---------$$--((-))--
REVIEW OF DRG 14 - REGION 

HOSP.  CANSOE.   ODRIREiG C ORR. ORr .I G  COWFT .  ERF-:Of:;'  CTAL\J/ f:iL  RE' / PI ,ySE T.) D I FFEF\ENCE 
"'s: 
767  ,.L 7t,  ::o
3527  :$:3  767  767 
71:-''' :$:0
':1""": /  767  767
HOSPITAL  3527  767  767 
BLENDED  1.  3527  7279  767  $::5  027  74:$0:0 
RATE  3527  767  $1 
2784. 75  3""5tJ:2-...7,-.   4857  $:3  776677   ;1;' 1.  77".."t. .6.-r:J,:  7 ' -,  41'1,
,.-r 
":I-- 767  767 
TOTAL:  $-=33 ., S)()2  2 S:' , 7 i:jf:  $:4 , 154  -----------------.,.".:- .-..&,-, --------------...... ..-  ...  .. .  , ''-...: .-.,',.:-,...,::/.,' -,..   ---:/,",.'-, ----'-"-.\. ..,"'   -'------ - --'----.--.'':'. '. "-'-' --,- -"'-  ,"."--  ;\, .,.-.--.------."+;-$"''$-"":'-"""-q' -,- --. /- ---/-:-.-..-. ---'---.--:"$ "-::-, ----:""$-$";--":((-"))-', -
REVIEW OF DRG 14 - REGION 

CASE  ORIG.  CORR.  OF: I r:.  CDRR.  ACTUP,L.  '' I SED
HOSP.  NO.  DF:G  Dr,\:W.r:   c1-r1; ,\r' .' ". ,\-:-:1: ;,,   (2: \.  I FFEF ENCE
3'30c-:8"., .( J "f"  Di''''J  c.:. .-,-: -:",hc   :$:0 
92t:.  0"", 
3527  :f:Lj.  :$:0 
J,  :'14  978  978 
HOSP I TAL  3386  926  926
BLENDED  130  3527  964,  :1:4  978  :$:3  54.  429
RATE  3527 
, 978  j:4  978 
3527  :;:4  978  978 
3679.  record 
386  :t4  926
3527  6673  978  455  523
3386  6604  926  430  496
1 '?
 14,  . 33552277   6673  $:$==44  ,,  997788   :j:":12:2   947585  $2 'i 523
338ti  0,. :f4 
""t:""'7 :$=4  C;,  ::t4  92. :$:0 
14- 33'-551.:2:..: 77   $$:44'   '7'  ::.*t.:q4.   9e'77C8   ::1:0
97C  97fJ  :f,
352  " -" Ij  -1"
;.r;C..=.."L"  .  $:::'L4L   9CII 7"I" C8
"   :t. /-'  OC,;"'""7C::'J ::1:0 
2c)  352:  :4.  a1/..c.
""""";"'1ctt =:-I '"\";  LLil..," 7" -:  ,-i1i,'   :$$:4: 4 ,'J  9C.9I77"78 8   :::.l11L:'":'f.2'..    'i 445555c.'   .:1' 'i c---"-::t..,. . 
":-1": /  :t.:.q.  978  ;1 /!  978  'J 
35:2:7  $4 j 978 
,,0:  :$:4 
":-1  .L  352:  $=4 j 978  978 
1 Lj  """'C1':.'-"-7,  ' II 6673  -:It'' "  -r  CJ7La...  :$: LI.  -:ff''   c-I=":-:''1.-"::0":   
I....:. "  q-'c,  97E
I"  L.' 
352"  4 , 978  978
27'  395  .1  3355227' "  7839  :$: LT  997788   , O88iC5,   -:ft"'   093
i ,. I :::0
3527 
978  978
$4 
. 3527  :$=4  97E1  978
3527 
978  978
-:t:"?.. 
\oJ..  978  $4 j 978
"'C'
'-I  978  978
":-1": /

3527  978  -:4 , 978 
:::0
. 3527  978  , 978
-: c: -, -.
'':I  $4 , 978  978
. 3527  $4 , 978  978
3527 
$4, , 978  978
3527 
978  978
. 3527  $4 , 978  978
4 -:  -: C"  978  $4 , 978
33552277   $$44   978  :::4  978  $;0
$4 , 978  978 
TOTAL  $218  760 $200 129  $18  631  -------------------------------------------------------------------------------
REVIEW OF DRG 14 - REGION 

HOSPITAL  CASE- ORIGINAL  CODRRRECGT O R I G I NAL  CORRECT  ERROR  ACTUAL
NUMBER  DRG  WE I GHT  WE I GHT  PAYMENT 
HOSPITAL  THIS HOSPITAL HAD A SAMPLE SIZE OF " 
BLENDED 
RATE  ---------------------------------------------------------------  ------------------
--.------------.-----. ---.-.-.--- 
'-.": - -  '-' $"":".,':'':: ., ,.  - - $!)

! I HJ OF DF  1 "-1 -- REG I m  I;r; 
CASE  OFiI G.  COF:F  COF  ECT  P1CTUAL  F\E / I SED 
HOSF.  . w.  DnG  W.,I'..  l.\'T.  E 1;:\.-1e,'"\,1 .11r:\,   D I r=:-EF:ENCE
3527  676  676 
14,  1 . 
299  1 . 3527  O. 9407  :!:4  676  $3, 252  $1 , 424 
3527  , 676  676 
1 . 
HOSPITAL  1 . 3527  $4 , 676  $4 , 676 
BLENDED  1 . 3527  67b  676 
RATE  1 . 3386  $4 , 627  :$:4  627 
3527  67b  676 
1 . 
3456.  2()  1 . 3527  3141  676  $4, , 54,  $134 
1 . 3386  627  627 
3527  676 
1 .  l4, , 67  t:. 
1.6  1 . 3527  O. 8592  i:.:-PI.I.  "l1 .L,J  "'L -:, 0-I' ('  :$1 , 706 
1 . 3527  $:4 , 6 7 t.  67t::.  :$:0 
416  L . ' C:,"I"" 1 . 5504  :.i:4  67c:;  :1.-.Jc : ""t':.':.= I,  (:$:683 ) 
1.4  3527  676  $4 , &,76  $:0 
1 . 3527  $4  676  $ 4, , 67(:;  :$:0 
1 . 35:  $4 , 676  $L1  67'::. 
01 ""C"""'' $1+ , 
.L . .":I..o&  ?E'
j.  ''T1  1. 3527  676  , h7e.  :ro 
1. . 35::  676  , 676 
1.. 3527  676  67t, 
$93  E41.  581 
TOTAL  422 $90 
i I
 "----------
-------------------------------------------------------------- -.-----------
-.---- -------.-.  ..- 
REVIEW OF DRG 14 - REGION 
I X

CASE OR I G COF,R. OF\! G .  CORF:ECT  APCTAUALY RE V I SED

NO. DRG 
HOSF' .  DRG  11JT.  l,)T .  ERROR  PAy"  D I FFEF,E:'

14
1144 17 1 . 35832972  *$ $33   83739 4
14 1. 335257 02.  7 $3
 834 $2 834$1 , 455
14 3527 $3 834 $3 834
14 1 . 3527 $3 834 $3
 834
3527 $3 834 $3

1 . 

HOSPITAL  1144 1 .1 .  3
 527 $3 834 $$3 38 I 32344 
BLENDED  3527 $3, 834  834
1 . 
--R-A-TE- --- 8  834 $3 
14
2834.  1101  114 415  11 . 33 52.75   32567627 73$  *$ :$333  883344  $$13 
 8889133 $441 943
, 834 
12  3527 $3 $3 
14 1 n  , 838L! 34 ;$:3 834
1145  11114  4 44462 111 .u  333 5.25 753 1.2 582227687 7O T$ H$E R:3 $:3    834 $$35 81783 ($41  344)
7 $3 834 $3 834
16 14
17 14 1. .  83LJ,
18  11 "   . 35::7 $33  , 834 $3  :to
19 14, 11. . 335: 527 $:3 834 ,8 S3::J4;,
834 :f3
20 
2212.  11144 414,0   111 . 3.5 32.7 5 O32. 75754 2:8$ *7: : $:3: 883344  $$23 ,88 13339 44$1 , 695
23  , 83LL , $3 
$3 \ 834 $3
14 
462 1. 3527 1. 8268 OTHER $3  834 $5 178 ($1  344) 
TOTAL  $88  1.84  77t:/  $2, 406 
:$:8=.: APPENDIX D

TYPES OF ERRORS WHICH AFFECT DRG ASSIGNMENT

physician documentation error in attesting to 
principal diagnosis; medical record does not 
substantiate diagnosis ( es ); or recording of vague
diagnosis 
, subj ect to misinterpretation 
physician error in documentation of operation( 
s) /

procedure ( s ) 
coding error - principal diagnosis miscoded 
coding error - procedure ( s) miscoded 
coding error - additional diagnoses or procedures added 
coding error - diagnoses or procedures left off 
sequencing error - codes rearranged to change DRG
assignment 
rehabilitation issue, billing error, etc.