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Terms in this set (50)
Case 1: PDx Selection - Pneumonia Admitted with SOB, pneumonia on CXR, COPD
vs COPD Exacerbation history; PDx is pneumonia when it is the main
reason for admission and resource use.
Case 2: PDx - Sepsis vs UTI Sepsis from UTI documented; PDx is sepsis when it
meets criteria and is the focus of care.
Case 3: PDx - CHF vs Atrial Admitted with acute decompensated CHF and
Fibrillation chronic AF; PDx is acute CHF when it drives
admission.
Case 4: PDx - Stroke vs Altered CT confirms acute ischemic stroke; PDx is stroke,
Mental Status not symptom of AMS.
Case 5: PDx - GI Bleed vs Anemia Admitted for melena and acute blood loss anemia;
PDx is GI bleed when source is identified and
treated.
Case 6: PDx - DKA vs Diabetes Admitted with DKA; PDx is diabetic ketoacidosis,
not generic diabetes.
Case 7: PDx - COVID-19 with COVID-19 with viral pneumonia; PDx is COVID-19
Pneumonia with pneumonia as manifestation.
, Case 8: PDx - Cellulitis vs Diabetic Admitted for infected diabetic foot ulcer; PDx is
Foot Ulcer diabetic foot ulcer with infection when
documented.
Case 9: PDx - Acute Renal Failure vs Admitted with AKI due to dehydration; PDx is AKI
Dehydration when it is the main focus of care.
Case 10: PDx - Hip Fracture vs Fall Admitted after fall with hip fracture; PDx is hip
fracture, not fall.
Case 11: MCC/CC - Acute Acute respiratory failure documented and treated
Respiratory Failure as MCC with high-flow oxygen; qualifies as MCC when
clinically supported.
Case 12: MCC/CC - Severe Severe malnutrition documented with dietitian
Malnutrition as MCC assessment; MCC impacting DRG and SOI/ROM.
Case 13: MCC/CC - Sepsis as MCC Sepsis documented as secondary to pneumonia;
MCC when PDx is pneumonia.
Case 14: MCC/CC - Acute Blood Postoperative acute blood loss anemia treated with
Loss Anemia as CC transfusion; CC when supported.
Case 15: MCC/CC - Encephalopathy Metabolic encephalopathy documented with AMS
as MCC and metabolic derangements; MCC.
Case 16: MCC/CC - AKI as CC or AKI may be CC or MCC depending on DRG logic;
MCC must meet clinical criteria.
Case 17: MCC/CC - Pressure Injury Stage 3 pressure injury documented; MCC when
Stage 3 not POA.