Which DRGs have the highest Kcentra Usage?


In Kcentra

By: Avinash Kumar  Apr. 18, 2019

Kcentra’s ICD 10 procedure code of 30283B1 is used by Hospitals to get NTAP payments over and above the DRG payment amount. Diagnosis Related Groups (DRGs) is a classification system which assigns a hospital stay to one of approximately 750 DRG codes. CMS pays a flat payment for a specific DRG to cover all costs associated with a hospital stay. Dexur analyzed medicare claims data (Jan 2017 to Dec 2017) when Kcentra was used a primary procedure and the top DRGs where it was used. The below table lists the top DRGs where KCentra was used.

Two of the top five ranked DRGs are related to Intracranial Hemorrhage (ICH) and another two are related to Coma <1 Hour and the fourth one of the top five was for Coagulation disorders, which also had the highest average payment ($14,063). ICH DRGs also have a higher payout compared to DRGs where the Coma (DRG 086) was less than 1 hour. This higher payment for ICH DRG is because ICH related hospitalizations have a longer length of stay and higher mortality rates.

Dexur also has a more in depth database tracking patients who are hospitalized for bleeding events and who have also had a prior hospitalization because of Afib or VTE (which implies that they are likely anticoagulation medication users). Cross correlating that database with Kcentra procedure codes shows that Kcentra is being used only in a small fraction of potential anti-coagulation related bleeding hospitalizations.

Rank of UsageDRG Code & Description where Kcentra was usedTotal Medicare payment per Hospitalization at DRG
1DRG 064: INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MAJOR COMPLICATION OR COMORBIDITY (MCC)$11,745
2DRG 086: TRAUMATIC STUPOR AND COMA, COMA <1 HOUR WITH COMPLICATION OR COMORBIDITY (CC)$7,493
3DRG 065: INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR COMORBIDITY (CC) OR TPA IN 24 HOURS $6,692
4DRG 813: COAGULATION DISORDERS$14,063
5DRG 085: TRAUMATIC STUPOR AND COMA, COMA <1 HOUR WITH MAJOR COMPLICATION OR COMORBIDITY (MCC)$13,767

DEXUR PRO MEMBERS:

Dexur Pro members get detailed quality outcomes for a combination of Kcentra usage and that DRG. Quality outcomes include LOS, Mortality, Readmission and SNF Discharge rates.


ABOUT THE AUTHOR

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Avinash Kumar

Avinash Kumar is a Business analyst with over 9 years of healthcare experience. He has expertise in Real World Evidence (RWE), healthcare claims analytics, market research, data analytics, benefits configuration, claim contractual reprising, adjudication, implementation of reimbursement rule edits for healthcare payers and revenue cycle management for providers. Avinash holds a Master's degree in Operations management and life sciences. He is a certified medical coder from American Association of Professional Coders (AAPC).