MitraClip is associated with lower 30 Day readmission rates in DRG 229



By: Avinash Kumar  May. 03, 2019

MitraClip’s ICD 10 procedure code of 02UG3JZ is used by Hospitals to get NTAP payments over and above the DRG payment amount. The largest use of the MitraClip ICD 10 Code is in DRG 229 - Other Cardiothoracic Procedures without Major Complications and Comorbidities. The all cause readmission rate at the DRG is 16.42% versus 13.92% when MitraClip is used.

Diagnosis Related Groups (DRGs) is a classification system which assigns a hospital stay to one of approximately 750 DRG codes. Dexur also has a more in depth database of patients who have Mitral valve diseases like Mitral regurgitation and Mitral valve prolapse and can benefit from MitraClip procedures.

The below table shows the top DRGs associated with MitraClip procedures:

Rank of UsageDRG Code & Description where MitraClip was usedTotal Medicare payment per Hospitalization at DRG
1DRG 229: OTHER CARDIOTHORACIC PROCEDURES WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC)$30,586
2DRG 228: OTHER CARDIOTHORACIC PROCEDURES WITH MAJOR COMPLICATION OR COMORBIDITY (MCC)$48,396
3DRG 219: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MAJOR COMPLICATION OR COMORBIDITY (MCC)$56,314
4DRG 220: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH COMPLICATION OR COMORBIDITY (CC)$34,951
5DRG 981: EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH MAJOR COMPLICATION OR COMORBIDITY (MCC)$32,609

Dexur Pro members get detailed quality outcomes for a combination of MitraClip 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).