1: Documentation and DRG Assignment
“You are a health information management (HIM) professional practicing in a 350-bed community hospital. You
are analyzing a patient’s medical record to determine the appropriate diagnosis-related group (DRG)
assignment. The patient complained of shortness of breath and chest pain on admission and received a
cardiac catheterization as part of a cardiac workup. The physician determined the final diagnosis to be chronic
obstructive pulmonary disease (COPD). The physician documented “possible valvular disorder or endocarditis”
on the history and physical. If a cardiac condition is coded, DRG 124 will be assigned, and the hospital will
receive over $11,750. If COPD is considered to be the principal diagnosis, DRG 088 will be assigned. The reimbursement for this diagnosis is $7,300, because this DRG does not recognize the catheterization procedure.
At this hospital, a cardiac catheterization costs $5,500. You are now facing an ethical issue.”
Question
“What should you do?”

Sample Solution