This is a 79 year old female patient admitted to the acute care hospital with acute on chronic systolic congestive heart failure (I50.23).

Patient B (Alice Jones)

This is a 79 year old female patient admitted to the acute care hospital with acute on chronic systolic congestive heart failure (I50.23). After successful diuresis with IV Lasix, she is discharged on hospital day four.

Based on the information above, what MS-DRG is assigned to this inpatient stay?

What is the expected length of stay for this MS-DRG? Did this patient stay longer than expected?

What is the expected total federal payment for this MS-DRG?

If this patient also had a urinary tract infection (UTI, N39.0) when she was admitted, does the MS-DRG change when you add this secondary diagnosis? If yes, why did it change and what is the expected payment (more or less than it was)? If no, why didn’t it change?

Suppose this patient developed the UTI due to a urinary catheter that was inserted when the patient complained of constantly having to go to the bathroom because of the IV Lasix. Does the MS-DRG change when you mark the secondary code for the UTI as NOT present on admission and add the code for the urinary catheter as the cause (T83.511A)?  Explain the impact of adding the code for the catheter-associated UTI (CAUTI). (Hint: Is there a CMS payment program that addresses catheter-associated UTIs?)